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 each and 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. Recognize cultural barriers that may impact your diverse patients
    • Culturally sensitive conversations with your patients can help with fear, embarrassment, anxiety, and misconceptions about screenings.
    • Go to mydiversepatients.com for information and resources.
  3. 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.
  4. 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 or supply access to data for those members who are due screenings.
    • Develop a reminder system, which has been demonstrated to be effective, to remind you and staff that patients have screenings due.
  5. Help members access benefit information about screenings to eliminate the cost barrier.
    • Log onto Availity.com and use the Patient Information tab to run an Eligibility and Benefits inquiry.
    • Members can access their benefit information by logging onto anthem.com, through Live Chat, or by downloading the Sydney Health App.
    • Blue Cross Blue Shield Service Benefit Plan members, also known as Federal Employee Program® members, can access their benefit information by logging onto www.fepblue.org, or by downloading the fepblue App from the Apple Store or on Google Play.

 

Measure up: HEDIS® measure specifications for cancer screenings for women

 

Cervical cancer screening

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

 

Cervical cancer screening is measured by the percentage of women, 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women 21 to 64 years of age who had cervical cytology performed within the last 3 years.
  • Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
  • Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.

 

Description

CPT/HCPCS 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, 58290–58294, 58548, 58550, 58552, 58553, 58554, 58570–58573, 58575, 58951, 58953, 58954, 58956, 59135

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

 

Breast cancer screening

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 is measured by 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 Code

Mammography

CPT: 77057, 77061–76063, 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

Online assessments

CPT: 98970–98972, 99421–99423, 99457

HCPCS: G0071, G2010, G2012, G2061–G2063

Telephone visits

CPT: 98966–98968, 99441–99443

 

Chlamydia screening in women

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 Providers Guide by clicking on the title or through this website: ctcfp.org.

 

Chlamydia screening in women 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/HCPCS Code

Chlamydia tests

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

 

1 CA: A Cancer Journal for Clinicians. Cancer Statistics, 2021 https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/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

 

1352-1021-PN-NE



Featured In:
October 2021 Anthem Connecticut Provider News