COL: Colorectal Cancer Screening

Members with one or more screenings for colorectal cancer. Any of the following meet criteria:

• Fecal occult blood test (FOBT Lab Test Value Set; FOBT Test Result or Finding Value Set) during the measurement period.
  For administrative data, assume the required number of samples were returned, regardless of FOBT type.
• Stool DNA (sDNA) with FIT test (sDNA FIT Lab Test Value Set; SNOMEDCT code 708699002) during the measurement period or the 2 years prior to the measurement period.
• Flexible sigmoidoscopy (Flexible Sigmoidoscopy Value Set; SNOMEDCT code 841000119107) during the measurement period or the 4 years prior to the measurement period.
• CT colonography (CT Colonography Value Set) during the measurement period or the 4 years prior to the measurement period.
• Colonoscopy (Colonoscopy Value Set; SNOMEDCT code 851000119109) during the measurement period or the 9 years prior to the measurement period.

The following notations are examples of acceptable documentation:

• Colonoscopies and flexible sigmoidoscopies found in "Surgical History" are acceptable as this is considered part of the "medical history."
• A pathology report that indicates the type of screening (e.g., colonoscopy, flexible sigmoidoscopy) and the date it was performed meets criteria.
• For pathology reports that do not indicate the type of screening and for incomplete procedures, use the following to determine compliancy:
• Evidence the scope advanced to the cecum meets the criteria for a completed colonoscopy
• Evidence the scope advanced to the terminal ileum meets the criteria for a completed colonoscopy (Terminal Ileum is synonymous with cecum per Attest).
• Evidence the scope advanced into the sigmoid colon meets criteria for a completed flexible sigmoidoscopy.
• Screening documentation which is clearly part of the member’s medical history. It is assumed the result is negative unless otherwise noted.
• Synchronous telehealth documentation is acceptable for abstracting member reported results, or for use in identifying exclusion criteria.
• There are two types of FOBT tests: guaiac (gFOBT) and immunochemical (FIT). Depending on the type of FOBT test, a specified number of samples are required for numerator compliance. Follow the instructions below to determine member compliance.
• If the medical record does not indicate the type of test and there is no indication of how many samples were returned, assume the required number were returned.
• If the medical record does not indicate the type of test and the number of returned samples is specified, the member meets the screening criteria only if the number of samples specified is greater than or equal to three samples.
• FIT tests may require fewer than three samples. If the medical record indicates that an FIT was done, the member meets the screening criteria, regardless of how many samples were returned.
• If the medical record indicates that a gFOBT was done, follow the scenarios below.
• If the medical record does not indicate the number of returned samples, assume the required number was returned.
• If the medical record indicates that three or more samples were returned, the member meets the screening criteria for inclusion in the numerator.
• If the medical record indicates that fewer than three samples were returned, the member does not meet the screening criteria
• Documentation of "around, about, or approximately" is acceptable for a completed screening provided the year subtracted from the DOS does not create a date outside of the limit for the appropriate timeframe.
• Documentation of "less than" or using the symbol (<) is an acceptable date format given the calculated date falls within the allowable timeframe. (ex. "Last colonoscopy done <4 years ago WNL")
• If there is documentation of more than one colorectal cancer screening performed in the allowable timeframe, it is best practice to look for the screening with the furthest lookback period, but a more recent one is also acceptable.

The following notations are examples of documentation that is not acceptable:

• Cscope, Cscopy, Colon, Colo, and Scope documented alone are NOT acceptable abbreviations for a Colonoscopy to meet guidelines.
• Digital rectal exams (DRE) or FOBT tests performed in an office setting or performed on a sample collected via a DRE are NOT compliant for this measure.
• Documentation of "up to date" is not acceptable as this is not specific enough to meet definitive date criteria.
• A Rigid Sigmoidoscopy in NOT acceptable to use as a Flexible Sigmoidoscopy because it does not access enough of the colon to meet the screening criteria.
• Home FOBT test kits that have a color change are subjective and are NOT acceptable for COL.
• Dates documented as 6/18 or 10/22 are NOT acceptable as a determination cannot be made whether the second number represents the day of the month or the year the procedure was completed.
• Documentations without clear indication it is part of medical history. If there is no clear indication of this the date and result or findings MUST be present and there must be documentation that the screening was completed, not just ordered.