Measure Description
The percentage of screening colonoscopies performed in patients greater than or equal to 86 years of age from January 1 to December 31.
Instructions
This measure is to be submitted each time a colonoscopy is performed for all patients during the performance period. There is no diagnosis associated with this measure. 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 the services provided and the measure-specific denominator coding.
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 screening colonoscopy examinations performed on patients greater than or equal to 45 years of age during the encounter period
Denominator Criteria (Eligible Cases):
All patients greater than or equal to 45 years of age on date of encounter receiving a colonoscopy for screening purposes only
AND
Patient encounter during the performance period (CPT or HCPCS): 45378, 45380, 45381, 45384, 45385, G0121
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
Numerator
Screening colonoscopies performed in patients greater than or equal to 86 years of age
Numerator Instructions:
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
Numerator Options:
Performance Met: Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s Disease (i.e., regional enteritis), familial adenomatous polyposis, Lynch Syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits (G9659)
OR
Performance Not Met: Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s Disease (i.e., regional enteritis), familial history of adenomatous polyposis, Lynch Syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits) (G9660)
OR
Performance Not Met: Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of GI tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions (G9661)
OR
Performance Not Met: Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period. (G2204)
Rationale
The benefit of colorectal cancer screening for an individual patient is dependent on that patient’s life expectancy and probability of harm from colonoscopy. Individuals aged 86 and older have an average life expectancy of less than 5 years [Cho Ann Intern Med. 2013; 59:667-676] and are at increased risk for colonoscopy-related complications [Ann Intern Med. 2009; 150:849-857].
The population of individuals aged 86 years and older is projected to double by 2050, hence, the clinical and economic effects of inappropriate performance of colorectal cancer screening in this age group can be expected to increase in the coming decade (Goodwin, 2011).
Clinical Recommendation Statements
The USPSTF (2021) recommends the following screening strategies for individuals 45-75 years of age who are average risk for colorectal cancer (Grade B recommendation for ages 45-49; Grade A recommendation for ages 50-75):
- Annual high-sensitivity fecal occult blood test (FOBT).
- Annual fecal immunochemical test (FIT).
- Multitarget stool DNA test every 1 or 3 years (interval based on manufacturer).
- Sigmoidoscopy every 5 years.
- Sigmoidoscopy every 10 years with annual FIT.
- Optical colonoscopy every 10 years.
- CT colonography every 5 years.
For individuals from 76–85 years of age, the Task Force recommends that the decision to screen should be personalized--based on overall health status, prior screening history, and preferences (USPSTF, 2021). For individuals aged 86 years and older, the Task Force does not recommend screening when comparing overall benefits to harms (USPSTF, 2021). The Task Force based these recommendations on a systematic review of the literature, supplemented with modeling data (USPSTF, 2021; NCI 2013; USCR, 2011).
For this subgroup, the Task Force concluded that the utility of screening is limited, given the time it takes for a polyp to develop into a clinically observable malignancy (10–26 years) (USPSTF, 2021; NCI 2013; USCR, 2011).
Moreover, individuals aged 86 and older are likely to have multiple comorbidities that influence any potential life-year gain (USPSTF, 2021; ACS 2018; NCI 2013; USCR, 2011). They are also at increased risk of suffering from adverse events related to performance of a colonoscopy; with the rate of adverse events being 2.8 per 1,000 procedures and increased by seven-fold if a polypectomy is performed (USPSTF, 2016; CDC 2012; NCI, 2013).