The percentage of women years of age who received one or more Pap tests to screen for cervical cancer.

Transcription

1 Measure Name: Cervical Cancer Screen Owner: NCQA (CCS) Measure Code: CER Lab Data: Y Rule Description: General Criteria Summary The percentage of women years of age who received one or more Pap tests to screen for cervical cancer. 1. Continuous enrollment: 3 year 2. Anchor date: 31 st 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: years Summary of changes for Added ICD-9 Diagnosis code to Table CCS-B Denominator Description: All women aged 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 Description # Evnt Detailed Criteria Gender Code Gender Code = F AND Age is Age in Years = As of the end of the measurement year Timeframe AND Has medical coverage Coverage Indicator Medical = Y During measurement year and the two years prior to the measurement year Page 1

2 Exclusion Criteria: Women with a previous hysterectomy and no residual cervix Condition Description Previous hysterectomy with no residual cervix # Evnt Detailed Criteria 1 Any Diagnosis Code CPT Procedure Code ICD9 Procedure Code Timeframe Anytime prior to or during the measurement year 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 Description At least one Pap test performed # Evnt Detailed Criteria 1 CPT Procedure Code HCPCS Procedure Code ICD9 Procedure Code Revenue Code UB = 0923 LOINC = Table CCS-A: Codes to Identify Cervical cancer Timeframe During the measurement year or the two years prior to the measurement year Page 2

3 Notes: 1. Because HCSC has historical data, the search for exclusion criteria extends to 10 years of data. 2. In 2012, ICD-9 diagnosis codes V72.32, V76.2 were deleted from Table CCS-A. 3. In 2013, ICD-9 Diagnosis code was added to Table CCS-B. Appendix Table CCS-A: Codes to Identify Cervical Cancer CPT Procedure Code Description: Pap test Cytopathology, cervical or vaginal, interpretation by physician Cytopathology, cervical or vaginal, manual screening under physician supervision Cytopathology, cervical or vaginal, manual screening and rescreening under physician supervision Cytopathology smears, cervical or vagina, screening by automated system under physician supervision Cytopathology smears, cervical or vagina, screening by automated system with manual rescreening under physician supervision Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision Cytopathology, slides, cervical or vaginal, manual screening and rescreening under physician supervision Cytopathology, slides, cervical or vaginal manual screening, computer assisted rescreening, under physician supervision Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation Cytopathology, slides, cervical or vaginal, manual screening, under physician supervision Cytopathology, slides, cervical or vaginal, manual screening and rescreening, under physician supervision Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening, under physician supervision Cytopathology, slides, cervical or vaginal, manual screening and computer assisted rescreening using cell selection, under physician supervision Page 3

4 88174 Cytopathology, cervical or vaginal collected in preservation fluid, automated thin layer preparation, screening by automated system, under physician supervision Cytopathology, cervical or vaginal collected in preservation fluid, screening by automated system, and manual rescreening, under physician supervision HCPCS G0123 Description: Pap test Cytopathology, cervical or vaginal, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124 G0141 G0143 G0144 G0145 G0147 G0148 P3000 P3001 Q0091 Cytopathology, cervical or vaginal, automated thin layer preparation, requiring physician interpretation Cytopathology, cervical or vaginal, automated thin layer preparation, with manual rescreening, requiring physician interpretation Cytopathology, cervical or vaginal, automated thin layer preparation, with manual screening and rescreening by cytotechnologist, under physician supervision Cytopathology, cervical or vaginal, automated thin layer preparation, with screening by automated system, under physician supervision Cytopathology, cervical or vaginal, automated thin layer preparation, with screening by automated system with manual rescreening under physician supervision Cytopathology smears, cervical or vaginal, performed by automated system under physician supervision Cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision Papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician Papanicolaou smear, obtaining, preparing and conveyance of cervical or vaginal smear to laboratory ICD-9-CM Procedure Description: Pap test Microscopic examination of specimen from female genital tract, cell block and Pap smear UB Revenue Description: Pap test Page 4

5 0923 PAP SMEAR LOINC Description: Pap test Pap test Pap test Pap test Pap test Pap test Pap test Pap test Pap test Pap test Pap test CPT Procedure Code Description: Hysterectomy Closure of vesicouterine fistula with hysterectomy Hysterectomy Total abdominal hysterectomy, with or without removal of tubes, with or without removal of ovaries Total abdominal hysterectomy, with colpo-urethrocystopexy Total abdominal hysterectomy, including partial vaginectomy, with para aortic lymph nodes sampling with or without removal of tubes, with or without removal of ovaries 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 ovaries Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tubes, with or without removal of ovaries, with removal of bladder and ureteral transplantations, and/ or abdominoperinealmresection of rectum and colon and colostomy or any combination Vaginal hysterectomy for uterus 250 grams or less Vaginal hysterectomy for uterus 250 grams or less, with removal of tubes, and/ or ovaries Vaginal hysterectomy for uterus 250 grams or less, with removal of tubes, and/ or ovaries, with repair of enterocele Vaginal hysterectomy for uterus 250 grams or less, with colpo- urethrocystopexy with or without endoscopic control Page 5

6 58270 Vaginal hysterectomy for uterus 250 grams or less with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy Vaginal hysterectomy with repair of enterocele Vaginal hysterectomy, radical Vaginal hysterectomy for uterus greater than 250 grams Vaginal hysterectomy with removal of tubes and/ or ovaries Vaginal hysterectomy with removal of tubes and/ or ovaries, with repair of enterocele Vaginal hysterectomy with colpo-urethrocystopexy with or without endoscopic control Vaginal hysterectomy with repair of enterocele Laparoscopy, surgical with vaginal hysterectomy, for uterus 250 grams or less Laparoscopy, surgical with vaginal hysterectomy, for uterus 250 grams or less, with removal of tubes and/ or ovaries Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams with removal of tubes and/ or ovaries Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less, with removal of tubes and/ or ovaries Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g with removal of tubes and/ or ovaries Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy, with total abdominal hysterectomy, pelvic and limited para-aortic lymhadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking, with pelvic lymphadenectomy and limited para aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Page 6

7 Hysterotomy, abdominal, interstitial, uterine pregnancy requiring total hysterectomy Excision of cervical stump, abdominal approach Excision of cervical stump, abdominal approach; with pelvic floor repair Excision of cervical stump, vaginal approach Excision of cervical stump, vaginal approach; with anterior and/or posterior repair Excision of cervical stump, vaginal approach; with repair of enterocele Laparoscopy with radical hysterectomy ICD-9 Diagnosis Description: Hysterectomy Prolapse of vaginal vault after hysterectomy Cervical agenesis 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 Laparoscopic total abdominal hysterectomy Other and unspecified, total abdominal hysterectomy 68.5 Vaginal hysterectomy Laparoscopically assisted vaginal hysterectomy (LAVH) Other and unspecified, vaginal hysterectomy 68.6 Radical abdominal hysterectomy Laparoscopic radical abdominal hysterectomy Other and unspecified, radical abdominal hysterectomy 68.7 Radical vaginal hysterectomy Laparoscopic radical vaginal hysterectomy Other and unspecified, radical vaginal hysterectomy 68.8 Pelvic evisceration Page 7