CMS 124v6: Cervical Cancer Screening

Measure: Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women age 21-64 who had cervical cytology performed every 3 years
  • Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator Women 23-64 years of age with a visit during the measurement period
Numerator

Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria:

  • Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test
  • Cervical cytology/human papillomavirus (HPV) co-testing performed during the measurement period or the four years prior to the measurement period for women who are at least 30 years old at the time of the test
Denominator Exceptions None
Denominator Exclusions

Women who:

  • Had a hysterectomy with no residual cervix
  • Were in hospice care during the measurement year

This eCQM requires a lab interface to be met. Customers interested in a lab interface should contact Sevocity Support to begin the process of a new interface setup. Interface setup requirements and fees vary per request.

Patients who meet the following criteria will be included in the denominator:

  • Have a birth sex of female

    AND

  • Age must be ≥ 23 years and < 64 years at the beginning of the Measurement Period

    AND

  • Must have at least one encounter during the Measurement Period finalized by the EC/EP

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99221, 99222, 99223, 99231, 99232, 99233, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99305, 99306, 99307, 99308, 99309, 99310, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99024, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439

A patient will be excluded from the measure if they had a hysterectomy performed any time before the end of the Measurement Period.

To document the performance of a hysterectomy, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 51925, 57540, 57545, 57550, 57555, 57556, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58548, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58951, 58953, 58954, 58956, 59135

Order Status must be marked as Complete in order to count as an exclusion.

Patients who were in hospice care during the measurement year will be excluded from the measure.

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted in the numerator if they received at least one screening for cervical cancer. Appropriate screenings and time frames for cervical cancer are defined as follows:

  • At least one Pap test performed during the Measurement Period or in the 2 years prior

    OR

  • For patients aged ≥30 years, one Pap test and one HPV test performed during the Measurement Period or in the 4 years prior
    • The patient must be 30 years or older at the time of the tests
    • The Pap test and HPV test must be performed on the same day or within 1 day of each other in order to count toward the numerator

To document that a Pap test or Pap test and HPV test were performed, an e-Lab result for the test(s) must be stored to the patient chart.

  1. From the Clinic Inbox, select the lab result to be stored and click View
  2. Click Select to search for and select a patient
  3. Verify patient displayed matches the lab result and select the I have verified the following lab results belong to the above patient checkbox
  4. Click Sign/Route
  5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.

https://ecqi.healthit.gov/ecqm/ep/2018/cms124v6

 

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