Measure Name: Colorectal Cancer Screen
Owner: NCQA (COL)
Measure Code: COL
Lab Data: N
Rule Description:
The percentage of members 50-75 years of age who had appropriate screening for colorectal cancer.
Applicable Provider Specialty:
Family Practice, Geriatric Medicine, Internal Medicine, Obstetrics-Gynecology
General Criteria Summary
1.
2.
3.
4.
5.
6.
7.
8.
9.
Measurement period: 1 year prior to measurement period end date
Continuous enrollment: 2 year
Anchor date: measurement period end date (ie. December 31 of calendar year)
Gaps in enrollment: One 45-day gap allowed in each year of continuous enrollment
Medical coverage: Yes
Drug coverage: No
Attribution time frame:2 year
Exclusions apply: Yes, when numerator is negative
Age range: 50-75 years
Summary of changes for 2014
NCQA replaced all coding table references with value set references. There were no coding changes.
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Denominator Description: All members aged 51-75 years at the end of the measurement year
Inclusion Criteria: Members who meet the age requirement in the measurement year and continuous enrollment criteria as summarized above for the coverage required. There are
no claims criteria for the denominator population.
Eligibility Criteria
Condition
Description
Age is 51-75
#
Evnt
Detailed Criteria
Timeframe
Age in Years = 51-75
As of the end of the measurement year
Coverage Indicator Medical = Y
During measurement year and the year prior to the measurement year
AND
Has medical coverage
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Exclusion Criteria: Members with a diagnosis of colorectal cancer or total colectomy
Condition
Description
#
Evnt
Diagnosis of colorectal
cancer
1
Detailed Criteria
Timeframe
Any Diagnosis Code for Colorectal Cancer
Colorectal Cancer Value Set
Or
Any time prior to or during the measurement year
HCPCS Procedure Code for Colorectal Cancer
Colorectal Cancer Value Set
OR
Total colectomy
procedure done
1
CPT Procedure Code for Total Colectomy
Total Colectomy Value Set
Or
Any time prior to or during the measurement year
ICD9 Procedure Code for Total Colectomy
Total Colectomy Value Set
Exclusion Note: The exclusions are applied according to the general NCQA rule of considering exclusions only if the numerator is negative
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Numerator Description: For each member who meets the denominator criteria, those who received appropriate screening for colorectal cancer
Inclusion Criteria: Members who had at least one of three possible procedures used for colorectal cancer screening, within the timeframe specified for the indicated procedure
Condition
Description
#
Evnt
Fecal occult blood test
(FOBT) done
1
Detailed Criteria
CPT Procedure Codes for
FOBT FOBT ValueSet
Or
Timeframe
During the measurement year
HCPCS Procedure Codes for FOBT
FOBT Value Set
Or
LOINC Codes for
FOBT FOBT Value Set
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Condition
Description
Flexible sigmoidoscopy done
#
Evnt
1
Detailed Criteria
OR
CPT Procedure codes for Flexible sigmoidoscopy
Flexible Sigmoidoscopy Value Set
Timeframe
During the measurement year and or up to four
years prior to the measurement year
Or
HCPCS Procedure Codes for Flexible
sigmoidoscopy
Flexible Sigmoidoscopy Value Set
Or
ICD9 Procedure Codes for Flexible
sigmoidoscopy
Flexible Sigmoidoscopy Value Set
OR
Colonoscopy done
1
CPT Procedure Code for Colonoscopy
Colonoscopy Value Set
Or
During the measurement year or up to nine years
prior to the measurement year
HCPCS Procedure Code for Colonoscopy
Colonoscopy Value Set
Or
ICD9 Procedure Code for Colonoscopy)
Colonoscopy Value Set
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Appendix
FOBT Value Set
Code
82270
82274
G0328
2335-8
12503-9
12504-7
14563-1
14564-9
14565-6
27396-1
27401-9
27925-7
27926-5
29771-3
56490-6
56491-4
57905-2
58453-2
Code Type
CPT
CPT
HCPCS
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
LOINC
Description
Blood, occult, feces, by peroxidase activity (guaiac)
Blood, occult, feces, by fecal hemoglobin determination by immunoassay
Colorectal cancer screening, fecal-occult blood test, immunoassay, 1-3 simultaneous determinations
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Fecal occult blood test
Flexible Sigmoidoscopy Value Set
Code
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
Code Type
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
Description
Sigmoidoscopy, flexible, diagnostic, with or without collection of specimen
Sigmoidoscopy, with biopsy, single or multiple
Sigmoidoscopy, with removal of foreign body
Sigmoidoscopy, with removal of tumors, polyps, by hot biopsy forceps or bipolar cautery
Sigmoidoscopy, with control of bleeding
Sigmoidoscopy, with directed submucosal injections, any substance
Sigmoidoscopy, with decompression of volvulus, any method
Sigmoidoscopy, with removal of tumor, polyp, or lesions by snare technique
Sigmoidoscopy, w ablation of tumor, polyp, or lesions not amenable to rem by hot biopsy forceps bi cautery or
snare
tech
Sigmoidoscopy,
with dilation by balloon, 1or more strictures
Sigmoidoscopy, with endoscopic ultrasound examination
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45342
45345
G0104
45.24
CPT
CPT
HCPCS
ICD-9 Procedure
Sigmoidoscopy, with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy
Sigmoidoscopy, with transendoscopic stent placement
Colorectal cancer screening, flexible
Flexible sigmoidoscopy
Colonoscopy Value Set
Code
44388
44389
44390
44391
44392
44393
44394
44397
45355
45378
45379
45380
45381
45382
45383
45384
45385
45386
45387
45391
45392
G0105
G0121
45.22
45.23
45.25
45.42
45.43
Code Type
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
HCPCS
HCPCS
ICD-9 Procedure
ICD-9 Procedure
ICD-9 Procedure
ICD-9 Procedure
ICD-9 Procedure
Description
Colonoscopy through stroma, diagnostic, with or without collection of specimens
Colonoscopy, with biopsy single or multiple
Colonoscopy, with removal of foreign body
Colonoscopy with control of bleeding
Colonoscopy with removal of tumors, polyps, or other lesions by hot biopsy forceps or bipolar cautery
Colonoscopy w ablation of tumors, polyps, lesions not amen to rem w hot biopsy forceps, bipolar cautery or snare tech
Colonoscopy, with removal of tumors, polyps, or other lesions by snare technique
Colonoscopy with transendoscopic stent placement
Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple
Colonoscopy, flex, prox to splenic flex; diag, w/wo colln of spec(s) by brush/wash with or without colon decompression
with removal of foreign body
with biopsy, single or multiple
Colonoscopy, flexible, proximal to the splenic flexure; with directed submucosal injection(s), any substance
with control of bleeding, any method
amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps or bipolar cautery
with removal of tumor(s), polyp(s) or other lesion(s) by snare technique
with dilation by balloon, 1 or more strictures
with transendoscopic stent placement
Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination
with transendoscopic ultrasound- guided intramural or transmural fine needle aspiration/biopsy(s)
Colorectal cancer screening, colonoscopy on individual at high risk
Colorectal cancer screening, colonoscopy on individual not meeting criteria for high risk
Endoscopy of large intestine through artificial stoma
Colonoscopy
Closed endoscopic biopsy of large intestine
Endoscopic polypectomy of large intestine
Endoscopic destruction of other lesion or tissue of large intestine
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Colorectal Cancer Value Set
Code
153*
154.0
154.1
197.5
V10.05
G0213
G0214
G0215
G0231
Code Type
ICD-9 Diagnosis
ICD-9 Diagnosis
ICD-9 Diagnosis
ICD-9 Diagnosis
ICD-9 Diagnosis
HCPCS
HCPCS
HCPCS
HCPCS
Description
Malignant neoplasm of colon
Malignant neoplasm of rectosigmoid junction
Malignant neoplasm of rectum
Secondary malignant neoplasm, large intestine and rectum
Personal history of malignant neoplasm, large intestine
Colorectal cancer
Colorectal cancer
Colorectal cancer
Colorectal cancer
Total Colectomy Value Set
Code
44150
44151
44152
44153
44155
44156
44157
44158
44210
44211
44212
45.8
45.81
45.82
45.83
Code Type
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
CPT
ICD-9 Procedure
ICD-9 Procedure
ICD-9 Procedure
ICD-9 Procedure
Description
Colectomy, total, abdominal, without proctectomy with ileostomy or ileoproctostomy
Colectomy, with continent ileostomy
Colectomy, with rectal mucosectomy, ileoanal anastomosis, with or without loop ileostomy
Colectomy, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J) w/wo loop ileostomy
Colectomy, total, abdominal, with proctectomy with ileostomy
Colectomy, total, abdominal, with proctectomy with ileostomy, with continent ileostomy
Colectomy, ttl, abd, w proctectomy with ileostomy, with ileoanal anastomosis, incl loop ileostomy, & rectal mucosectomy
Colectomy, tt, abdl, w proctect w ileost w ileoanal anastomosis, creat of ileal res incl loop ileostomy/rec mucosectomy
Colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy
Colectomy, total, abd, w proctectomy, w ileoanal anastomosis, creat of ileal res incl loop ileostomy/rectal mucosectomy,
Colectomy, total, abdominal, with proctectomy, with ileostomy
Total intra abdominal colectomy
Laparoscopic total intra-abdominal colectomy
Open total intra-abdominal colectomy
Other and unspecified total intra-abdominal colectomy
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