According to the American Cancer Society’s 2023 colorectal cancer statistics, treatment in its earliest stage can lead to a 91 percent survival rate after five years, if the cancer is diagnosed at a localized stage. However, more than a third of adults 45-75 do not receive recommended screenings. As stated on NCQA.org, colorectal cancer screening of asymptomatic adults in that age group can catch polyps before they become cancerous or detect colorectal cancer in its early stages, when treatment is most effective.
Measure Compliance
Patients 45–75 years of age who had one or more appropriate screenings for colorectal cancer within the required timeframe:
- Fecal Immunochemical Test (FIT) and Fecal Occult Blood Test (FOBT) – Current Year
- CPT Codes: 88270, 82274
- HCPCS: G0328
- Fecal Occult Blood Test (FOBT)
- CPT Codes: 88270, 82274
- HCPCS: G0328
- Flexible sigmoidoscopy – 5 years
- CPT® Code(s): 45330-45335, 45337-45342, 45345-45347, 45349, 45350
- HCPCS: G0104
- Colonoscopy – also known as lower endoscopy –10 years
- CPT® Code(s): 44388-44394, 44397, 44401-44408, 45355, 45378-45393, 45398
- HCPCS: G0105, G0121
- Computed Tomography (CT) colonography – virtual colonoscopy – 5 years
- CPT® Code(s): 74261-74263
- FIT DNA – 3 years
Note: A FIT DNA is a Cologuard, while a FIT non-DNA is the FOBT; they are not the same.- CPT® Code: 81528
- HCPCS: G0464
Measure Tips
- When documenting a colorectal screening, identify the type (Colonoscopy, Cologuard, FOBT), date of completion, and place of service, if known.
- Scan colonoscopy report into the medical record.
Measure Exclusions
- Patients with evidence of colorectal cancer or total colectomy.
- Patients receiving hospice or palliative care at any time during the measurement year.
Best Practices
Highlight the importance of routine screening, early detection, and treatment starting at age 45.
- Use reminder calls and personalized letters for check-ups and screening reminders.
Discuss all options for screening, including FIT and stool DNA, and how they work.
- Describe testing options and frequencies, discuss patient preferences and include patient in treatment plan for colorectal screening.
Remind patients that preventive colon cancer screenings are legally covered under U.S. healthcare reform and the Affordable Care Act.
Address their fears and concerns and discuss which screening may be most appealing to them.
Other Tips:
- Provide order for testing.
- Ensure the patient’s history is updated yearly and includes prior colorectal cancer screening test(s).
- Place a reminder in the patient’s chart for when the next screening is due.
Pros of completing the FIT Kit
Although a colonoscopy is the gold standard for colorectal cancer screening, the FIT Kit is a valuable alternative for the following reasons:
- Promotes good health through early detection.
- Determines whether the patient needs follow-up with a GI specialist.
- Non-invasive screening alternative.
- Can be done in the comfort of your patients’ homes and takes about 10 minutes to complete.
- Satisfies the COL HEDIS® measure requirement when completed annually.
HealthCare Partners (HCP) is here to help!
HCP Pharmacy Staff
Call: (516) 515–8861
Monday through Friday, 8:30am – 5:30pm EST
HCP Case Managers
Call: (888) 258–0203
Monday through Friday, 8:30 am – 5:30 pm EST
Our Case Managers can:
- Teach patients about their condition.
- Guide them in making a treatment plan.
- Help them get medications and care.
- Coordinate transportation based on member’s assigned benefit.
- Set up referrals and doctor visits.
- Provide a Nurse on call, 24/7 at (516) 238-6124.
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