#146: Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms

Quality ID

146

NQF

0508

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Diagnostic Radiology

Measure description

Percentage of final reports for screening mammograms that are classified as “probably benign”

 

Instructions

This measure is to be submitted each time a screening mammogram is performed during the performance period. It is anticipated that eligible clinicians who provide the professional component of diagnostic imaging studies for screening mammograms will submit thismeasure.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All final reports for screening mammograms

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

Denominator Criteria (Eligible Cases):

Diagnosis for screening mammogram (ICD-10-CM): Z12.31

AND

Patient procedure during the performance period (CPT or HCPCS): 77067

 

Numerator

Final reports classified as “probably benign”

Numerator Instructions:

INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

A lower percentage, with a definitional target approaching 0%, indicates appropriate assessment of screening mammograms.

The mammogram assessment category (corresponding CPT Category II 33xxF code for assessment categories”) to be submitted is the final assessment for the screening mammographic study. If a diagnostic mammographic study follows the screening exam, the assessment category for the screening exam should be submitted with the corresponding CPT Category II code, i.e. 3340F for Mammogram assessment category of “incomplete: need additional imaging evaluation,” documented. Of note, the performance tags indicating ‘Performance Met’ and ‘Performance Not Met’ are included to highlight what is being measured and submitted and not to encourage the use and documentation of “probably benign”.

Definition:

“Probably Benign” Classification – Mammography Quality Standards Act (MQSA) assessment category of “probably benign”; Breast Imaging-Reporting and Data System (BI-RADS®) category 3; or Food and Drug Administration (FDA)-approved equivalent assessment category

Numerator Options:

Performance Met: Mammogram assessment category of “probably benign,” documented (3343F)

OR

Performance Not Met: Mammogram assessment category of “incomplete: need additional imaging evaluation,” documented (3340F)

OR

Performance Not Met: Mammogram assessment category of “negative,” Documented (3341F)

OR

Performance Not Met: Mammogram assessment category of “benign,” Documented (3342F)

OR

Performance Not Met: Mammogram assessment category of “suspicious,” Documented (3344F)

OR

Performance Not Met: Mammogram assessment category “highly suggestive of malignancy,” documented (3345F)

OR

Performance Not Met: Mammogram assessment category of “known biopsy proven malignancy,” documented (3350F)

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