Colorectal Cancer Screening - Exploratory Measure Tip Sheet

This is an exploratory measure; there is no payment for 2023. For additional information, refer to the CBI Technical Specifications.

Members who had colorectal cancer or total colectomy during any time in the member’s history.

Members in hospice or receiving hospice services or palliative care during the measurement year.

Members 66 years of age and older as of December 31 of the measurement year with frailty and advanced illness:

• At least one encounter for frailty during the measurement year.
• At least one of the following during the measurement year or year prior to the measurement period:
  • At least two outpatient, observation, emergency department (ED) visits, telephone visits, e-visits or virtual check-ins, non-acute inpatient discharges, or non-acute inpatient encounter on a different date of service (DOS), with an advanced illness diagnosis. Visit types need not be the same for the two visits.
  • At least one acute inpatient encounter with an advanced illness diagnosis.
  • At least one acute inpatient discharge with advance illness diagnosis on discharge claim.
  • Dispensed dementia medication.

Fecal occult blood test

• CPT: 82270, 82274

Flexible sigmoidoscopy

• CPT: 45330-45350

Colonoscopy

• CPT: 44388-44394, 44397, 44401-44408, 45355, 45378-45393, 45398
• ICD-9: 22-45.23, 45.25, 45.42-45.43

CT colonography

• CPT: 74261-74263

Stool DNA (sDNA) with FIT

• CPT: 81528

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 colorectal cancer screenings or evidence of colorectal cancer or total colectomy 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 members or another time-bound filter. Many practices make patients inactive after 18, 24 or 36 months, which may miss patients due for their colorectal 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 colorectal 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.
• Promote test choice. Studies have shown that when provided with options, many patients choose stool-based testing over colonoscopy for colorectal cancer screening and are more likely to adhere to regular screening when they have a choice of tests

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 colorectal cancer screening.
• Ensure screening is ordered when it is due, regardless of the reason for the visit.
• For patients that may have completed their colorectal 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 colorectal cancer screening.
• 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 diagnosis screening 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.

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• 2022 Messaging Guidebook for Black & African American People
• 2018 Asian Americans and Colorectal Cancer Companion Guide
• 2016 Hispanics/Latinos and Colorectal Cancer Companion Guide
• A Provider’s Guide to Colorectal Cancer Screening