Posted March 2, 2020
Apart from some forms of skin cancer, breast cancer is the most common cancer among American women, regardless of race or ethnicity.1 Screening can help improve outcomes. Early detection not only reduces the risk of dying from breast cancer but can also provide a greater range of treatment options and lower health care costs.2 Blue Cross and Blue Shield of Illinois (BCBSIL) encourages providers to discuss the importance of mammograms with their patients.
One tool that may encourage women to schedule a mammogram is a five-minute online questionnaire developed by Bright Pink. We are working with Bright Pink, a nonprofit organization, on a pilot program to help bridge the gap for breast and ovarian cancer. Bright Pink has created an AssessYourPink tool that allows women to take a quick assessment online to learn about their risk of developing breast or ovarian cancer. You may want to share this information with your patients when you remind them to get a mammogram.
The Breast Cancer Screening Healthcare Effectiveness Data and Information Set (HEDIS®) measure evaluates the percentage of women between 50 and 74 years of age who had a mammogram screening performed between October 1 two years prior to the measurement year, through December 31 of the measurement year. For example, for the measurement year 2020, the mammogram would need to have been performed between Oct. 1, 2018 and Dec. 31, 2020. Members in hospice are excluded from the eligible population. HEDIS is one of the most widely used set of health care performance measures in the U.S.
Reminders:
- All types and methods of mammograms such as screening, diagnostic, film, digital or digital breast tomosynthesis, will count as compliant for this HEDIS measure.
- This measure does not include biopsies, breast ultrasounds or magnetic resonance imaging (MRI).
- As an administrative measure that is captured through claims data, it is vital mammograms are billed using the correct Current Procedural Terminology (CPT®) codes.
- If a patient has a history of bilateral mastectomy, it is important to submit the appropriate ICD-10 diagnosis code to reflect this.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
CPT copyright 2019 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
1Centers for Disease Control and Prevention, Breast Cancer Statistics, May 28, 2019. https://www.cdc.gov/cancer/breast/statistics/index.htm
2American Cancer Society, Recommendations for the Early Detection of Breast Cancer, Oct. 3, 2019. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
The information in this article is being provided for educational purposes only and is not the provision of medical care or advice. Physicians and other health care providers are to their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.