CERVICAL CANCER SCREENING

Transcription

1 CERVICAL CANCER SCREENING APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE What screening should be done? NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? HEDIS (Hybrid) NCQA Accreditation NCQA Rating Member Incentive* Kyhealthnow 2019 goal** To identify members who are due for a cervical cancer screening and HPV co-testing Women years of age as of December 31st of the measurement year. Women who have had a complete, total, or radical hysterectomy (acquired absence of cervix) or a diagnosis of cervical agenesis are excluded. Also following meets exclusion criteria: Documentation of a vaginal pap smear in conjunction with documentation of hysterectomy Documentation of hysterectomy in combination with documentation that the patient no longer needs pap testing/cervical cancer screening. At least one (1) pap test every three (3) years for women age years. Women age may have cervical cytology and human papillomavirus (HPV) co-testing at least every five (5) years. Please see code table. If screening was done: Lab results for pap test and HPV test (when applicable) or Documentation in the medical record indicating when the pap and HPV screenings, when applicable, were done and the result(s) or finding(s). If screening was not done: Documentation in the medical record

2 indicating the member had a hysterectomy with no residual cervix. Documentation of complete, total, or radical abdominal or vaginal hysterectomy meets criteria. Documentation of hysterectomy in conjunction with a vaginal pap smear. Documented diagnosis of cervical agenesis. Documentation of hysterectomy in combination with documentation that the patient no longer needs pap testing/cervical cancer screening. REFERENCES Documentation of hysterectomy alone does not meet criteria because it is not sufficient evidence that the cervix was removed. For more information, please refer to Passport Health Plan s Preventive Health Clinical Practice Guideline. The criteria above are based on standards established under NCQA s HEDIS 2016 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). * For more information on member incentives, please contact Fran Crawford, Manager of Passport s Rapid Response Department at ** Governor Steve Beshear has made improving the health and wellness of Kentucky s children, families and workforce one of his highest priorities. To significantly advance the wellbeing of Kentucky s citizens, Governor Beshear announced several health goals for the Commonwealth in February He outlined a number of strategies to help achieve these goals over the next five years, and will continue to add strategies throughout his term. These strategies will be implemented through executive and legislative actions, public-private partnerships and through the success of enrolling Kentuckians in health care coverage.

3 CERVICAL CANCER SCREENING Meet Screening Criteria Code System Code Definition CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology CPT Cervical Cytology HCPCS G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision (G0123) HCPCS G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician (G0124) HCPCS G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician (G0141) HCPCS G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision (G0143) HCPCS G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision (G0144) HCPCS G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision (G0145) HCPCS G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision (G0147) HCPCS G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening (G0148) HCPCS P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision (P3000) HCPCS P3001 Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician (P3001) HCPCS Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical

4 or vaginal smear to laboratory (Q0091) LOINC Microscopic observation [Identifier] in Cervix by Cyto stain LOINC Microscopic observation [Identifier] in Cervix by Cyto stain.thin prep LOINC General categories [interpretation] of Cervical or vaginal smear or scraping by Cyto stain LOINC Statement of adequacy [interpretation] of Cervical or vaginal smear or scraping by Cyto stain LOINC Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain LOINC Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain Narrative LOINC Cytology study comment Cervical or vaginal smear or scraping Cyto stain LOINC Cytology Cervical or vaginal smear or scraping study LOINC Cytology report of Cervical or vaginal smear or scraping Cyto stain.thin prep LOINC Cytology report of Cervical or vaginal smear or scraping Cyto stain UBREV 0923 Cervical Cytology CPT HPV Test CPT HPV Test CPT HPV Test LOINC Human papilloma virus DNA [Presence] in Cervix by DNA probe LOINC Human papilloma virus DNA [Presence] in Cervix by Probe and signal amplification method LOINC Human papilloma virus DNA [Presence] in Cervix by Probe and signal amplification method LOINC Human papilloma virus DNA [Presence] in Unspecified specimen by Probe and target amplification method LOINC Human papilloma virus DNA [Presence] in Cervix by Probe and signal amplification method LOINC Human papilloma virus 16 and E6+E7 mrna [Presence] in Cervix by Probe with amplification LOINC Human papilloma virus E6+E7 mrna [Presence] in Cervix by Probe and signal amplification method Exclusions Code System Code Definition CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix

5 CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix CPT Absence of Cervix ICD10CM Q51.5 [Q51.5] Agenesis and aplasia of cervix ICD10CM Z [Z90.710] Acquired absence of both cervix and uterus ICD10CM Z [Z90.712] Acquired absence of cervix with remaining uterus ICD10PCS 0UTC0ZZ [0UTC0ZZ] Resection of Cervix, Open Approach ICD10PCS 0UTC4ZZ [0UTC4ZZ] Resection of Cervix, Percutaneous Endoscopic Approach ICD10PCS 0UTC7ZZ [0UTC7ZZ] Resection of Cervix, Via Natural or Artificial Opening ICD10PCS 0UTC8ZZ [0UTC8ZZ] Resection of Cervix, Via Natural or Artificial Opening Endoscopic ICD9CM Prolapse of vaginal vault after hysterectomy ICD9CM Cervical agenesis ICD9CM V88.01 Acquired absence of both cervix and uterus ICD9CM V88.03 Acquired absence of cervix with remaining uterus ICD9PCS Laparoscopic total abdominal hysterectomy ICD9PCS Other and unspecified total abdominal hysterectomy ICD9PCS Laparoscopically assisted vaginal hysterectomy (LAVH)

6 ICD9PCS Other and unspecified vaginal hysterectomy ICD9PCS Laparoscopic radical abdominal hysterectomy ICD9PCS Other and unspecified radical abdominal hysterectomy ICD9PCS Laparoscopic radical vaginal hysterectomy [LRVH] ICD9PCS Other and unspecified radical vaginal hysterectomy ICD9PCS 68.8 Pelvic evisceration