What qualifies as Total Colectomy procedure type 6 in PIPE?
NCQA is a steward for the measure, we align with their definition for total colectomy exclusion. Their codes selected for this exclusion all reflect a total colectomy (all of the colon has been removed). If a total removal of the colon can't be confirmed, then the patient should not be pulled in with a total colectomy procedure. Therefore, no, any instance of colectomy plus the provider waiving screening does not count as a procedure type 6 (total colectomy).
SNOMED codes are attached for guidance to identify "TOTAL" colectomy procedures.
That being said, NCQA also excludes patients with current or history of colon cancer (see crc-02 value set listed below). These diagnoses would flow through the encounter file and problem list and PIPE programming would remove them from the denominator of the measure. Many of the patients that would have a waived colon cancer screening flag or partial colectomy may be excluded from the measure via this mechanism. Instead, it would be best to let the data flow.
5 2023MY DDS Colorectal Cancer Prelim 10-2022.xlsx
5 2023MY DDS Colorectal Cancer Prelim 10-2022.xlsx
CRC-02 value set for 2022MY.xlsx
CRC-02 value set for 2022MY.xlsx
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5 2023MY DDS Colorectal Cancer Prelim 10-2022.xlsx 75 KB |
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CRC-02 value set for 2022MY.xlsx 13 KB |
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