Mount Carmel Health Partners HEDIS Tip Sheets - Page 10

HEDIS Tip Sheet Colorectal Cancer Screening Definition: Members ages 50 - 75 years who have had an appropriate screening for colon cancer. Service Needed: One of the following: • Fecal occult blood test between January 1 and December 31 of the measurement year. • FIT-DNA (cologuard) during the measurement year or two years prior. • Flexible sigmoidoscopy or CT colongraphy during the measurement year or four years prior. • Colonoscopy during the measurement year or nine years prior. Exclusions: • Diagnosis of colorectal cancer OR total colectomy at any time in the patient’s chart through December 31 of the measurement year. • Hospice care in the measurement year. Chart Review Tips: • Fecal occult blood tests (FOBT) and FIT-DNA (cologuard) are usually in the "Laboratory" section of the medical record. • Flexible sigmoidoscopy or colonoscopy reports are usually found in the “Procedures” or “Operative/Surgical” sections of the medical record. • CT colongraphy reports are usually found in the "Procedures" or "Radiology" sections of the medical record. • Review progress notes and correspondence for history of total colectomy or colorectal cancer. • FOBTs are needed every year. • FIT-DNA (cologuard) tests are needed every 3 years. • Flexible sigmoidoscopies and CT colongraphies are needed every 5 years. • Colonoscopies are needed every 10 years. • If the patient has had a total colectomy or colorectal cancer, the patient does not need a screening; please note for future reference. Member Outreach Tips: • Ask patients if they have had screening for colorectal cancer (see above for types of tests). • Ask patients if they have had colorectal cancer or a total colectomy if not noted in the chart. If patients have had colorectal cancer or a total colectomy, please note for future reference. • A colorectal cancer screening should be covered under a patient’s insurance benefits. For questions regarding coverage, the patient should contact his or her insurance company. • Patients may need a referral from their PCP for screening. Supplemental Data Tips • Any colonoscopy within the past 10 years counts for meeting the measure, even if the patient has had a FOBT or flexible sigmoidoscopy since then. • Documentation in the medical record must include a note indicating the date when the colorectal cancer screening was performed, may use pathology report as long as it indicates the date and type of screening. • A result is not required if the documentation is clearly part of the “Medical History” section of the record; if this is not clear, the result or finding must also be present (this ensures that the screening was performed and not merely ordered). It is always best to have the results. • Member-reported data is not allowed. For example, the patient states, “I had a colonoscopy in June,” is not valid. 10