CMS130v9 – Colorectal Cancer Screening

All patients 50-75 years of age with a visit during the measurement period.

– DENOMINATOR EXCLUSION

• Exclude patients whose hospice care overlaps the measurement period.
• Exclude patients with a diagnosis or past history of total colectomy or colorectal cancer.
• Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.
• Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.

– NUMERATOR

Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria:

• Fecal occult blood test (FOBT) during the measurement period.
• Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period.
• Colonoscopy during the measurement period or the nine years prior to the measurement period.
• FIT-DNA during the measurement period or the two years prior to the measurement period.
• CT Colonography during the measurement period or the four years prior to the measurement period.

For Denominator:

The patient of age 50-75 with a qualifying encounter during the measurement year is considered for this measure. To record a visit, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedures- CPTs’ heading, enter the encounter code.

• Annual Wellness Visit
• Home Healthcare Services
• Preventive Care Services-Initial Office Visit, 18 and Up
• Preventive Care Services – Established Office Visit, 18 and Up
• Office Visit

For Numerator:

Patients fulfilling any of the following criteria are considered for the numerator of this measure:

• Patients who had colonoscopy procedure performed ten years or less on or before the end of the measurement period. To document the procedure, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.  

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button.  

• Patients who had flexible sigmoidoscopy procedure performed five years or less on or before the end of the measurement period. To document the procedure, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’.

• Patients who had ‘Fecal Occult Blood Test’ performed during the measurement period. The fecal occult test result must not be null. To perform a laboratory test, navigate to Patient > Clinical > Orders & Result > Labs to click on the ‘+ Add Order’ button. Select a Laboratory and search for a fecal occult blood test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’.

Next, click on the ‘Mark as received’ button.

On the lab result screen, add the observations and click on the ‘Save’ button.

Note:

• For LOINC Code Based Labs: Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button. Once done, click on ‘Save’.  

• For CPT Code Based Labs: When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’.  

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

• Patients who had ‘FIT DNA’ test performed three years or less on or before the end of the measurement period. To perform a laboratory test, navigate to Patient > Clinical > Orders & Result > Labs to click on the ‘+ Add Order’ button. Select a Laboratory and search for a ‘FIT DNA’ test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’. Next, click on the ‘Mark as received’ button. On the lab result screen, add the observations and click on the ‘Save’ button.
• Patients who had ‘CT Colonography’ diagnostic study performed five years or less on or before the end of the measurement period. To document a ‘CT Colonoscopy’ diagnostic study performed, use the workflow Patient > Clinical > Orders & Results > Radiology. Click ‘+ Order’ and add the radiology order details. Then hover over ‘Sign’ and click ‘Queue’.

CT Colonography

Mark the radiology order as completed by clicking the ‘Mark As Completed’ button.

Note:

• For LOINC Code Based Radiology: Please ensure that the test code is mapped to a LOINC Code from the Settings. To map a LOINC with the radiology test code, navigate to Settings > EHR > Radiology. Select the radiology test and navigate to the ‘Code’ tab. Then, click on a code. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button. Once done, click on ‘Save’.  

• For CPT Code Based Radiology: When a CPT code is added to a test order, please ensure that the CPT code is present in the ‘Procedures’.  

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

For Denominator Exclusions:

Patients satisfying any of the following criteria are excluded from the denominator:

• Patients who received hospice care during the measurement year. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations 

• Patients aged 65 years or older at the start of the measurement period who spent longer than 90 consecutive days in a long term care during the measurement period. To record the encounter, navigate to Patient > Provider Note > eSuperbill.
• Patients 65 years of age or older with two or more outpatient encounters with advanced illness and fulfilling frailty criteria. Outpatient encounters should occur two years or less prior to the end of the measurement period. To document an outpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document an advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

• Patients 65 years of age or older having an inpatient encounter with advanced illness and fulfilling frailty criteria. Inpatient encounter should occur two years or less prior to the end of the measurement period. To document an inpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document an advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill
• Patients 65 years of age or older taking dementia medication one year prior to or during the measurement period and fulfilling frailty criteria. Record the medication via the workflow Patient > Clinical > Prescription.Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill
• Patients diagnosed with malignant neoplasm of colon and who had colorectal cancer prevalence on or before the end of the measurement period. To record the cancer diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the malignant neoplasm of colon diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.

• Patients who had ‘Total Colectomy’ procedure performed on or before the end of the measurement period. To document the procedure, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’.