Cervical Cancer Screening Tip Sheet
The percentage of women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
- Women age 21–64 who had cervical cytology (Pap smear) performed within the last 3 years.
- Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
- Women age 30–64 who had cervical cytology (Pap smear) and human papillomavirus (HPV) co-testing performed within the last 5 years.
Note: When looking for the hrHPV or co-testing for women 30-64 years of age, the member must be 30 years or older on the date of the test
Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information, refer to the 2021 and 2022 CBI Technical Specifications.
Pap Smear Laboratory Billing
The Alliance partners with our contracted laboratories to receive comprehensive lab data. However, the Alliance has identified instances where CBI credit had not been given due to inconsistencies in laboratory data transmissions. Providers can ensure they receive credit by billing the non-reimbursable code Q0091 during the visit in which the Pap smear is obtained.
- Q0091: Screening Papanicolaou smear: obtaining, preparing and conveyance of cervical or vaginal smear to laboratory.
Providers who obtain the Pap smear during a well woman exam should report code Q0091 along with the appropriate E&M code.
Indicating Measure Ineligibility
To remove women without a cervix from the screening requirement, their history must be reported to the Alliance as a diagnosis on any encounter claim using one of the two codes below:
- Z90.710 - Acquired absence of both cervix and uterus.
- Z90.712 - Acquired absence of cervix with remaining uterus.
- Q51.5 - Agenesis and aplasia of cervix (Can be used for a male-to-female transgender person).
These codes should NOT be used as a primary diagnosis per coding guidelines. To qualify for lifetime exclusion, please resubmit any claims prior to 2009 using codes listed above.
Additional screening codes and exclusion codes are located in the CBI code set located in the CBI Technical Specifications.
Data for this measure will be collected using claims, laboratory data, DHCS Fee-for-Service encounter claims, and provider data submissions via the Data Submission Tool on the Provider Portal. To find gaps in data:
- Run a report from your electronic health record (EHR) system; or.
- Manually compile patient data. (Example: Download monthly cervical cancer screening quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).
This measure allows providers to submit cervical cancer screenings or evidence of a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix information from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the Data Submission Tool on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.
Identify Patients Due
- Run population health management reports out of your EHR, including either active and inactive women or another time-bound filter. Many practices make patients inactive after 18, 24 or 36 months, which may miss women due for their cervical cancer screening.
- Develop prompts or flags that pop up to alert care teams for when members are due for preventative health screenings during chart prep or when a member presents in your health center.
Outreach for Patient Engagement
- Designate a care team member to outreach to patients due for cervical cancer screening.
- Send targeted mailings, text messages or emails and follow up with telephone calls to chronically noncompliant patients. Studies have shown that the best way to reach patients is by combining a variety of methods, so don’t just stop with the old reminder postcard. Pick up the phone or send a text.
- Take it to the next level! Individual education sessions can help people overcome barriers to screening for cervical cancer. Lay health volunteers or healthcare staff can conduct sessions by phone or in person in a variety of settings.
When Patient Presents for Care
- Display culturally appropriate posters and brochures at an appropriate literacy level in patient areas to encourage patients to talk to providers about cervical cancer screening.
- A recent study found that using narrative storytelling video to educate women about their screening can be effective.
- Ensure screening is ordered when it is due, regardless of the reason for the visit.
- For patients that may have completed their cervical cancer screening at an outside clinic, assess and document the last time, location and result of their last screening, and have the patient sign a release of records.
- Empower your medical assistants and nurses with standing orders to screen and identify patients currently due or past due for their Pap.
- Don’t forget to assess health literacy. A lack of understanding and/or language differences may create barriers in following a recommended care plan.
- A patient may choose to decline screening even if strongly encouraged by the health care team. A patient should be periodically re-assessed and supported to complete screenings as per current guidelines.
- Document the current care plan and routinely provide a copy to the patient.
Post-Visit Follow Up:
- Create prompts in your EMR for screening that do not turn off until results are received rather than when the test is ordered.
- Initiate a patient follow up, recall system and/or log to ensure screening follow-through and results are received.
Creating an Inclusive Culture:
- Access is key! Offer extended hours on weekends and evenings.
- Hire clinicians to accommodate language needs, gender preference and LGBT sensitivity of patients served.
- Encourage continuing medical education (CME) for providers that support culturally competent screening, culturally competent education and Pap follow up per national guidelines.
- Remember, cultural competence is not just limited to race, ethnicity and culture. Perceptions, values, beliefs and trust can also be influenced by factors such as religion, age, sexual orientation, gender identity and socioeconomic status.