1. Azara Proprietary & Confidential Cervical Cancer Screening 2014 Measure Changes Improving Patient Outcomes through Data

2. 0032 Cervical Cancer Screening CMS124 2 2 Measure Update Measure Title & Steward # Measure Description Measure Comparison MU 2011 vs MU 2014 What did the old measure include What changes are applied to the new measure What are current considerations due to measure update Azara CQM’s

3. 0032 Cervical Cancer Screening CMS124 3 3 LOINC Additional LOINC codes e.g., 18500-9, Cytopathology stain thin prep were added The additional LOINC codes will help to improve performance rates provided the clinic captures the appropriate codes in their lab requisitions, EMR, etc. LOINC Additional LOINC codes e.g., 18500-9, Cytopathology stain thin prep were added The additional LOINC codes will help to improve performance rates provided the clinic captures the appropriate codes in their lab requisitions, EMR, etc. SNOMED SNOMED codes for Sampling of cervix for Papanicolaou smear e.g., 439958008 were removed from criteria of patients that meet the numerator Potential reduction in performance rate if deleted codes were exclusively used to document screening SNOMED SNOMED codes for Sampling of cervix for Papanicolaou smear e.g., 439958008 were removed from criteria of patients that meet the numerator Potential reduction in performance rate if deleted codes were exclusively used to document screening Population Criteria Revisions/ additions to “visit types” for patients who will meet the initial denominator criteria were made. Look-back period for encounter shortened from 2 years to 1 year. Look-back period for Pap test unchanged, though worded differently. Population Criteria Revisions/ additions to “visit types” for patients who will meet the initial denominator criteria were made. Look-back period for encounter shortened from 2 years to 1 year. Look-back period for Pap test unchanged, though worded differently. MU 2014 Measure Update Change Summary ICD 9 and 10 codes Diagnosis Some ICD 9 & 10 Dx codes for pap smear were removed as indicators for patients that meet the numerator criteria Changes may cause a potential reduction in performance rate if deleted codes are exclusively used to document screening Several Hysterectomy codes were also deleted. This further clarifies the need for a patient to have “no residual cervix” in order for them to be excluded from the initial population/ denominator criteria ICD 9 and 10 codes Diagnosis Some ICD 9 & 10 Dx codes for pap smear were removed as indicators for patients that meet the numerator criteria Changes may cause a potential reduction in performance rate if deleted codes are exclusively used to document screening Several Hysterectomy codes were also deleted. This further clarifies the need for a patient to have “no residual cervix” in order for them to be excluded from the initial population/ denominator criteria CPT Codes & HCPCS Visit codes for patient encounters performed as a group visit e.g. 99411, 99412 or non-physician presence visit e.g., 99211 were removed as encounter types. Some Pap test Cytopathology codes e.g., 88141, 88142 were removed as indicators for patients meeting the numerator criteria. (see excel for detail). Potential reduction in performance rate if deleted codes were exclusively used to document screening. HCPCS Codes related to Medicare Cytopathology were removed, e. g., G0123 correlates to the CPT 88142 which was also removed as an indicator for patients meeting the numerator Potential reduction in performance rate if deleted codes were exclusively used to document screening CPT Codes & HCPCS Visit codes for patient encounters performed as a group visit e.g. 99411, 99412 or non-physician presence visit e.g., 99211 were removed as encounter types. Some Pap test Cytopathology codes e.g., 88141, 88142 were removed as indicators for patients meeting the numerator criteria. (see excel for detail). Potential reduction in performance rate if deleted codes were exclusively used to document screening. HCPCS Codes related to Medicare Cytopathology were removed, e. g., G0123 correlates to the CPT 88142 which was also removed as an indicator for patients meeting the numerator Potential reduction in performance rate if deleted codes were exclusively used to document screening What’s New with MU 2014 Cervical Cancer Screening What’s New with MU 2014 Cervical Cancer Screening

4. 0032 Cervical Cancer Screening CMS124 4 4 Cervical Cancer Screening Measure MU 2014 Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer. National Quality Strategy (NQS) Domain – Clinical Process/Effectiveness Women with one or more Pap tests during the measurement period or the two years prior to the measurement period Numerator Women 23-64 years of age with a visit during the measurement period Denominator

5. 0032 Cervical Cancer Screening CMS124 5 5 Explanation and Impact of Changes Population Criteria 5  Look-back period for encounter shortened from 2 years to 1 year, so population eligible for the denominator will be smaller.  Look-back period for Pap unchanged [measurement period or the two years prior to the measurement period], although worded differently in 2014 specs.  Look-back period for encounter shortened from 2 years to 1 year, so population eligible for the denominator will be smaller.  Look-back period for Pap unchanged [measurement period or the two years prior to the measurement period], although worded differently in 2014 specs.

6. 0032 Cervical Cancer Screening CMS124 6 6 Explanation and Impact of Changes Population Criteria Revisions/ additions to the visit types for patients that will fall into the initial population/ denominator. 2011 Criteria Encounter Types :OB/GYN or Outpatient Pap laboratory test result had a 3 year look back 2014 Criteria Encounter Types Performed: Office Visit, Face-to-Face Interaction, Preventive Care Services, Established Office Visit, 18 and Up, Preventive Care Services-Initial Office Visit, 18 and Up, Home Healthcare Services See excel for population criteria

7. 0032 Cervical Cancer Screening CMS124 7 7 Explanation and Impact of Changes CPT Codes Removed Encounter outpatient- 99211, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245 99384, 99394, 99245, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456 PAP Test - 88141, 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174, 88175 CPT Codes Added Hysterectomy with No Residual Cervix-57540,57545, 57550, 57555, 57556, 58548 CPT CODES  Visit codes for patient encounters performed as a group visit e.g. 99411, 99412 or non-physician presence visit e.g., 99211 were removed as encounter types  Some Pap test Cytopathology codes e.g., 88141, 88142 were removed as indicators for patients meeting the numerator criteria. (see excel for detail)  Potential reduction in performance rate if deleted codes were exclusively used to document screening  Visit codes for patient encounters performed as a group visit e.g. 99411, 99412 or non-physician presence visit e.g., 99211 were removed as encounter types  Some Pap test Cytopathology codes e.g., 88141, 88142 were removed as indicators for patients meeting the numerator criteria. (see excel for detail)  Potential reduction in performance rate if deleted codes were exclusively used to document screening

8. 0032 Cervical Cancer Screening CMS124 8 8 Explanation and Impact of Changes  HCPCS Codes related to Medicare Cytopathology were removed, e. g., G0123 correlates to the CPT 88142 which was also removed as an indicator for patients meeting the numerator  Potential reduction in performance rate if deleted codes were exclusively used to document screening  HCPCS Codes related to Medicare Cytopathology were removed, e. g., G0123 correlates to the CPT 88142 which was also removed as an indicator for patients meeting the numerator  Potential reduction in performance rate if deleted codes were exclusively used to document screening Health Care Common Procedure Codes (HCPCS) HCPCS Codes Removed Pap Test- G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091 HCPCS Codes Added NONE

9. 0032 Cervical Cancer Screening CMS124 9 9 Explanation and Impact of Changes ICD 10/ ICD 9 CODES  Some ICD 9 & 10 Dx codes for pap smear were removed (see excel for detail) as indicators for patients that meet the numerator criteria. These changes may cause a potential reduction in performance rate if deleted codes are exclusively used to document screening  Several Hysterectomy codes were also deleted (see excel for detail). This further clarifies the need for a patient to have “no residual cervix” in order for them to be excluded from the initial population/ denominator criteria  Some ICD 9 & 10 Dx codes for pap smear were removed (see excel for detail) as indicators for patients that meet the numerator criteria. These changes may cause a potential reduction in performance rate if deleted codes are exclusively used to document screening  Several Hysterectomy codes were also deleted (see excel for detail). This further clarifies the need for a patient to have “no residual cervix” in order for them to be excluded from the initial population/ denominator criteria ICD-9-CM Removed Encounter ob/gyn- V24, V25, V26, V27, V28, V45.5, V61.5, V61.6, V61.7, V69.2, V72.3, V72.4 Encounter outpatient- V70.0 V70.3 V70.5 V70.6 V70.8 V70.9 Hysterectomy - 68.15 68.4 68.41 68.49 68.5 68.51 68.59 68.6 68.61 68.69 68.7 68.71 68.79 68.8 V67.01 V76.47 V88.01 V88.03 Pap test - 91.46, V72.32 ICD-9-CM Added NONE ICD-10-CM Removed Hysterectomy- N81.81 Z12.72 Z90.71 Z90.710 Z90.7112 Pap test -Z12.4 ICD-10-CM Added NONE

10. 0032 Cervical Cancer Screening CMS124 10 Explanation and Impact of Changes SNOMED- CT Codes Removed Hysterectomy 236886002, 79095000 Pap test - 439958008, 440615002, 440623000 SNOMED-CT Codes Added Fact To Face Interaction 12843005, 18170008, 185349003, 185463005, 185465003, 19681004, 207195004, 27042700,3 270430005, 308335008, 390906007, 406547006, 439708006, 4525004, 87790002, 90526000 Hysterectomy with No Residual Cervix (that will exclude patients from the denominator) 112918004, 112918004 24293001 265056007 27185000 287924009 30160001 309880009 359971002 359974005 359977003 359983000 413145007 41566006 43791001 441820006 446446002 446679008 447771005 448539002 54490004 63516002 75835007 77902002 Systematized Nomenclature of Medicine Codes (SNOMED-CT)  SNOMED codes for Sampling of cervix for Papanicolaou smear e.g., 439958008 were removed from criteria of patients that meet the numerator  Potential reduction in performance rate if deleted codes were exclusively used to document screening  SNOMED codes for Sampling of cervix for Papanicolaou smear e.g., 439958008 were removed from criteria of patients that meet the numerator  Potential reduction in performance rate if deleted codes were exclusively used to document screening

11. 0032 Cervical Cancer Screening CMS124 11 Explanation and Impact of Changes  Additional LOINC codes e.g., 18500-9, Cytopathology stain thin prep were added  The additional LOINC codes will help to improve performance rates provided the clinic captures the appropriate codes in their lab requisitions, EMR, etc.  Additional LOINC codes e.g., 18500-9, Cytopathology stain thin prep were added  The additional LOINC codes will help to improve performance rates provided the clinic captures the appropriate codes in their lab requisitions, EMR, etc. LOINC CODES LOINC Codes Added Pap Test- 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0, 47527-7, 47528-5