Measure Name: Cervical Cancer Screen Owner: NCQA (CCS) Measure Code: CER Lab Data: Y Rule Description: The percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer. Applicable Provider Specialty: Family Practice, Internal Medicine, Mixed Specialties Clinic, Obstetrics-Gynecology General Criteria Summary 1. Continuous enrollment: 3 year 2. Anchor date: 31st December of the measurement year 3. Gaps in enrollment: One 45-day gap allowed in each year of continuous enrollment 4. Medical coverage: Yes 5. Drug coverage: No 6. Attribution time frame:2 year 7. Exclusions apply: Yes, when numerator is negative 8. Age range: 21-64 years

Summary of changes for 2011 Added CPT codes 57540, 57545, 57550, 57555, 57556, and 58548 to Table CCS-B: Codes to Identify Exclusions ------Denominator Description: All women aged 24-64 years at the end of the measurement year Inclusion Criteria: Women who meet the age requirement in the measurement year and continuous enrollment criteria as summarized above for the coverage required. There are no claims criteria for the denominator population. Eligibility Criteria Condition # Detailed Criteria Timeframe Description Evnt Gender Code Gender Code = F AND Age is 24-64 Age in Years = 24-64 As of the end of the measurement year

AND Has medical coverage Coverage Indicator Medical = Y During measurement year and the two years prior to the measurement year

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Exclusion Criteria: Women with a previous hysterectomy and no residual cervix

Condition # Detailed Criteria Timeframe Description Evnt Previous hysterectomy 1 Any Diagnosis Code Anytime prior to or during the with no residual cervix Table CCS-B: Codes to Identify Exclusions measurement year Or CPT Procedure Code Table CCS-B: Codes to Identify Exclusions Or ICD9 Procedure Code Table CCS-B: Codes to Identify Exclusions

Exclusion Note: The exclusions are applied according to the general NCQA rule of considering exclusions only if the numerator is negative ------

Numerator Description: For each woman who meets the denominator criteria, those who received a Pap test during the measurement year or the two years prior to the measurement year Inclusion Criteria: Women who had at least one Pap test during the measurement year or the two years prior to the measurement year

Condition # Detailed Criteria Timeframe Description Evnt At least one Pap test 1 Any Diagnosis Code During the measurement year or the performed Table CCS-A: Codes to Identify Cervical cancer two years prior to the measurement Screening year Or CPT Procedure Code Table CCS-A: Codes to Identify Cervical cancer Screening Or HCPCS Procedure Code Table CCS-A: Codes to Identify Cervical cancer Screening Or ICD9 Procedure Code

12/5/2012 Page 2 Table CCS-A: Codes to Identify Cervical cancer Screening Or During the measurement year or the two years prior to the measurement Revenue Code UB = 0923 year Table CCS-A: Codes to Identify Cervical cancer Screening

Or LOINC = Table CCS-A: Codes to Identify Cervical cancer Screening

Notes: 1. Because HCSC has historical data, the search for exclusion criteria extend to 10 years of data.

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Table CCS-A: Codes to Identify Cervical Cancer Screening CPT Procedure Code Description: Pap test 88141 Cytopathology, cervical or vaginal, interpretation by physician 88142 Cytopathology, cervical or vaginal, manual screening under physician supervision 88143 Cytopathology, cervical or vaginal, manual screening and rescreening under physician supervision 88147 Cytopathology smears, cervical or vagina, screening by automated system under physician supervision 88148 Cytopathology smears, cervical or vagina, screening by automated system with manual rescreening under physician supervision 88150 Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision 88152 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision 88153 Cytopathology, slides, cervical or vaginal, manual screening and rescreening under physician supervision 88154 Cytopathology, slides, cervical or vaginal manual screening, computer assisted rescreening, under physician supervision 88155 Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation 88164 Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision 88165 Cytopathology, slides, cervical or vaginal, manual screening and rescreening, under physician supervision 88166 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision 88167 Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening using cell selection, under physician supervision 88174 Cytopathology, cervical or vaginal collected in preservation fluid, automated thin layer preparation, screening by automated system, under physician supervision

12/5/2012 Page 4 88175 Cytopathology, cervical or vaginal collected in preservation fluid, screening by automated system, and manual rescreening, under physician supervision HCPCS Description: Pap test G0123 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, requiring physician interpretation G0141 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with manual rescreening, requiring physician interpretation G0143 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with manual screening and rescreening by cytotechnologist, under physician supervision G0144 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with screening by automated system, under physician supervision G0145 Screening Cytopathology, cervical or vaginal, automated thin layer preparation, with screening by automated system with manual rescreening under physician supervision G0147 Screening Cytopathology smears, cervical or vaginal, performed by automated system under physician supervision G0148 Screening Cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening P3000 Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision P3001 Screening Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician Q0091 Screening Papanicolaou smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory ICD-9 Diagnosis Description: Pap test V72.32 Encounter for Pap cervical smear to confirm findings of recent normal smear following initial abnormal smear V76.2 Special screening for malignant neoplasm, cervix ICD-9-CM Procedure Description: Pap test 91.46 Microscopic examination of specimen from female genital tract, cell block and Pap smear

12/5/2012 Page 5 UB Revenue Description: Pap test 0923 PAP SMEAR LOINC Description: Pap test 10524-7 Pap test 18500-9 Pap test 19762-4 Pap test 19764-0 Pap test 19765-7 Pap test 19766-5 Pap test 19774-9 Pap test 33717-0 Pap test 47527-7 Pap test 47528-5 Pap test

Table CCS-B: Codes to Identify Exclusions CPT Procedure Code Description: Hysterectomy 51925 Closure of vesicouterine fistula with hysterectomy 56308 Hysterectomy 58150 Total abdominal hysterectomy, with or without removal of tubes , with or without removal of ovarys 58152 Total abdominal hysterectomy, with colpo-urethrocystopexy 58200 Total abdominal hysterectomy, including partial vaginectomy, with para aortic lymph nodes sampling with or without removal of tubes , with or without removal of ovarys 58210 Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para aortic lymph node biopsy, with or without removal of tubes , with or without removal of ovarys 58240 Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tubes , with or without removal of ovarys, with removal of bladder and ureteral transplantations, and/ or abdominoperinealmresection of rectum and colon and colostomy or any combination 58260 Vaginal hysterectomy for uterus 250 grams or less 58262 Vaginal hysterectomy for uterus 250 grams or less, with removal of tubes, and/ or ovarys 58263 Vaginal hysterectomy for uterus 250 grams or less, with removal of tubes, and/ or ovarys, with repair of enterocele

12/5/2012 Page 6 58267 Vaginal hysterectomy for uterus 250 grams or less, with colpo- urethrocystopexy with or without endoscopic control 58270 Vaginal hysterectomy for uterus 250 grams or less with repair of enterocele 58275 Vaginal hysterectomy, with total or partial vaginectomy 58280 Vaginal hysterectomy with repair of enterocele 58285 Vaginal hysterectomy, radical 58290 Vaginal hysterectomy for uterus greater than 250 grams 58291 Vaginal hysterectomy with removal of tubes and/ or ovarys 58292 Vaginal hysterectomy with removal of tubes and/ or ovarys, with repair of enterocele 58293 Vaginal hysterectomy with colpo-urethrocystopexy with or without endoscopic control 58294 Vaginal hysterectomy with repair of enterocele 58550 Laparoscopy, surgical with vaginal hysterectomy, for uterus 250 grams or less 58552 Laparoscopy, surgical with vaginal hysterectomy, for uterus 250 grams or less, with removal of tubes and/ or ovarys 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams with removal of tubes and/ or ovarys 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less, with removal of tubes and/ or ovarys 58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g with removal of tubes and/ or ovarys 58951 Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy, with total abdominal hysterectomy, pelvic and limited para-aortic lymhadenectomy 58953 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking

12/5/2012 Page 7 58954 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking, with pelvic lymphadenectomy and limited para aortic lymphadenectomy 58956 Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy 59135 Hysterotomy, abdominal, interstitial, uterine pregnancy requiring total hysterectomy 57540 Excision of cervical stump, abdominal approach 57545 Excision of cervical stump, abdominal approach; with pelvic floor repair 57550 Excision of cervical stump, vaginal approach 57555 Excision of cervical stump, vaginal approach; with anterior and/or posterior repair 57556 Excision of cervical stump, vaginal approach; with repair of enterocele 58548 Laparoscopy with radical hysterectomy ICD-9 Diagnosis Description: Hysterectomy 618.5 Prolapse of vaginal vault after hysterectomy V67.01 Follow up vaginal pap smear V76.47 Special screening for malignant neoplasm, vagina V88.01 Acquired absence of both cervix and uterus V88.03 Acquired absence of both cervix with remaining uterus ICD-9-CM Procedure Description: Hysterectomy 68.4 Total abdominal hysterectomy 68.41 Laparoscopic total abdominal hysterectomy 68.49 Other and unspecified, total abdominal hysterectomy 68.5 Vaginal hysterectomy 68.51 Laparoscopically assisted vaginal hysterectomy (LAVH) 68.59 Other and unspecified, vaginal hysterectomy 68.6 Radical abdominal hysterectomy 68.61 Laparoscopic radical abdominal hysterectomy 68.69 Other and unspecified, radical abdominal hysterectomy 68.7 Radical vaginal hysterectomy 68.71 Laparoscopic radical vaginal hysterectomy

12/5/2012 Page 8 68.79 Other and unspecified, radical vaginal hysterectomy 68.8 Pelvic evisceration

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