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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
113 0034 Process Yes Effective Clinical Care Claims

Measure Description

Percentage of patients 50-75 years of age who had appropriate screening for colorectal cancer

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. Performance for this measure is not limited to the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding.

NOTE: No notes for this Quality ID

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

The intent of the exclusion for individuals age 65 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusions allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy.

Numerator

Patients with one or more screenings for colorectal cancer.

Numerator Instructions:

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
  • Computed tomography (CT) colonography during the measurement period or the four years prior to the measurement period
  • Fecal immunochemical DNA test (FIT-DNA) during the measurement period or the two years prior to the measurement period

Numerator Quality-Data Coding Options

Denominator Exclusion: G9710:

Patient receiving Hospice Services, Patient Not Eligible

Patient was provided hospice services any time during the measurement period

Denominator Exclusion: G9711:

Colorectal Cancer Screening Not Performed for Medical Reasons

Patients with a diagnosis or past history of total colectomy or colorectal cancer

Denominator Exclusion: G9901:

Patient age 65 or older in Institutional Special Needs Plans (SNP) or residing in long-term care
facility, Patient Not Eligible

Patients age 65 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54 or 56 during the measurement period

Performance Met: CPT II 3017F:
Colorectal Cancer Screening Performed

Colorectal cancer screening results documented and reviewed

Performance Not Met: 3017F with 8P:
Colorectal Cancer Screening not Performed, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 3017F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Colorectal cancer screening results were not documented and reviewed, reason not otherwise specified

NUMERATOR NOTE:

Data not available

Denominator

Patients 50-75 years of age with a visit during the measurement period

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients 50 to 75 years of age on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

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