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.
Incentives will be paid on an annual basis, following the end of quarter 4. For additional information refer to the 2021 CBI Technical Specifications.
Data for this measure will be collected using provider data submissions via the Data Submission Tool on the Provider Portal, and claims.
- Run a report from your EHR system
- Manually compile patient data
This measure allows providers to submit cervical cancer screenings or hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix information from the clinic EMR/EHR system or paper records to the Alliance at the end of the measurement year by uploading data files to the Data Submission Tool on the Provider Portal. The files are required to be submitted as a CSV file to be accepted. A Data Submission Tool Guide is available on the Provider Portal to provide you with step-by-step instructions.
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
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 exclusion codes located in CBI code set.
Identify Patients Due:
- Run population health management reports out of your EMR, 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 to alert care teams that patients are due for their preventative health screenings that pop up whenever the patient is present 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 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 CCS.
- A recent study found that using narrative story-telling video to educate women about their screening to be effective: https://www.cancer.gov/news-events/cancer-currents-blog/2015/cervical-screening-narrative-video
- Ensure screening is ordered when it is due, regardless of reason for visit.
- For those patients that may have completed their CCS at an outside clinic, assess and document the last time, location and result of their last CCS, 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 CMEs 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.