May 17, 2018
Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Some methods of colorectal cancer screening can detect premalignant polyps and guide their removal, with a goal of preventing cancer from developing. Compelling evidence shows that systematic screening can reduce deaths from colorectal cancer by detecting cancer at earlier stages, when treatment is more effective.
Premera collects data on the quality of care that our members receive, including certain preventive screenings. We track measures based on the Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by more than 90 percent of America's health plans to measure performance related to care and service.
What's the HEDIS measure related to colorectal cancer screening?
The measure consists of members ages 50-75 who receive the appropriate screening for colorectal cancer. There are multiple test types that meet the requirements for screening completion:
- Screening colonoscopy every 10 years (preferred option recommended above all the others below) or
- Screening flexible sigmoidoscopy every 5 years
- Computed tomography (CT) colonography every 5 years
- Screening fecal occult blood test (FOBT) every 1 year
- Note: Performing FIT (FOBT or iFOBT) in an office setting or on a sample collected during a digital rectal exam doesn’t meet HEDIS and the American Cancer Society’s screening requirements.
- The patient should complete 3 samples to meet screening criteria.
- FIT DNA (i.e., Cologuard®) test every 3 years
What do high performing practices do?
- Describe test procedures and frequency, discuss patient preferences, and make a plan for screening.
- If the patient declines a colonoscopy, discuss non-invasive screening options and have FIT kits available
- If screening has already been performed, let Premera know by documenting it in the medical record and using a CPT II code on the claim.
- Use the assessment section of the medical record to document where and when the exam was performed, the results of the exam, and that an attempt to obtain the original record is in process.
- Code 3017F (colorectal cancer screening results documented and reviewed) with the (COL) Colorectal Cancer Screening diagnosis code (Z12.11)
- Offer your patient a FIT/FOBT kit for this year.
View the tip sheet to learn more about the colorectal cancer screening measure.
For more information and/or questions regarding the article above, email ProviderClinicalConsulting@premera.com.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).