Terminology defines sets of clinical concepts and convey the specific distinguishing characteristics of the included member concepts.

• Clinical Focus - A statement describing the general focus of the set, including a description of the intended constituent concepts. This can include information about clinical relevancy or a statement about the general focus of the set.
• Inclusions - A statement that describes what specific concept or code criteria are included and why.
• Exclusions - A statement that describes what specific concept or code criteria would normally be included, but are specifically excluded by the authors, including their rationale for exclusions.

Content

BREAST CANCER Clinical Focus Diagnosis or billing codes for invasive breast cancer Inclusions Invasive and non-invasive forms of breast cancer. Exclusions Cancers affecting skin of breast, Paget's disease.

BILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of bilateral mastectomy Inclusions Exclusions

UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of unilateral mastectomy with unspecifed laterality. Inclusions Unspecified laterality Exclusions Specified laterality

LEFT UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of left unilateral mastectomy Inclusions Exclusions Unspecified laterality

RIGHT UNILATERAL MASTECTOMY Clinical Focus Diagnosis codes for history of right unilateral mastectomy Inclusions Exclusions Unspecified laterality

BILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for bilateral mastectomy Inclusions Exclusions

LEFT UNILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for left unilateral mastectomy Inclusions Exclusions Unspecified laterality

RIGHT UNILATERAL MASTECTOMY PROCEDURE Clinical Focus Procedure codes for right unilateral mastectomy Inclusions Exclusions Unspecified laterality

CHEST RADIOTHERAPY Clinical Focus History of radiation to chest Inclusions Exclusions

ATYPICAL HYPERPLASIA Clinical Focus Diagnosis codes for past atypical hyperplasia on tissue biopsy Inclusions ADH and ALH Exclusions

ATYPICAL DUCTAL HYPERPLASIA Clinical Focus Diagnosis codes for past atypical ductal hyperplasia on tissue biopsy Inclusions Exclusions

ATYPICAL LOBULAR HYPERPLASIA Clinical Focus Diagnosis codes for past atypical lobular hyperplasia on tissue biopsy Inclusions Exclusions

LOBULAR CARCINOMA IN SITU Clinical Focus Diagnosis codes for past LCIS on tissue biopsy Inclusions Exclusions

HOSPICE INTERVENTION Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

HOSPICE ENCOUNTER Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

PALLIATIVE INTERVENTION Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

PALLIATIVE ENCOUNTER Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

CODES TO IDENTIFY FRAILTY Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

DEMENTIA EXCLUSION MEDICATIONS Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

CODES TO IDENTIFY ADVANCED ILLNESS Clinical Focus Codes from HEDIS measure denominator exclusions Inclusions Exclusions

SCREENING MAMMOGRAPHY Clinical Focus Mammogram intended for routine screening purposes Inclusions Film, digital or digital breast tomosynthesis (3D) mammography Exclusions Diagnostic mammography

DIAGNOSTIC MAMMOGRAPHY Clinical Focus Mammogram intended for diagnostic purposes Inclusions Film, digital or digital breast tomosynthesis (3D) mammography Exclusions Screening mammography

SCREENING MRI Clinical Focus Breast MRI intended for routine screening purposes Inclusions Exclusions Diagnostic breast MRI

SCREENING ULTRASOUND Clinical Focus Breast ultrasound intended for routine screening purposes Inclusions Exclusions Diagnostic breast ultrasound

DIAGNOSTIC ULTRASOUND Clinical Focus Breast ultrasound intended for diagnostic purposes Inclusions Exclusions Screening breast ultrasound

BREAST SURGERY Clinical Focus Specialty codes for breast surgery Inclusions Exclusions

MEDICAL ONCOLOGY Clinical Focus Specialty codes for medical oncology Inclusions Exclusions

BREAST-RELATED SIGNS OR SYMPTOMS Clinical Focus Breast signs or symptoms which could be indicative of breast cancer. Inclusions Palpable signs, such as a breast mass, asymmetric thickening/nodularity, asymmetric breast enlargement, or change in shape/contour. Skin changes (e.g. peau d'orange, erythema, nipple excoriation, scaling, eczema, skin ulcers) Breast pain Nipple inversion, retraction, or discharge Axillary mass Exclusions

BRCA-1 MUTATION Clinical Focus Lab codes for BRCA-1 mutation diagnostic testing. Inclusions Pathology reports Exclusions

BRCA-2 MUTATION Clinical Focus Lab codes for BRCA-2 mutation diagnostic testing. Inclusions Pathology reports Exclusions

BRCA-1 MUTATION CONDITION Clinical Focus Condition codes for BRCA-1 mutation carrier. Inclusions Exclusions

BRCA-2 MUTATION CONDITION Clinical Focus Condition codes for BRCA-2 mutation carrier. Inclusions Exclusions

GENETIC MARKER OR SYNDROME Clinical Focus Condition codes for genetic marker or syndrome associated with a high risk of breast cancer (e.g., BRCA1 or BRCA2 genetic variation). Inclusions Exclusions

GENETIC SUSCEPTIBILITY FOR BREAST CANCER Clinical Focus Condition codes for genetic marker or syndrome associated with a high risk of breast cancer (eg, BRCA1 or BRCA2 genetic variation). Inclusions Exclusions

LI-FRAUMENI SYNDROME Clinical Focus Condition codes for Li-Fraumeni syndrome (TP53 gene) Inclusions Exclusions

COWDEN SYNDROME Clinical Focus Condition codes for Cowden syndrome Inclusions Exclusions

BANNAYAN-RILEY-RUVALCABA SYNDROME Clinical Focus Condition codes for Bannayan-Riley-Ruvalcaba syndrome (PTEN gene) Inclusions Exclusions

OVARIAN CANCER Clinical Focus Condition codes for ovarian cancer. Inclusions Exclusions

TUBAL CANCER Clinical Focus Condition codes for tubal cancer. Inclusions Exclusions

PERITONEAL CANCER Clinical Focus Condition codes for peritoneal cancer. Inclusions Exclusions

BREAST BIOPSY PROCEDURE Clinical Focus Procedure codes for breast tissue biopsy Inclusions Excisional, core, and aspiration (FNA) Exclusions

BREAST BIOPSY Clinical Focus Report type codes for breast tissue biopsy Inclusions Excisional, core, and aspiration (FNA) Exclusions

INDETERMINATE HISTOLOGY Clinical Focus Diagnosis codes for breast tissue biopsy indeterminate results. Inclusions Exclusions