The American Cancer Society estimates there will be approximately 1,898,160 cancer cases diagnosed in 2021. That’s the equivalent of 5,200 new cases every day.1 The good news is, patients say they are more likely to get screened when you recommend it. What else can you do to influence cancer screenings?2

  1. Understand the power of the physician recommendation:
    • Your recommendation is the most influential factor in whether a person decides to get screened.
    • Patients are 90% more likely to get a screening when they reported a physician recommendation.
    • “My doctor did not recommend it,” is the primary reason for screening avoidance.
  2. Measure the screening rates in your practice; it may not be as high as you think:
    • Set goals to get screening rates up.
    • Follow the HEDIS® guidelines included in this article to help accurately track your care gap closures.
  3. More screening doesn’t have to mean more work for you:
    • Reach out to us about available member data — We may be able to help identify those members who are due for screenings.
    • Develop a reminder system, which has been demonstrated to be effective, to remind you and staff that patients have screenings due.
  4. Help members access benefit information about screenings to eliminate the cost barrier:
    • Log on to Availity.com* and use the Patient Registration tab to run an Eligibility and Benefits Inquiry.
    • Members can access their benefit information by logging on to anthem.com/california-medicaid and selecting the Benefits tab.


Members earn rewards for screenings through the Healthy Rewards Program

Through Healthy Rewards, members may be eligible to receive incentives for completing certain screenings. They can redeem their reward dollars for retail gift cards — just another way we can work together for better health outcomes.


Measure up: Cancer screening for women HEDIS measure specifications

Organized and continuous screenings along with removal of precancerous lesions can lead to a 60% decrease in cervical cancer.3

Cervical Cancer Screening (CCS) is measured by the percentage of women 21 to 64 years of age who were screened for cervical cancer using one of the following criteria:

  • Women 21 to 64 years of age who had cervical cytology performed within the last three years
  • Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years
  • Women 30 to 64 years of age who had cervical cytology/hrHPV co-testing within the last five years

Description and code

Cervical cytology lab test

CPT®: 88141-88143, 88147, 88148, 88150, 88152-88153, 88164-88167, 88174, 88175

HCPCS: G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091

LOINC: 10524-7, 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0, 47527-7, 47528-5

hrHPV lab test

CPT: 87620-87622, 87624-87625

HCPCS: G0476

LOINC: 21440-3, 30167-1, 38372-9, 59263-4, 59264-2, 59420-0, 69002-4, 71431-1, 75694-0, 77379-6, 77399-4, 77400-0, 82354-2, 82456-5, 82675-0

Absence of cervix diagnosis

ICD-10-CM: Q51.5, Z90.710, Z90.712

Hysterectomy with no residual cervix

CPT: 51925, 56308, 57530, 57531, 57540, 57545, 57550, 57555, 57556, 58150, 58152, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58548, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58575, 58951, 58953, 58954, 58956, 59135

ICD-10-PCS: 0UTC0ZZ, 0UTC4ZZ, 0UTC7ZZ, 0UTC8ZZ

  

More women in the United States are surviving and thriving after breast cancer than ever before. In fact, in the last 30 years, the breast cancer death rate has dropped an astounding 40%. The decreases are believed to be the result of finding breast cancer earlier through screening, increased awareness, and better treatments.4

Breast Cancer Screening (BCS): The percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer. Compliant members have one or more mammograms any time on or between October 1, two years prior to the measurement year and December 31 of the measurement year.

 

Description

CPT/HCPCS

Mammography

CPT: 77061-77063, 77065-77067

LOINC: 24604-1, 24605-8, 24606-6, 24610-8, 26175-0, 26176-8, 26177-6, 26287-3, 26289-9, 26291-5, 26346-7, 26347-5, 26348-3, 26349-1, 26350-9, 26351-7, 36319-2, 36625-2, 36626-0, 36627-8, 36642-7, 36962-9, 37005-6, 37006-4, 37016-3, 37017-1, 37028-8, 37029-6, 37030-4, 37037-9, 37038-7, 37052-8, 37053-6, 37539-4, 37542-8, 37543-6, 37551-9, 37552-7, 37553-5, 37554-3, 37768-9, 37769-7, 37770-5, 37771-3, 37772-1, 37773-9, 37774-7, 37775-4, 38070-9, 38071-7, 38072-5, 38090-7, 38091-5, 38807-4, 38820-7, 38854-6, 38855-3, 42415-0, 42416-8, 46335-6, 46336-4, 46337-2, 46338-0, 46339-8, 46350-5, 46351-3, 46356-2, 46380-2, 48475-8, 48492-3, 69150-1, 69251-7, 69259-0

 

Sexual health is an essential element of overall health and well-being. Many patients want to discuss their sexual health with you, but most of them want you to bring it up. The National Coalition for Sexual Health has published a guide to help physicians feel comfortable about the conversation. Get a copy of the Sexual Health and Your Patients: A Provider’s Guide by clicking on the title or through this website: http://www.ctcfp.org.

Chlamydia Screening in Women (CHL) is measured by the percentage of women 16 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.

 

Description

CPT

Chlamydia tests

CPT: 87110, 87270, 87320, 87490, 87491, 87492, 87810

LOINC: 14463-4, 14464-2, 14467-5, 14474-1, 14513-6, 16600-9, 21190-4, 21191-2, 21613-5, 23838-6, 31775-0, 31777-6, 36902-5, 36903-3, 42931-6, 43304-5, 43404-3, 43405-0, 43406-8, 44806-8, 44807-6, 45068-4, 45069-2, 45075-9, 45076-7, 45084-1, 45091-6, 45095-7, 45098-1, 45100-5, 47211-8, 47212-6, 49096-1, 4993-2, 50387-0, 53925-4, 53926-2, 557-9, 560-3, 6349-5, 6354-5, 6355-2, 6356-0, 6357-8, 80360-1, 80361-9, 80362-7, 91860-7

  

  1. A Cancer Journal for Clinicians Cancer Statistics, 2021 https://acsjournals.onlinelibrary.wiley.com/doi/full/10.322/caac.21654
  2. http://thecanceryoucanprevent.org/wp-content/uploads/14893-80_2018-PROVIDER-PHYS-4-PAGER-11-10.pdf
  3. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/9253676/
  4. Research to Help Women Prevent Breast Cancer or Live their best life with it. American Cancer Society. https://www.cancer.org/latest-news/research-to-help-women-prevent-breast-cancer-or-live-their-best-life-with-it.html


ACAPEC-3051-21

 

 

 

 



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November 2021 Anthem Blue Cross Provider News - California