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Colorectal Cancer Screening (COL)

Based on current NCQA HEDIS recommendations, your TO-DO LIST for patients age 50-75 years old should include:

  • One or more screening tests which can include: Fecal occult blood test, Flexible Sigmoidoscopy, Colonoscopy, FIT-DNA Test, CT Colonography

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

HEDIS Colorectal Cancer Screening (COL) Definition:

(NCQA HEDIS guidelines, Measurement Year (MY) 2022)

  • The percentage of members 50-75 years of age who had appropriate screening for colorectal cancer
  • Line of Business: Commercial, Medicare

Requirement:

One or more screenings for colorectal cancer. Any of the following meet criteria:

  • Fecal occult blood test (FOBT Value Set) during the measurement year
  • Flexible sigmoidoscopy (Flexible Sigmoidoscopy Value Set) during the measurement year or the four years prior to the measurement year
  • Colonoscopy (Colonoscopy Value Set) during the measurement year or the nine years prior to the measurement year
  • FIT-DNA (FIT-DNA Value Set) test during the measurement year or two years prior to the measurement year
  • CT Colonography (CT Colonography Value Set) during the measurement year or the four years prior to the measurement year

How does your completion of the TO-DO LIST get recorded?

Codes Related to Colorectal Cancer Screening

Colonoscopy

CPT 44388 44389 44390 44391 44392 44393 44394 44397 44401 44402 44403 44404 44405 44406 44407 44408 45355 45378 45379 45380 45381 45382 45383 45384 45385 45386 45387 45388 45389 45390 45391 45392 45393 45398

HCPCS G0105 G0121

ICD9PCS 45.22 45.23 45.25 45.42 45.43

SNOMED CT US Edition 8180007 12350003 25732003 34264006 73761001 174158000 235150006 235151005 310634005 367535003 425672002 425937002 427459009 443998000 444783004 446521004 446745002 447021001 709421007 710293001 711307001 713154003 789778002


CT Colonography

CPT 74261 74262 74263

LOINC 60515-4 72531-7 79069-1 79071-7 79101-2 82688-3

SNOMED CT US Edition 418714002


FIT DNA Lab Test

CPT 81528

HCPCS G0464

LOINC 77353-1 77354-9


FIT DNA Test Result or Finding

SNOMED CT US Edition 708699002


Flexible Sigmoidoscopy

CPT 45330 45331 45332 45333 45334 45335 45337 45338 45340 45341 45342 45346 45347 45349 45350

HCPCS G0104

ICD9PCS 45.24

SNOMED CT US Edition 44441009 396226005 425634007


FOBT Lab Test

CPT 82270 82274

HCPCS G0328

LOINC 12503-9 12504-7 14563-1 14564-9 14565-6 2335-8 27396-1 27401-9 27925-7 27926-5 29771-3 56490-6 56491-4 57905-2 58453-2 80372-6

SNOMED CT US Edition 104435004 441579003 442067009 442516004 442554004 442563002


FOBT Test Result or Finding

SNOMED CT US Edition 59614000 167667006 389076003


History of Colonoscopy

SNOMED CT US Edition 851000119109


History of Flexible Sigmoidoscopy

SNOMED CT US Edition 841000119107

*ICD9PCS codes are accepted for procedures prior to 10.1.16

Supplemental Data Requirements

  1. A signed and dated progress note indicating the procedure type (colonoscopy, FIT-DNA, etc.) and date of service can be submitted as supplemental data.
  2. A signed and dated procedure or pathology report from the appropriate timeframe can be submitted as supplemental data for gap closure.
  3. When lab results are imported into the EHR by interface the laboratory report from the appropriate timeframe can be submitted as supplemental data for gap closure. When the report has been scanned into the EHR it must be signed and dated by the provider.

Note: Digital Rectal Exams are not acceptable to meet this measure. FOBT processed in the office is acceptable as long as the specimen is not collected in the office setting.

General Notes

The most accurate method to submit data for clinical quality gap closure is through correct coding. Supplemental data submission can be used for gap closure when information is not received through coding. All supplemental data must be signed and dated by a treating physician, nurse practitioner or physician assistant. All dates must include month, day and year.

Patient name and birthdate needs to be on all supplemental documentation. If birthdate is not officially on a report, it needs to be either written on the document and signed by the physician, or a demographic cover sheet should be included as an additional page with the submission.

Resources available for you and your patients:

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey: 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.