CMS 125v6: Breast Cancer Screening

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99221, 99222, 99223, 99231, 99232, 99233, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99305, 99306, 99307, 99308, 99309, 99310, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99024, 99391, 99392, 99393, 99394, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439

A patient will be excluded from the measure if they meet any of the following conditions:

• Have an active diagnosis for two unilateral mastectomies
• Have an active diagnosis for history of bilateral mastectomy
• Have a documented history of a bilateral mastectomy or two unilateral mastectomies
• Had a bilateral mastectomy or two unilateral mastectomies

Diagnosis

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for bilateral and unilateral mastectomies can be located here.

If documenting two unilateral mastectomies, the Anatomical Location Site must be specified when adding each diagnosis code.

History of Bilateral Mastectomy or Two Unilateral Mastectomies

To document a bilateral or two unilateral mastectomies in the patient history:

1. Go to Encounter > Past History > Structured > Surgical History
2. Select the hardcoded Mastectomy node
3. Select the appropriate bilateral or unilateral mastectomy type for the patient
   1. If selecting a unilateral mastectomy type, both Right Breast and Left Breast must be selected
4. Populate the Date of Surgery for the mastectomy
5. Click OK to save

Bilateral Mastectomy or Two Unilateral Mastectomies Performed

Document Mastectomy Performed in the Breast Cancer Screening Flowsheet

1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
2. Click Add New Flowsheet
3. Select the Breast Cancer Screening flowsheet and click Add
4. Click Add Column
5. Select a Value for Patient excluded due to the following reason
6. Click OK to save

Document Procedure for Mastectomy Performed

To document the performance of two unilateral mastectomies as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add any of the eligible codes listed below:

CPT: 19180, 19307, 19306, 19305, 19304, 19303, 19240, 19220, 19200

Order Status must be marked as Complete in order to count as an exclusion.

Patients who were in hospice care during the measurement year will be excluded from the measure.

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

Note

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
2. Click Add New Flowsheet
3. Select the Breast Cancer Screening flowsheet and click Add
4. Click Add Column
5. Select Yes for Has the patient had a mammogram in the last two years?
6. Populate a date for If yes, what date was it performed?
7. Click OK to save

To document the performance of a mammogram as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add any of the eligible codes listed below:

HCPCS: G0202, G0206, G0204

Order Status must be marked as Complete in order to count toward the numerator.