CMS 130v9: Colorectal Cancer Screening

Measure: Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Measure TypeHigh Priority MeasureScoring
ProcessNoA higher percentage indicates better quality
DenominatorPatients 50-75 years of age with a visit during the measurement period
Numerator

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

  • Fecal occult blood test (FOBT) during the measurement period
  • Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period
  • Colonoscopy during the measurement period or the nine years prior to the measurement period
  • FIT-DNA during the measurement period or the two years prior to the measurement period
  • CT Colonography during the measurement period or the four years prior to the measurement period
Denominator ExceptionsNone
Denominator Exclusions
  • Patients with a diagnosis or past history of total colectomy or colorectal cancer
  • Patients whose hospice care overlaps the measurement period
  • Patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period
  • Patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured
Setup Note

A lab interface can be used to meet this eCQM but is not required. 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.

Denominator

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

  • Age is ≥ 50 years and < 75 years at the beginning of the Measurement Period

    AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC/EP
Encounter Codes Eligible for Denominator

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

HCPCS: G0438, G0439

Denominator Exclusions

A patient will be excluded from the measure if they meet any of the following conditions:

  • Has an active diagnosis of colorectal cancer during the Measurement Period
  • Had a total colectomy
  • Is in hospice care during the Measurement Period
  • Age is ≥ 65 at the start of the Measurement Period and has spent more than 90 consecutive days during the Measurement Period living in long term care
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of advanced illness
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of frailty
Diagnosis

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for malignant neoplasm of the colon can be located here.

Total Colectomy Performed

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

CPT: 44150, 44151, 44155, 44156, 44157, 44158, 44210, 44211, 44212

Order Status must be marked as Complete.

Hospice Care Services

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 Pending or Complete.

Note

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

Long Term Care

To document a stay in long term care:

  1. Go to Chart > Admissions and click Add
  2. Select a Place of Service
  3. Optional: select a Facility
  4. Populate the Admit Date
  5. Optional: populate the Discharge Date
  6. Click OK
Note

If the admissions event does not have a Discharge Date when the eCQM report is generated, the length of stay will be calculated with a discharge date of the Reporting Period end date or the Measurement Period end date, whichever occurs first.

Advanced Illness

A patient has evidence of advanced illness if they meet any of the following criteria:

  • Had an inpatient encounter with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
  • Had 2 or more outpatient encounters with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
    • Diagnosis must be active during all eligible encounters
  • Was prescribed medication for dementia during the Measurement Period or in the year prior
Advanced Illness Diagnosis

“Advanced illness” refers to a wide range of conditions and includes diseases such as Alzheimer’s disease, cancer, and heart failure.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for advanced illness can be located here.

Inpatient Encounter Codes Eligible for Denominator Exclusion

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291

Outpatient Encounter Codes Eligible for Denominator Exclusion

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439, G0463, T1015

Medication

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible dementia medications can be located here.

Frailty

A patient has evidence of frailty if they meet any of the following criteria:

  • Has an active diagnosis of Frailty during the Measurement Period
  • Has an active diagnosis of Frailty Symptom during the Measurement Period
  • Is using a frailty device during the Measurement Period
  • Has a frailty encounter during the Measurement Period
Frailty Diagnosis

“Frailty” refers to a range of conditions that includes falls and problems affecting mobility.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for frailty can be located here.

Frailty Symptom Diagnosis

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for frailty symptoms are:

ICD-10: R26.0, R26.1, R26.2, R26.89, R26.9, R41.81, R53.1, R53.81, R53.83, R54, R62.7, R63.4, R63.6, R64

Frailty Device Use

The use of a frailty device can be documented in the patient’s Medical or Social History.

Frailty Device Use in Medical History

To document the patient’s use of oxygen:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Oxygen use node

    1. Optional: select continuously or when ambulating

To document the patient’s use of a respiratory assistive device:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Respiratory assistive device node

    1. Optional: select BIPAP, CPAP, Home ventilator, or Ventilator

Frailty Device Use in Social History

To document a patient’s bedridden status:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Mobilizing/Moving subnode

  4. Select Bedridden

  5. Click OK to save

To document a patient’s use of mobility aids:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Use of Mobility Aids subnode

  4. Select Dependent on cane, Dependent on walker, or Dependent on wheelchair

  5. Click OK to save

Frailty Encounter Codes Eligible for Denominator Exclusion

CPT: 99504, 99509

HCPCS: G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031

Numerator

A patient will be counted in the numerator if they received at least one of the following colon cancer screenings:

  • FOBT during the Measurement Period
  • Flexible sigmoidoscopy during the Measurement Period or in the 4 years prior
  • Colonoscopy during the Measurement Period or in the 9 years prior
  • FIT-DNA test during the Measurement Period or in the 2 years prior
  • CT Colonography during the Measurement Period or in the 4 years prior
Colonoscopy or Flexible Sigmoidoscopy Performed

To document a colonoscopy or flexible sigmoidoscopy procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete.

Colonoscopy

CPT: 44388, 44389, 44390, 44391, 44392, 44394, 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45378, 45379, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45389, 45390, 45391, 45392, 45393, 45398

HCPCS: G0105, G0121

Flexible Sigmoidoscopy

CPT: 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345, 45346, 45347, 45349, 45350

HCPCS: G0104

CT Colonography, FOBT, or FIT-DNA Test Results

To document that a CT Colonography, FOBT, or FIT-DNA test was performed, an e-Lab result for the test must be stored to the patient chart.

Store e-Lab Result
  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.

eCQI Reference

https://ecqi.healthit.gov/ecqm/ep/2021/cms130v9

Return to 2021 eCQMs