Electronic Records Review Programming Criteria
Eligibility Criteria
- Age 50-79
- Visit to practice within 2 years
- Complete mailing address (first and last name, street address, city, State, ZIP Code)
- No diagnosis of CRC or polyps or inflammatory bowel disease (refer to Table 1, ICD-9 Codes for Excluded Diagnoses)
- No family history of CRC diagnosis before age 60
- No recent CRC tests (refer to Table 2, Excluded Procedure Codes):
- Stool blood test within 1 year
- Sigmoidoscopy within 5 years
- Barium enema within 5 years
- Colonoscopy within 10 years
Table 1. ICD-9 Codes for Excluded Diagnoses
| Diagnosis | ICD-9 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 (including Crohn's disease) | 555.0-555.9 |
| Ulcerative colitis | 556.0-556.9 |
| History of colon polyps | V12.72 |
Table 2. Excluded Procedure Codes
| Procedure | CPT Codes | HCPCS Codes | ICD-9 Codes |
|---|---|---|---|
| Stool blood test | 82270, 82274 | G0107, G0328 | V76.51 |
| Sigmoidoscopy | 45330-45335, 45337-45342, 45345 | G0104 | 45.24, 45.42 |
| Barium enema | 74270, 74280 | G0106, G0120, G0122 | |
| Colonoscopy | 44388-44394, 44397, 45355, 45378-45387, 45391, 45392 | G0105, G0121 | 45.22, 45.23, 45.25, 45.43 |
Key: CPT = Current Procedure Terminology; HCPCS = Healthcare Common Procedure Coding System; ICD-9 = International Classification of Diseases, 9th edition.
