NQF 0032: Cervical Cancer Screening

Measure: Record percentage of women 21-64 years of age, who received one or more Pap tests to screen for Cervical Cancer.
Numerator: Patients who meet the denominator criteria with one or more Pap tests during the measurement period or the two years prior to the measurement period.
Denominator: Women 23-64 years of age with a visit during the measurement period and do not meet one or more of the exclusions.
Exclusion: Women who had a hysterectomy with no residual cervix.
NQS Domain: Clinical Process / Effectiveness

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the female patient (age 23 to 64) at least one time during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*:

• Office Visit Encounter or Face-to-Face Interaction Code during the measurement period
Office Visit Encounter Codes:
CPT  
Code Description
99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342 Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99385 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
99386 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
99387 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
99397 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
Face-to-Face Interaction Codes:
SNOMED:  
Code Description
4525004 Emergency department patient visit (procedure)
12843005 Subsequent hospital visit by physician (procedure)
18170008 Subsequent nursing facility visit (procedure)
19681004 Nursing evaluation of patient and report (procedure)
87790002 Follow-up inpatient consultation visit (procedure)
90526000 Initial evaluation and management of healthy individual (procedure)
185349003 Encounter for "check-up" (procedure)
185463005 Visit out of hours (procedure)
185465003 Weekend visit (procedure)
207195004 History and physical examination with evaluation and management of nursing facility patient (procedure)
270427003 Patient-initiated encounter (procedure)
270430005 Provider-initiated encounter (procedure)
308335008 Patient encounter procedure (procedure)
390906007 Follow-up encounter (procedure)
406547006 Urgent follow-up (procedure)
439708006 Home visit (procedure)

 

Required Data Elements for the Numerator*:

• Pap Test (LOINC) within 2 year prior to or during the measurement period
LOINC: 
CodeDescription
10524-7Microscopic observation [Identifier] in Cervix by Cyto stain
18500-9Microscopic observation [Identifier] in Cervix by Cyto stain.thin prep
19762-4General categories [interpretation] of Cervical or vaginal smear or scraping by Cyto stain
19764-0Statement of adequacy [interpretation] of Cervical or vaginal smear or scraping by Cyto stain
19765-7Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain
19766-5Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain Narrative
19774-9Cytology study comment Cervical or vaginal smear or scraping Cyto stain
33717-0Cytology Cervical or vaginal smear or scraping study
47527-7Cytology report of Cervical or vaginal smear or scraping Cyto stain.thin prep
47528-5Cytology report of Cervical or vaginal smear or scraping Cyto stain

EXCLUSION DETAILS:

Exclusion includes women who had a hysterectomy with no residual cervix.  In order to meet the requirements for this exclusion, the appropriate information must be documented in the chart:

• Hysterectomy with no Residual Cervix Procedure or SNOMED (attached to Patient Surgical History) with a date prior to or during the measurement period

 

CPT:  
Code Description
51925 Closure of vesicouterine fistula; with hysterectomy
56308 Laparoscopy, surgical; with vaginal hysterectomy with or without removal of tube(s), with or without removal of ovary(s) (laparoscopic assisted vaginal hysterectomy)
57540 Excision of cervical stump, abdominal approach;
57545 Excision of cervical stump, abdominal approach; with pelvic floor repair
57550 Excision of cervical stump, vaginal approach;
57555 Excision of cervical stump, vaginal approach; with anterior and/or posterior repair
57556 Excision of cervical stump, vaginal approach; with repair of enterocele
58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);
58152 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)
58200 Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)
58210 Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)
58240 Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof
58260 Vaginal hysterectomy, for uterus 250 g or less;
58262 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)
58263 Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele
58267 Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele
58275 Vaginal hysterectomy, with total or partial vaginectomy;
58280 Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele
58285 Vaginal hysterectomy, radical (Schauta type operation)
58290 Vaginal hysterectomy, for uterus greater than 250 g;
58291 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58292 Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele
58293 Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
58294 Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele
58548 Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed
58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less;
58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g;
58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g;
58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58951 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy
58953 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking;
58954 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy
58956 Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy
59135 Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy
SNOMED:  
Code Description
24293001 Excision of cervical stump by abdominal approach (procedure)
27185000 Vaginal hysterectomy with partial colpectomy and repair of enterocele (procedure)
27950001 Total hysterectomy with unilateral removal of ovary (procedure)
30160001 Vaginal hysterectomy with total colpectomy and repair of enterocele (procedure)
31545000 Total hysterectomy with unilateral removal of tube (procedure)
35955002 Radical vaginal hysterectomy (procedure)
41566006 Excision of cervical stump by vaginal approach (procedure)
43791001 Vaginal hysterectomy with total colpectomy (procedure)
54490004 Vaginal hysterectomy with repair of enterocele (procedure)
59750000 Total hysterectomy with unilateral removal of tube and ovary (procedure)
63516002 Vaginal hysterectomy with colpo-urethrocystopexy, Pereyra type (procedure)
75835007 Laparoscopic-assisted vaginal hysterectomy (procedure)
77902002 Vaginal hysterectomy with partial colpectomy (procedure)
86477000 Total hysterectomy with removal of both tubes and ovaries (procedure)
88144003 Removal of ectopic interstitial uterine pregnancy requiring total hysterectomy (procedure)
112918004 Vaginal hysterectomy with colpo-urethrocystopexy, Marshall-Marchetti-Krantz type (procedure)
116140006 Total hysterectomy (procedure)
116142003 Radical hysterectomy (procedure)
116143008 Total abdominal hysterectomy (procedure)
116144002 Total abdominal hysterectomy with bilateral salpingo-oophorectomy (procedure)
236888001 Total laparoscopic hysterectomy (procedure)
236891001 Radical laparoscopic hysterectomy (procedure)
265056007 Vaginal hysterectomy (procedure)
287924009 Excision of cervix stump (procedure)
307771009 Radical abdominal hysterectomy (procedure)
309880009 Vaginal hysterocolpectomy (procedure)
359971002 Ward-Mayo operation for vaginal hysterectomy (procedure)
359974005 Tuffier operation for vaginal hysterectomy (procedure)
359977003 Mayo operation for vaginal hysterectomy (procedure)
359983000 Heaney operation for vaginal hysterectomy (procedure)
361222003 Wertheim-Meigs abdominal hysterectomy (procedure)
361223008 Wertheim operation (procedure)
413145007 Vaginal hysterectomy with conservation of ovaries (procedure)
414575003 Laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy (procedure)
441820006 Laparoscopy assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (procedure)
446446002 Total abdominal hysterectomy and removal of vaginal cuff (procedure)
446679008 Total laparoscopic excision of uterus by abdominal approach (procedure)
447771005 Abdominal hysterectomy and excision of periuterine tissue (procedure)
448539002 Vaginal hysterectomy and excision of periuterine tissue (procedure)

SurgicalHx_SNOMED_Hysterectomy

*ADDITIONAL INFORMATION:

•  The female patient must be at least 23 years and younger than 64 years of age prior to the start of the measurement period.

•  It is recommend to include the code used to document the Pap Test in a health maintenance/preventive care procedure checklist.

Example of a Health Maintenance Procedure Checklist

health maintenance

•   The LOINC code for the Pap Test preformed must be linked to a result and must contain the date that the Pap Test was done in the procedure order date.  If a result does not exist, a fake procedure code can be added via Practice Manager and then marked as a result and linked the the appropriate LOINC Code in Clinical.

•   The LOINC code should NOT be linked to the code used to order the Pap Test. 

Example of the LOINC setup for Pap Test

 

  • Edit > System Tables > Conditions > Procedures

 

pap loinc

•  If using the SNOMED code for to indicate hysterectomy, it must be linked to an applicable entry in the patient's surgical history.  This is done via the surgical history button in a note.

•  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes

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