Can an MRI replace mammography and count as breast cancer screening for HEDIS?
Do not count biopsies, breast ultrasounds or MRIs for this measure because they are not appropriate methods for “primary breast cancer screening.” Many women have implants and there are certain methods of doing mammograms for pts with implants that are the preferred method of screening. It is up to the patient and provider to determine what is best for a particular patient. However, MRI cannot count towards HEDIS. MTFs are not expected to reach 100% of their enrolled patients, as there will always be unique circumstances. What the MTF can do is exclude this patient from the action list in the MHSPHP if the provider determines it is “clinically inappropriate” for this patient to have a mammogram. This should be supported by a note in AHLTA (and the note pointed to in the exclusion comment). The provider could simply note the pt had a bilateral MRI of the breasts and doesn’t need further breast cancer screening until (specify a date). If the provider believes the pt still needs a mammogr
