DER Reference Model Version 1.0.0
ecqm.dataelement

History Of Bilateral Mastectomy Diagnosis

Description:
Clinical Focus: This value set contains codes that identify a previous history of having a bilateral mastectomy.
Data Element Scope: This value set was intended to identify patients who had a bilateral mastectomy.
Inclusion Criteria: Includes codes that identify a bilateral mastectomy was performed in the past.
Exclusion Criteria: Excludes codes that indicate a unilateral mastectomy or are unspecified.
ResultValue constrained to codes in the History of bilateral mastectomy valueset (2.16.840.1.113883.3.464.1003.198.12.1068)
QDM Datatype: Diagnosis

Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

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