Cervical Cancer Screening Tip Sheet

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

Members recommended for routine cervical cancer screening with the following criteria:

• Administrative gender of female any time in the member’s history captured on the member’s Medi-Cal enrollment file.

• Administrative members at the end of the measurement period.
• Dual coverage members.
• Members with a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix any time during the member’s history through December 31 of the measurement year.
• Members in hospice, receiving hospice services or palliative care, had an encounter for palliative care, or who died during the measurement year.

Note: Laboratory claims with POS 81 are not included to identify eligible members with diagnostic codes for frailty or advanced illness, or encounters for palliative care.

Pap Smear Laboratory Billing
The Alliance partners with contracted laboratories to receive comprehensive lab data. However, the Alliance identified instances where CBI credit was not 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 a Pap smear during a well-woman exam should report code Q0091 along with the appropriate E&M code.

Indicating Measure Ineligibility
To remove a person 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 three 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 a lifetime exclusion, please resubmit any claims prior to 2009 using the 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 is collected using claims, laboratory data, DHCS Fee-for-Service encounter claims and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system; or
• Manually compile patient data. For example, download your monthly Cervical Cancer Screening Quality report or Care-Based Incentives Measure Details report on the Provider Portal and compare it to your EHR/paper records.

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, upload data files to the DST 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 members due for their cervical cancer screening.
• Develop prompts or flags to alert care teams when members are due for their preventive 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.
• Individual education sessions can help people overcome barriers to screening for cervical cancer.

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.
• Use a narrative storytelling video approach to educate members about screening for cervical cancer. This has been an effective method to increase screenings and attitudes toward screenings, as found by a National Cancer Institute study.
• Ensure screening is ordered when it is due, regardless of the reason for the visit.
• For patients who completed their cervical cancer screening at an outside clinic, assess and document the time, location and result of their last screening, and ask the patient to 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:

• In your EMR, create screening prompts that stay active 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.

Create an Inclusive Culture:

• Offer extended hours on weekends and evenings.
• Hire clinicians to accommodate language needs, gender preference and LGBT sensitivity of patients served.
• Refer to the UCSF Transgender Care & Treatment Guidelines for screening of cervical cancer in transgender men.
• 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.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with the member.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874, ext. 5577 (TTY: Dial 711).
• Cervical Cancer – CDC.