This HEDIS measure measures anyone that is between 45 and 75 years old that had appropriate colorectal cancer screening.

This post for any provider that attests to HEDIS or part of NCQA PCMH program.

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Required documentation:

• Type of screening, when done and what was the result
• Pathology or other procedure reports that list the type of screening with the date
• Pathology reports from aborted screening: To the cecum = completed colonoscopy Beyond the splenic fissure = complete colonoscopy. Into the sigmoid colon = completed flexible sigmoidoscopy.
• Member reported screenings if reported and documented in the patient record (2016)

Types of screening procedures that qualify for this HEDIS measure:

• Colonoscopy completed 2016 – 2025.
• Flexible sigmoidoscopy during 2021 – 2025.
• CT colonography (virtual colonoscopy) during 2021 – 2025

Non-invasive screenings:

• Stool DNA (sDNA) + FIT, also known as Cologuard, done 2023 – 2025.
• Fecal occult blood test (FOBT) done annually (2025) such as: -Fecal immunochemical test (FIT). -Guaiac FOBT (gFOBT).

Not acceptable documentation:

• “colorectal screening done”, “colo done”

Not acceptable for this HEDIS Measure:

• A sample taken from a digital rectal exam (DRE) or FOBT performed in the office setting does not count as evidence of colorectal screening

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More information: click here

• Colorectal Cancer Screening: Patient Version (National Institute of Health).
• Colorectal Cancer Screenings Tests (CDC).

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Find this type of information useful? Follow my blog for more payer updates! #medicalbilling, #medicalcoding, #reimbursement, #HEDIS

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