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1 Supplementary Online Content Tran AH, Ngor EWM, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med. Published online August 11, doi: /jamainternmed eappendix 1. Abbreviations eappendix 2. CPT and ICD-9-CM Codes etable 1. Primary Diagnoses of Hospitalized Patients, Individual Chart Review etable 2. Procedure-Related Complications etable 3. Gastrointestinal-Related Causes for Hospitalizations etable 4. Other Causes for Hospitalizations etable 5. Demographics and CRC Incidence in Colorectal Cancer Group vs Polyp Group etable 6. Demographics, CRC Incidence and Hospitalization Based on Gender etable 7. Gender-Based CRC Incidence Rate efigure. Hospitalized Patients Within 30 Days of Surveillance Exam and Incidence of CRC This supplementary material has been provided by the authors to give readers additional information about their work.

2 Appendix 1. Abbreviations SBO=small bowel obstruction, GI: gastrointestinal, IBD: inflammatory bowel disease, COPD: chronic obstructive pulmonary disease, ACS: acute coronary syndrome, CVA: cardiovascular attack, CHF: congestive heart failure, ASA: aspirin, AMS: altered mental status, PE: pulmonary embolism, DVT: deep venous thrombosis, SIADH: syndrome of inappropriate anti-diuretic hormone, MM: multiple myeloma eappendix 2 ICD Codes CPT-procedure codes for polypectomy/biopsies 45380: colonoscopy with biopsy, single or multiple 45385: colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), lesion(s) by snare technique 45383: colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion (s) not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique 45384: colonoscopy, flexible, proximal to splenic flexure; with removal of tumor (s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 45378: Colonoscopy, flexible, proximal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression. ICD 9 codes for personal history of polyps and CRC V12.72: Personal history of colonic polyps V10.0: Personal history of malignant neoplasm of GI tract V10.00: personal history of malignant neoplasm of GI tract, unspecified V10.05: Personal history of malignant neoplasm of large intestine V10.06 Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus V10.09 Personal history of malignant neoplasm of other gastrointestinal tract ICD 9 codes for family history of polyps and CRC V18.51: family history of colonic polyps V16.0: family history of malignant neoplasm of GI tract ICD 9 codes for diagnosis of polyps and CRC 153 Malignant neoplasm of colon Malignant neoplasm of hepatic flexure Malignant neoplasm of transverse colon Malignant neoplasm of descending colon Malignant neoplasm of sigmoid colon Malignant neoplasm of cecum Malignant neoplasm of appendix vermiformis Malignant neoplasm of ascending colon Malignant neoplasm of splenic flexure Malignant neoplasm of other specified sites of large intestine 153.9: Malignant neoplasm of colon, unspecified site

3 211 Benign neoplasm of other parts of digestive system Benign neoplasm of duodenum, jejunum, and ileum Benign neoplasm of colon Benign neoplasm of rectum and anal canal Benign neoplasm of other and unspecified site in the digestive system 154 Malignant neoplasm of rectum rectosigmoid junction and anus Malignant neoplasm of rectosigmoid junction Malignant neoplasm of rectum Malignant neoplasm of anal canal Malignant neoplasm of anus, unspecified site Malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus ICD 9 codes for GI bleed 578: GI hemorrhage : hemorrhage of GI tract unspecified 578.1: blood in stool ICD 9 codes for GI risk factors V15.82: personal history of tobacco use 305.1: tobacco use disorder 278 Overweight, obesity and other hyperalimentation Overweight and obesity Obesity, unspecified Morbid obesity Overweight Nondependent alcohol abuse Alcohol abuse, unspecified Alcohol abuse, continuous Alcohol abuse, episodic Alcohol abuse, in remission V58.64 Long term (current) use of non-steroidal anti-inflammatories (NSAID) ICD 9 codes for inflammatory bowel disease 556.0, Ulcerative (chronic) enterocolitis; 556.1, Ulcerative (chronic) ileocolitis; 556.2, Ulcerative (chronic) proctitis; 556.3, Ulcerative (chronic) proctosigmoiditis; 556.4, Pseudopolyposis of colon; 556.5, Left-sided ulcerative (chronic) colitis; 556.6, Universal ulcerative (chronic) colitis (pancolitis) 556.8, Other ulcerative colitis 556.9, Ulcerative colitis, unspecified , Crohn s disease of small intestine, including duodenum, ileum, and jejunum (regional ileitis); 555.1, Crohn s disease of large intestine (regional colitis); 555.2, Crohn s disease of small intestine with large intestine (regional ileocolitis); and 555.9, Crohn s disease of unspecified site (regional enteritis, not otherwise specified).

4 etable 1. Primary Diagnoses of Hospitalized Patients, individual chart review No Records (unable to determine main cause of admission) Including all cause hospitalizations (N=711) % hospitalized (N=711) % Other % Procedure related % GI related % etable 2. Procedure-related complications Procedure Complications (N=92) Percent GI bleeding after biopsy or polypectomy % GI perforation % Abdomen pain, nausea, emesis, ileus % Arrthymia % etable 3. Gastrointestinal-related causes for hospitalizations GI causes for hospitalizations (N=235) GI surgery 156 Colonoscopy 1 SBO 6 GI bleed 27 Volvulus 1 Diverticulitis 4 Pancreatitis 4 Colostomy adjustment 7 Abdomen pain, nausea, emesis, diarrhea 13 Cholecystitis/Choledocholithiasis 5 GI cancer 3 Liver disease 2 Appendicitis 3 Constipation 1 Perforation of ulcer 1 New diagnosis of IBD 1 Total 235

5 etable 4. Other causes for hospitalizations Other (N=214) joint replacement surgery 12 Infections 26 Prostate surgery 14 Bladdery surgery 3 Other surgeries 36 COPD Exacerbation 3 Chest pain/acs rule out/arrthymias 49 Anemia work up 2 Fall 3 CVA 10 CHF 5 ASA densitization 1 Hematuria 2 Kidney stones 3 Syncope/Pre-syncope symptoms 10 Dyspnea/Respiratory failure 7 Angioedema 1 Clots: PE/DVT 3 Renal Failure 4 Hypoglycemia 2 Epitaxis 1 Eye problems 2 Weakness 1 AMS/Intoxication 4 Thyroid ablation 1 Intracranial bleed 2 SIADH 1 Brain tumor 1 Leukemia/MM/Lymphoma 4 Spinal Stenosis 1 Total 214

6 etable 5. Demographics and CRC incidence in Colorectal Cancer group vs polyp group Characteristics Personal history of polyps or CRC CRC (N=3073) Polyp (N=24690) Total (N=27763) pvalue Mean (SD) 69.7 (9.80) 65.6 (8.65) 66.0 (8.88) Median 70.1 ( ) 65.2 ( ) 65.7 ( ) Range ( ) ( ) ( ) Age group (8.5%) 3137 (12.7%) 3398 (12.2%) (10.6%) 4152 (16.8%) 4479 (16.1%) (14.1%) 4838 (19.6%) 5270 (19%) (16.5%) 4723 (19.1%) 5229 (18.8%) (18.1%) 3998 (16.2%) 4553 (16.4%) (32.3%) 3842 (15.6%) 4834 (17.4%) Gender F 1502 (48.9%) (41.8%) (42.6%) M 1571 (51.1%) (58.2%) (57.4%) Race/ethnicity Asian Pacific Island 231 (7.5%) 2004 (8.1%) 2235 (8.1%) Black 370 (12%) 2818 (11.4%) 3188 (11.5%) Hispanic 415 (13.5%) 3452 (14%) 3867 (13.9%) Other/Unknown 157 (5.1%) 2170 (8.8%) 2327 (8.4%) White 1900 (61.8%) (57.7%) (58.2%) Category of Charlson's index (32.6%) (61.1%) (58%) (9.1%) 4294 (17.4%) 4574 (16.5%) (24.5%) 2937 (11.9%) 3689 (13.3%) >= (33.8%) 2372 (9.6%) 3411 (12.3%) Alcohol abuse 80 (2.6%) 611 (2.5%) 691 (2.5%) Tobacco use 918 (29.9%) 4926 (20%) 5844 (21%) Overweight/obese 830 (27%) 5033 (20.4%) 5863 (21.1%) NSAID use 10 (0.3%) 17 (0.1%) 27 (0.1%) Family history of CRC/polyps 460 (15%) 3357 (13.6%) 3817 (13.7%) CRC 43 (1.4%) 330 (1.3%) 373 (1.3%) Age < 75 N CRC, N (%) 42 (2.0%) 326 (1.6%) 368 (1.6%) Age >=75 N CRC, N (%) 1 (0.1%) 4 (0.1%) 5 (0.1%) Length of follow up Mean (SD) 38.8 (22.93) 54.9 (32.63) 53.1 (32.11) Median 39.2 (19.4, 56.0) 54.4 (25.1, 80.4) 52.3 (23.5, 76.8) Range 119.9) 119.9) 119.9)

7 etable 6. Demographics, CRC incidence and hospitalization based on gender Characteristics Male Total <75 >=75 (N=15939 p value (N=13241) (N=2698) ) <75 (N=9688) Female >=75 (N=2136) Total (N=11824) p value Mean (SD) 63.3 (6.78) 63.0 (6.76) 66.0 (9.01) (3.50) (8.78) (3.57) Median Range ( ) ( ) ( ) ( ) ( ) ( ) Age group (14.4%) 2561 (19.3%) 2964 (22.4%) 3080 (23.3%) 2730 (20.6%) (100%) 1906 (12%) 2561 (16.1%) 2964 (18.6%) 3080 (19.3%) 2730 (17.1%) 2698 (16.9%) 1492 (15.4%) 1918 (19.8%) 2306 (23.8%) 2149 (22.2%) 1823 (18.8%) 2136 (100%) 1492 (12.6%) 1918 (16.2%) 2306 (19.5%) 2149 (18.2%) 1823 (15.4%) 2136 (18.1%) Race/ethnicity Asian Pacific Island 815 (8.4%) 924 (7.8%) (8.5%) (6.8%) (8.2%) (5.1%) Black 277 (13%) (10.3%) (8.6%) (10%) (13.6%) (13.5%) Hispanic 1858 (14%) (10.6%) (13.4%) (15.4%) (10.7%) (14.6%) Other/Unknown 109 (4%) 842 (8.7%) 944 (8%) (9.6%) (8.7%) (4.8%) White (57.5%) (70.1%) (59.7%) (53.9%) (66.4%) (56.1%) Personal history of polyp or CRC CRC (8.2%) (18.1%) (9.9%) (10.3%) (23.6%) (12.7%) Polyp (91.8%) 2211 (81.9%) (90.1%) 8691 (89.7%) 1631 (76.4%) (87.3%)

8 Characteristics Male Total <75 >=75 (N=15939 p value (N=13241) (N=2698) ) <75 (N=9688) Female >=75 (N=2136) Total (N=11824) p value Category of Charlson's index (60.5%) (39.1%) (56.9%) (62.2%) (46.8%) (59.4%) (16.4%) (17.4%) (16.6%) (16.1%) (17.1%) (16.3%) (12.3%) (18%) (13.3%) (12.3%) (18.3%) (13.3%) >= (9.5%) (10.8%) (25.5%) (13.3%) (17.8%) 1296 (11%) Alcohol abuse 477 (3.6%) 88 (3.3%) 565 (3.5%) (1.1%) 15 (0.7%) 126 (1.1%) Tobacco use (23.1%) (27.2%) (23.8%) (17.5%) (16.8%) (17.4%) Overweight/obese (20.3%) (16.2%) (19.6%) (24%) (19.2%) (23.1%) NSAID use 3 (0%) 7 (0.3%) 10 (0.1%) (0.1%) 6 (0.3%) 17 (0.1%) Family history of CRC/polyps (12.2%) (8.7%) (11.6%) (17.4%) (13.1%) (16.6%) Outcomes CRC 221 (1.7%) 4 (0.1%) 225 (1.4%) 147 (1.5%) 1 (0%) 148 (1.3%) Hospitalized within 30 days (2.4%) after surveillance (4.0%) (2.6%) 214 (2.2%) 77 (3.6%) 291 (2.5%) colonoscopy

9 etable 7. Gender-based CRC incidence rate Incidence rate of CRC per gender Male Female <75 >=75 Total P value <75 >=75 Total P value Length of follow up (mos) Mean (SD) (32.24) (30.35) (31.91) (32.24) (30.35) (31.91) Median Range 119.9) 119.5) 119.9) 119.9) 119.5) 119.9) CRC Total follow up (person years) Incidence rate (1000 personyears) Incidence rate (100,000 person years) 221 (1.7%) 4 (0.1%) 225 (1.4%) 147 (1.5%) 1 (0%) 148 (1.3%) <

graph demonstrating percent of hospitalization and detection of CRC on surveillance exam by 5

10 efigure. Hospitalized patients within 30 days of surveillance exam and incidence of CRC efigure: Bar graph demonstrating percent of hospitalization and detection of CRC on surveillance exam by 5 year age interval. Comparison between the younger and older cohorts find older cohort with decrease in incidence of CRC and increasing incidence of hospitalizations (p value < )

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Billing Guideline. Subject: Colorectal Cancer Screening Exams (Invasive Procedures) Effective Date: 1/1/14 Last revision effective 4/16 Billing Guideline Subject: Colorectal Cancer Screening Exams (Invasive Procedures) Effective Date: 1/1/14 Last revision effective 4/16 Florida Hospital Care Advantage plans include full coverage of in-network