Colorectal Cancer Screening

The Center for Medicare & Medicaid Services (CMS) recommends colorectal screenings via high sensitivity fecal occult blood testing (FOBT) at least once every two years. In recent reports, only 59-63% of adults were up to date with colorectal cancer screening. Risk for colorectal cancer increases with age and members should understand the importance of preventive screening and early detection. Whether or not symptoms are present may be directly related to survival rates.1

The Measure This measure is defined as the percentage of Medicare Advantage beneficiaries ages 50-75 who had an appropriate screening for colorectal cancer.

Common Barriers Members do not follow through with provider referrals. Often, this occurs due to a fear of the procedure or results may deter members from proper examinations. Colorectal screenings are an invasive measure and come with added risks. Many members may not realize that preventive care is free. Medicare Advantage members pay a $0 copayment - even with specialists - to have a screening. We’re also giving members a $15 gift card if they have a colorectal cancer screening in 2014.

Best Practices  Monitor dates of service of preventive screenings: – FOBT every calendar year; – Sigmoidoscopy every five calendar years; or – Colonoscopy every 10 calendar years.  Address the preparation, medications administered and procedure openly and clearly to dispel any members’ fears.  Encourage members to use in-network physicians to facilitate execution of a care plan.  Remember to report all exclusions of members whose medical history indicates a diagnosis of colorectal cancer or a total colectomy through December 31 of the current calendar year.  It is best to schedule this preventive screening during routine office visits.  Follow the U.S. Preventive Services Task Force Guidelines.

How to Close the Measure 1. Submit or adjust claims with appropriate codes and be sure to include Category II Codes. See Table 1 for more information. 2. Complete and submit the Physician Assessment Form (PAF).

1 US Preventive Services Task Force (USPSTF) Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2008; 149(9):627–637.

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3. Complete the self-report section online within the Physician Quality Incentive Program tool on BlueAccess℠.* 4. Submit an abstract of the member’s medical record. This is the method of last resort and should only be used when previous methods are not feasible.

Code Code Type Definition 3017 CPT II Colorectal cancer screening results documented and reviewed

82270 CPT® Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces 1 determination 82274 CPT® Blood, occult, by fecal hemoglobin, qualitative, 1-3 simultaneous determinations G0328 HCPCS Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous determinations

45330 CPT® Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

45331 CPT® Sigmoidoscopy, flexible; with biopsy, single or multiple

45332 CPT® Sigmoidoscopy, flexible; with removal of foreign body

45333 CPT® Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s) or other lesion(s) by hot biopsy forceps or bipolar cautery

45334 CPT® Sigmoidoscopy, flexible; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 45335 CPT® Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance 45337 CPT® Sigmoidoscopy, flexible; with decompression of volvulus, any method 45338 CPT® Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s) or other lesion(s) by snare technique 45339 CPT® Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy, forceps, bipolar cautery or snare technique

45340 CPT® Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures 45341 CPT® Sigmoidoscopy, flexible; with endoscopic ultrasound examination

45342 CPT® Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)

45345 CPT® Sigmoidoscopy, flexible; with transendoscopic stent placement (includes Table 1

BlueCross BlueShield of Tennessee Support

 We offer a $15 gift card incentive to members for completing a colorectal cancer screening in 2014. We will even help schedule the screening for them. Please have BlueAdvantage (PPO)SM members call 1- 800-831-BLUE (2583) or BlueChoice (HMO)SM members call 1-800-317-BLUE (2583) if they need help scheduling an appointment or finding a participating facility.  We conduct outreach campaigns via letters, postcards and calls that encourage and remind members to have their screenings.  We partner with CenseoHealth to provide an in-home assessment to include a few preventive services such as a FOBT for members. To use this service, please call 1-877-868-5351.  We partner with Home Access Health Corporation to offer members an in-home, self-administered FOBT kit. Please call 1-866-435-4372 to use this service.  We provide Quality Resources on our website for your convenience.

Regardless of the method or person closing the gap, all gaps closed will be credited to the attributed primary care provider on file. View more information on how we attribute members to your practice here.

*We know some gaps in care may already be closed but not reported through claims. When this occurs, simply login through our secure BlueAccess tool, access the members account and self-report. This must be completed by a licensed clinician designated by a BlueAccess practitioner user role. You may also see which members have gaps in care that need to be closed. If training or access to the tool’s practitioner role is needed for any licensed clinician staff members, please contact: