COLORECTAL CANCER SCREENING

Transcription

1 COLORECTAL CANCER SCREENING APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? REFERENCES HEDIS (Hybrid) NCQA Accreditation NCQA Rating To assess the percentage of members 50 to 75 years of age who had appropriate colorectal cancer screening. Members 51 to 75 years of age as of December 31st of the measurement year. Members who have had colorectal cancer or a total colectomy are excluded. Members ages 50 to 75 should have one or more of the following screenings for colorectal cancer: FOBT during the measurement year Flexible sigmoidoscopy during the measurement year or four years prior to the measurement year Colonoscopy during the measurement year or the nine years prior to the measurement year Please see code table. Documentation in the medical record must include a note indicating the date the colorectal cancer screening was performed and evidence that the test was completed, (not just ordered). For more information, please refer to Passport Health Plan s Adult Preventive Health Clinical Practice Guideline. The criteria above are based on standards established under NCQA s HEDIS 2017 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

2 COLORECTAL CANCER SCREENING Meet Screening Criteria Code System Code Definition CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT HCPCS G0105 Colorectal cancer screening; colonoscopy on individual at high risk (G0105) HCPCS G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (G0121)

3 ICD9PCS Endosc lg bowel thru st ICD9PCS Colonoscopy ICD9PCS Clos large bowel biopsy ICD9PCS Endo polpectomy lrge int ICD9PCS Endosc destru lg int les CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT HCPCS G0104 Colorectal cancer screening; flexible sigmoidoscopy (G0104) ICD9PCS Flexible sigmoidoscopy CPT CPT CPT CPT HCPCS G0464 Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) (G0464) LOINC Noninvasive colorectal cancer DNA and occult blood screening [Interpretation] in Stool Narrative LOINC Noninvasive colorectal cancer DNA and occult blood screening [Presence] in Stool HCPCS G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous (G0328) LOINC Hemoglobin.gastrointestinal [Presence] in Stool --4th LOINC Hemoglobin.gastrointestinal [Presence] in Stool --5th LOINC Hemoglobin.gastrointestinal [Presence] in Stool --1st LOINC Hemoglobin.gastrointestinal [Presence] in Stool --2nd LOINC Hemoglobin.gastrointestinal [Presence] in Stool --3rd

4 LOINC Hemoglobin.gastrointestinal [Presence] in Stool LOINC Hemoglobin.gastrointestinal [Mass/mass] in Stool LOINC Hemoglobin.gastrointestinal [Presence] in Stool --6th LOINC Hemoglobin.gastrointestinal [Presence] in Stool --7th LOINC Hemoglobin.gastrointestinal [Presence] in Stool --8th LOINC Hemoglobin.gastrointestinal [Presence] in Stool by Immunologic method LOINC Hemoglobin.gastrointestinal [Presence] in Stool by Immunologic method --2nd LOINC Hemoglobin.gastrointestinal [Presence] in Stool by Immunologic method --3rd LOINC Hemoglobin.gastrointestinal [Presence] in Stool by Immunologic method --1st LOINC Hemoglobin.gastrointestinal [Mass/volume] in Stool by Immunologic method LOINC Hemoglobin.gastrointestinal [Presence] in Stool by Rapid immunoassay Exclusions Code System Code Definition HCPCS G0213 Pet imaging whole body; diagnosis; colorectal [G0213] HCPCS G0214 Pet imaging whole body; initial staging; colorectal [G0214] HCPCS G0215 Pet imaging whole body; restaging; colorectal cancer [G0215] HCPCS G0231 Pet, whole body, for recurrence of colorectal or colorectal metastatic cancer; gamma cameras only [G0231] ICD10CM C18.0 [C18.0] Malignant neoplasm of cecum ICD10CM C18.1 [C18.1] Malignant neoplasm of appendix ICD10CM C18.2 [C18.2] Malignant neoplasm of ascending colon ICD10CM C18.3 [C18.3] Malignant neoplasm of hepatic flexure ICD10CM C18.4 [C18.4] Malignant neoplasm of transverse colon ICD10CM C18.5 [C18.5] Malignant neoplasm of splenic flexure ICD10CM C18.6 [C18.6] Malignant neoplasm of descending colon ICD10CM C18.7 [C18.7] Malignant neoplasm of sigmoid colon ICD10CM C18.8 [C18.8] Malignant neoplasm of overlapping sites of colon ICD10CM C18.9 [C18.9] Malignant neoplasm of colon, unspecified ICD10CM C19 [C19] Malignant neoplasm of rectosigmoid junction ICD10CM C20 [C20] Malignant neoplasm of rectum ICD10CM C21.2 [C21.2] Malignant neoplasm of cloacogenic zone ICD10CM C21.8 [C21.8] Malignant neoplasm of overlapping sites of rectum, anus and anal canal ICD10CM C78.5 [C78.5] Secondary malignant neoplasm of large intestine and rectum ICD10CM Z [Z85.038] Personal history of other malignant neoplasm of large intestine ICD10CM Z [Z85.048] Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus ICD9CM Mal neo hepatic flexure ICD9CM Mal neo transverse colon ICD9CM Mal neo descend colon

5 ICD9CM Mal neo sigmoid colon ICD9CM Malignant neoplasm cecum ICD9CM Malignant neo appendix ICD9CM Malig neo ascend colon ICD9CM Mal neo splenic flexure ICD9CM Malignant neo colon NEC ICD9CM Malignant neo colon NOS ICD9CM Mal neo rectosigmoid jct ICD9CM Malignant neopl rectum ICD9CM Sec malig neo lg bowel ICD9CM V10.05 Hx of colonic malignancy ICD9CM V10.06 Hx-rectal & anal malign CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT CPT ICD10PCS 0DTE0ZZ [0DTE0ZZ] Resection of Large Intestine, Open Approach ICD10PCS 0DTE4ZZ [0DTE4ZZ] Resection of Large Intestine, Percutaneous Endoscopic Approach ICD10PCS 0DTE7ZZ [0DTE7ZZ] Resection of Large Intestine, Via Natural or Artificial Opening ICD10PCS 0DTE8ZZ [0DTE8ZZ] Resection of Large Intestine, Via Natural or Artificial Opening Endoscopic ICD9PCS Lap tot intr-ab colectmy ICD9PCS Op tot intr-abd colectmy ICD9PCS Tot abd colectmy NEC/NOS