October 18, 2018
Breast cancer is one of the most common cancers among women in the U.S., according to the American Cancer Society. Even with these statistics, nearly 30 percent of eligible Premera Medicare Advantage members haven’t had a mammogram in two years.
The Centers for Medicare & Medicaid Services (CMS) uses the HEDIS® Breast Cancer Screening measure as a star rating measure to drive improvements in patient health.
Quick Tips:
- Provide patients with an order for a screening mammogram and assist patients with getting the mammogram scheduled before they leave the office.
- Patients who have had bilateral mastectomies are excluded from the breast cancer screening measure. When you submit an office visit claim for patients who are excluded from needing a mammogram, please include the following ICD–10–CM diagnosis codes as appropriate:
- Z90.13 — Acquired absence of bilateral breasts and nipples
- Z90.12 — Acquired absence of left breast and nipple
- Z90.11 — Acquired absence of right breast and nipple
You can refer to the HEDIS® breast cancer screening tip sheet for exclusions from the HEDIS measure, information that patient medical records and claims should include, and tips for talking to patients.