Office Visit

In recognition of Colorectal Cancer Awareness Month, we hope you will take this opportunity to talk to your patients about the importance of colorectal cancer screening, prevention, and treatment. Screening should begin at age 45 for those with average risk. 

HEDIS Measure Tips for Colorectal Cancer Screening

This HEDIS measure focuses on members 45 to 75 years old who have had appropriate screenings for colorectal cancer. 

Types of screening

• Colonoscopy completed 2016 – 2025.
• Flexible sigmoidoscopy during 2021 – 2025.
• Fecal occult blood test (FOBT) done annually (2025) such as:
  • Fecal immunochemical test (FIT).
  • Guaiac FOBT (gFOBT).
• CT colonography (virtual colonoscopy) during 2021 – 2025.
• Stool DNA (sDNA) + FIT, also known as Cologuard, done 2023 – 2025.

For patients refusing colonoscopy, discuss options of noninvasive screenings such as Cologuard or FIT.

Acceptable documentation

• Medical record documentation must include the type of screening, date it was performed, and the result or finding.
• Member-reported colorectal screenings are acceptable if the screening is documented in the patient’s history (member reports colonoscopy in 2016).
• Pathology or procedure reports that include the type of screening and the date the screening was performed are acceptable.
• Pathology reports that do not indicate type of screening (or if aborted) are acceptable if there is evidence the scope advanced:
  • To the cecum = completed colonoscopy.
  • Beyond the splenic fissure = complete colonoscopy.
  • Into the sigmoid colon = completed flexible sigmoidoscopy.

Unacceptable documentation

• Simply documenting “colorectal screening done,” “colo done,” or “UTD” does not meet criteria.
• A sample taken from a digital rectal exam (DRE) or FOBT performed in the office setting does not count as evidence of colorectal screening.

The following resources can help you educate your patients: 

• Colorectal Cancer Screening: Patient Version (National Institute of Health). 
• Colorectal Cancer Screenings Tests (CDC).

National Kidney Month is the perfect opportunity to teach patients about the importance of screening to help prevent kidney disease. It’s especially important for patients with chronic conditions such as diabetes and high blood pressure who are at high risk for developing kidney disease. One way to help measure your patient's risk is with a urine albumin-creatinine ratio (uACR) test.

Why this matters

The uACR test detects microalbuminuria, an early sign of kidney damage in patients with diabetes. In contrast, urine protein-creatinine ratio (uPCR) measures total protein, which may show more advanced kidney disease but does not fulfill the NCQA’s criteria for early detection. 

Additional ways to help your patients: 

• Teach patients about the importance of diet, exercise, nutrition, weight control, and sleep. 
• Create a treatment plan for at-risk patients that fits their lifestyle and dietary needs. 
• Order a kidney health evaluation annually for all patients with Type 1 or Type 2 diabetes.  

 This evaluation should include: 

• Estimated glomerular filtration rate (eGFR). 
• Urine albumin-creatinine ratio (uACR). 

Here are some resources you can share with your patients: 

• National Kidney Month infographic (National Kidney Foundation). 
• Kidney Professionals (National Kidney Foundation). 
• Kidney Disease (National Institute of Diabetes and Digestive and Kidney Diseases).
• Medication list (EmblemHealth).