CMS Measure ID 113: Colorectal Cancer Screening

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Description

Percentage of patients 45-75 years of age who had appropriate screening for colorectal cancer.

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. Performance for this measure is not limited to the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measurement Submission Type

Measure data may be submitted by individual MIPS-eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

The intent of the exclusion for individuals age 66 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusion allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy.

Denominator

Patients 45 to 75 years of age on the date of the encounter.

Date of Birth information can be entered in DrChrono in the patient chart under the Demographics tab with the Patient Date of Birth. 

AND

• A relevant CPT or HCPCS code for the encounter: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99386*, 99387*, 99396*, 99397*, G0402, G0438, G0439

Codes for the encounter can be entered in any of the billing areas in DrChrono. 

DENOMINATOR NOTE:

To assess the age for exclusions, the patient’s age at the end of the measurement period should be used.

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with a diagnosis or past history of total colectomy or colorectal cancer: G9711

OR

Patient was provided hospice services any time during the measurement period: G9710

OR

Patient was provided palliative care services any time during the measurement period: G9993

OR

Patient age 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 for more than 90 days during the measurement period: G9901

OR

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period: G2100

OR

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period: G2101

Please see your Healthmonix MIPSpro account, the attached document, the CMS website, or the attached document for a full list of codes that identify frailty and/or advanced illness. 

Table: Dementia Exclusion Medications

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
• Computed tomography (CT) colonography during the measurement period or the four years prior to the measurement period.
• Fecal immunochemical DNA test (FIT-DNA) during the measurement period or the two years prior to the measurement period.

NUMERATOR GUIDANCE
Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.

NUMERATOR NOTE: Patient-reported procedures and diagnostic studies, when recorded in the medical record, are acceptable for meeting the numerator.

Performance Met:

Colorectal cancer screening results documented and Reviewed (3017F)

 OR

Performance Not Met:

Colorectal cancer screening results were not documented and reviewed, reason not otherwise specified (3017F with 8P)