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. 14