Important Update Regarding HEDIS MY 2023 Reporting and CCS Exclusion Criteria
Date: 08/24/23
Louisiana Healthcare Connections is reminding provider about important updates related to the Cervical Cancer Screening (CCS) measure for HEDIS MY 2023 reporting. These updates are about making sure our data is accurate and reflects the best patient care possible.
Understanding Who's Excluded
There are certain members who need to be excluded from the HEDIS measures no matter what. These required exclusions are a big part of making sure we're looking at the right data. These exclusions are a key part of deciding who's in the denominator of the measure. We figure out who to exclude based on information from claims, encounters, pharmacies, and enrollment data.
New for HEDIS MY 2023 - CCS Exclusions
In HEDIS MY 2023, a change was introduced in relation to the CCS exclusion for members who have undergone a hysterectomy. Specifically, members with documentation of a "hysterectomy" and documentation indicating that they no longer need Pap testing or cervical cancer screening must not be excluded from the measure for MY 2023 reporting. Similarly, members with documentation of a "vaginal pap smear" and documentation of a "hysterectomy" must also remain within the measure for HEDIS MY 2023 reporting.
This update is critical because the documentation must align with the clinical specificity of the codes in the value sets provided. There are no codes that are clinically synonymous with the mentioned examples. To satisfy the required exclusion criteria for MY 2023 reporting, there must be evidence of a hysterectomy with no residual cervix, cervical agenesis, or acquired absence of cervix.
Why Documentation Matters
This change is about making sure our documentation matches up with the codes in those value sets they gave us. If we want to say someone meets the exclusion criteria for MY 2023 reporting, documentation that they had a hysterectomy without partial cervix, cervical agenesis, or acquired absence of cervix.
How to Prove Exclusion
This update underscores the importance of aligning documentation with the clinical specificity of the codes found in the provided value sets. There are no codes that are synonymous with the examples mentioned, which reinforces the need for accurate and comprehensive documentation. To meet the required exclusion criteria for MY 2023 reporting, it is imperative that the evidence demonstrates a hysterectomy with no residual cervix, cervical agenesis, or acquired absence of cervix.
Valid Documentation and Meeting Criteria
- Denominator: The number of members who qualify for the measure criteria, based on NCQA technical specifications.
- Numerator: The number of members who meet compliance criteria based on NCQA technical specifications for appropriate care, treatment, or services.
Documented terms such as "vaginal hysterectomy" or "complete/total/radical hysterectomy" that correspond with definitions in the applicable value sets may be used to meet the criteria for exclusion. In order for a member to meet the exclusion criteria for the CCS measures, there must be evidence of a hysterectomy with no residual cervix, cervical agenesis, or acquired absence of cervix at any point during the member's history up to December 31 of the measurement year.