Colorectal Cancer Screening
Helping you improve your scores, as you improve the health of your patients.
Healthcare Effectiveness Data and Information Set (HEDIS®) scores are not only important for you as a provider; they also help guide your patients to quality care. As your trusted partner with the mutual goal of helping people lead healthier lives, Cigna is happy to provide support in every way we can. Use this quick reference guide for tips and up-to-date procedure codes that will help you maintain and even improve your HEDIS scores.
What you need to know
Colorectal cancer screening looks for patients 50-75 years of age who had appropriate screening for colorectal cancer.
Appropriate screening, for men and women aged 50-75 years, for HEDIS is defined by any one of the following criteria:
- FOBT with required number of samples for each test every year. There are two types of FOBT tests: guaiac (gFOBT) which requires 2 or more samples and immunochemical (iFOBT).
- Stool DNA Test (Cologuard) every three years.
- CT Colonography (Virtual Colonoscopy) every five years.
- Flexible sigmoidoscopy every five years.
- Colonoscopy every 10 years.
- HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.
Tips for improving your scores
- Educate your patients on the facts about colorectal cancer.
- Do yearly FOBT on patients after age 50.
- Update patient history annually regarding colorectal cancer screening (test done and date of service).
- Encourage all patients age 50 and older to complete their colorectal cancer screening.
Common billing codes accepted by HEDIS® for colorectal cancer screening
Colonoscopy
| Current Procedural Terminology (CPT®) | Healthcare Common Procedure Coding System (HCPCS) |
|---|---|
| 44388 | G0105 |
| 44389 | G0121 |
| 44390 | |
| 44391 | |
| 44392 | |
| 44393 | |
| 44394 | |
| 44397 | |
| 44401 | |
| 44402 | |
| 44403 | |
| 44404 | |
| 44405 | |
| 44406 | |
| 44407 | |
| 44408 | |
| 45355 | |
| 45378 | |
| 45379 | |
| 45380 | |
| 45381 | |
| 45382 | |
| 45383 | |
| 45384 | |
| 45385 | |
| 45386 | |
| 45387 | |
| 45388 | |
| 45389 | |
| 45390 | |
| 45391 | |
| 45392 | |
| 45393 | |
| 45398 |
Colorectal Cancer
| HCPCS | International Classification of Diseases – 10th Edition (ICD-10) | International Classification of Diseases – 9th Edition (ICD-9) |
|---|---|---|
| G0213 | C18.0 | 153 |
| G0214 | C18.1 | 153.1 |
| G0215 | C18.2 | 153.2 |
| G0231 | C18.3 | 153.3 |
| C18.4 | 153.4 | |
| C18.5 | 153.5 | |
| C18.6 | 153.6 | |
| C18.7 | 153.7 | |
| C18.8 | 153.8 | |
| C18.9 | 153.9 | |
| C19 | 154 | |
| C20 | 154.1 | |
| C21.2 | 197.5 | |
| C21.8 | V10.05 | |
| C78.5 | V10.06 | |
| Z85.038 | ||
| Z85.048 |
Flexible Sigmoidoscopy
| CPT | HCPCS |
|---|---|
| 45330 | G0104 |
| 45331 | |
| 45332 | |
| 45333 | |
| 45334 | |
| 45335 | |
| 45337 | |
| 45338 | |
| 45339 | |
| 45340 | |
| 45341 | |
| 45342 | |
| 45345 | |
| 45346 | |
| 45347 | |
| 45349 | |
| 45350 |
FOBT
| CPT | HCPCS | LOINC |
|---|---|---|
| 82270 | G0328 | 12503-9 |
| 82274 | 12504-7 | |
| 14563-1 | ||
| 14564-9 | ||
| 14565-6 | ||
| 2335-8 | ||
| 27396-1 | ||
| 27401-9 | ||
| 27925-7 | ||
| 27926-5 | ||
| 29771-3 | ||
| 56490-6 | ||
| 56491-4 | ||
| 57905-2 | ||
| 58453-2 | ||
| 80372-6 |
Total Colectomy
| CPT |
|---|
| 44150 |
| 44151 |
| 44152 |
| 44153 |
| 44155 |
| 44156 |
| 44157 |
| 44158 |
| 44210 |
| 44211 |
| 44212 |
Exclusions apply to medical record documentation or claim indicating a patient history of colorectal cancer or total colectomy.
Billing and medical record documentation should always support the level of service provided at that visit.®HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)
Reproduced with permission from HEDIS 2017, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). To purchase copies of this publication, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications.
Current Procedural Terminology (CPT) codes copyright 2016 American Medical Association. All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Uniform Bill Codes (“UB Codes”) are protected under federal copyright laws and are owned by the American Hospital Association (AHA). The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Software vendors and all others desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other use, must obtain a commercial use license directly from the AHA. To inquire about licensing, please contact ub04@healthforum.com.