Mount Carmel Health Partners HEDIS Tip Sheets | Page 14

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.
Coding:
CPT 4
HCPCS
FOBT – 82270, 82274
Flexible Sigmoidoscopy – 45330-45335, 45337-45342, 45345-45347, 45349, 45350
FIT – 81528
Colonoscopy – 44388-44394, 44397, 44401-44408, 45355, 45378-45393, 45398
CT Colonoscopy – 74261-74263
FOBT – G0328
Flexible Sigmoidoscopy – G0104
FIT – G0464
Colonoscopy – G0105, G0121
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.
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