Form #1 Form #1 Electronic patient record review

Health Care Systems for Tracking Colorectal Cancer Screening Tests

Attachment C7_Electronic Records Review Eligibility Criteria.xls

Electronic patient record review

OMB: 0935-0146

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Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Electronic Records Review Programming Guide
Eligibility Criteria
1 Age 50-79






2 Visit to practice within 2 years






3 Complete mailing address (first and last name, street address, city, state, zip code)






4 No DX of CRC or polyps or inflammatory bowel disease








(see Table 1 - List of Excluded DX Codes)





5 No family HX of CRC diagnoses before age 60






6 No recent CRC tests (see Table 2 - List of Excluded Procedure Codes)








SBT within 1 year







Sig within 5 years







BE within 5 years







CX within 10 years














Table 1. List of ICD9 Codes for Excluded Diagnoses

Diagnosis


ICD9 Codes



Malignant neoplasms


153.0 – 154.8



Benign neoplasms


211.3 – 211.4



Colorectal and Intestinal neoplasms


159







197.5, 197.8







211.9







230.3 – 230.4, 230.7







235.2, 239.0



Regional enteritis (Crohn’s disease)


555.0 – 555.9



Ulcerative colitis


556.0 – 556.9



History of colon polyps


V12.72











Table 2 - List of Excluded Procedure Codes

Procedure
CPT Codes
HCPCS Codes
ICD9 Codes










Stool Blood Test
82270, 82274
G0107, G0328
V76.51










Sigmoidoscopy
45330-45335,
G0104
45.24, 45.42



45337-45342,







45345














Barium Enema
74270, 74280
G0106, G0120,







G0122












Colonoscopy
44388-44394,
G0105, G0121
45.22, 45.23,



44397, 45355,


45.25, 45.43



45378-45387,







45391, 45392






















Public reporting burden for this collection of information is estimated to average 5.66 hours per response, the estimated time required to complete the review. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Form Approved: OMB Number 0935-XXXX Exp. Date xx/xx/20xx. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.
File Typeapplication/vnd.ms-excel
Authorjrc102
File Modified2008-07-24
File Created2007-03-05

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