Measure Description
Percentage of patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report.
Instructions
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. 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. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into the measure
Measure 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.
Denominator
All patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy
Denominator Instructions:
MIPS eligible clinicians who indicate that the colonoscopy procedure is incomplete or was discontinued should use the procedure number and the addition (as appropriate) of modifier 52, 53, 73, or 74. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into this measure.
Denominator Criteria (Eligible Cases):
Patients aged 50 to 75 on date of encounter
AND
Patient undergoing screening for malignant neoplasm of colon (ICD-10-CM): Z12.11
AND
Patient procedure during the performance period (CPT or HCPCS): 44388, 45378, G0121
WITHOUT
Modifiers: 52, 53, 73, or 74
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
Numerator
Patients who had recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report
Numerator Options
Performance Met: Recommended follow-up interval for repeat colonoscopy of at least 10 years documentedin colonoscopy report (0528F)
OR
Denominator Exception: Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is ≥ 66 years old, or life expectancy < 10 years, other medical reasons) (0528F with 1P)
OR
Performance Not Met: At least 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified (0528F with 8P)
Rationale
In the average-risk population, colorectal cancer screening using colonoscopy is recommended in all current guidelines at 10-year intervals. Inappropriate interval recommendations can result in overuse of resources and can lead to significant patient harm. Performing colonoscopy too often not only increases patients’ exposure to procedural harm, but also drains resources that could be more effectively used to adequately screen those in need (Lieberman et al, 2008). The most common serious complication of colonoscopy is post-polypectomy bleeding (Levin et al, 2008).
Variations in the recommended time interval between colonoscopies exist for patients with normal colonoscopy findings. In a 2006 study of 1282 colonoscopy reports, recommendations were consistent with contemporaneous guidelines in only 39.2% of cases and with current guidelines in 36.7% of cases. Further, the adjusted mean number of years in which repeat colonoscopy was recommended was 7.8 years following normal colonoscopy (Krist et al, 2007)
Clinical Recommendation Statements
At present, CSPY (colonoscopy) every 10 years is an acceptable option for CRC screening in average-risk adults beginning at age 50 years. (USPSTF 2016; USMSTF 2017). The USPSTF recommends screening for colorectal cancer using stool-based tests (fecal occult blood test, fecal immunochemical test [FIT], FIT-DNA), sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until the age of 75 years. The risks and benefits of these screening methods vary (Grade A Recommendation) (USPTF, 2016).
The decision to screen for colorectal cancer in adults 76 to 85 years of age should be an individual one, taking into account the patient’s overall health and prior screening history (Grade C recommendation) (USPSTF, 2016). The preferred tests are colonoscopy every 10 years or annual fecal immunochemical test (FIT), beginning at age 50 (USMSTF/Rex et al AJG 2017).