Reporting Codes for Cancer Screening

June 1, 2017

You might be receiving notification from us about our members (your patients) who are due for certain types of care. These notifications help prevent gaps in patient care and are part of our work on healthcare quality.

It's easy to let Premera know that your patient isn't due for breast, cervical and/or colorectal cancer screening. Simply add a reporting code (CPT II) code on the patient's claim at their next visit.

Breast and cervical cancer screenings

For screenings for breast cancer or cervical cancer, include a copy of the exam or results in the patient's record. This enables you to use the specified reporting code. Premera may request a copy of this record at a later date.

Colorectal cancer screenings

For colorectal cancer screenings, a copy of the report is required for the fecal immunochemical test (FIT) or fecal occult blood test (FOBT) screenings, but not for previous colonoscopies. The best practice is to retain a copy of patient's colonoscopy in the record. Premera may request a copy of this record at a later date.

If you can't obtain the report, the previous screening must be documented in the assessment portion of the visit note. The documentation should indicate where and when the exam happened, the results of the exam, and that an attempt to obtain the original record is in process. For example, “Patient states she had colonoscopy completed 12/1/12 at North Regional and states it was normal.” You might also choose to offer the patient a FIT/FOBT kit for this year.

The reporting codes are as follows and should be paired with the ICD-10 code.

For further training or questions on closing care gaps using reporting codes, contact ProviderEngagementTeam@Premera.com.

Back to News