Tracking and Improving Screening for Colorectal Cancer Intervention

3.a-1 Sample Programming Criteria for Initial Electronic Record Review

Electronic Records Review Programming Criteria

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 diagnosis of CRC or polyps or inflammatory bowel disease (refer to Table 1, ICD-9 Codes for Excluded Diagnoses)
  5. No family history of CRC diagnosis before age 60
  6. 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.

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Page last reviewed October 2014
Internet Citation: 3.a-1 Sample Programming Criteria for Initial Electronic Record Review. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool3a1.html