Colorectal Cancer Facts for You and Your Patient

March is National Colorectal Cancer Awareness Month.  Most everyone is familiar with these three points: 

          The risk of getting colorectal cancer increases with age

          More than 90% of cases occur in people who are 50 years old or older  

          Colorectal cancer can often be prevented  

To better serve your patients and help save lives, now is the time to review current information available on statistics, causes and prevention.

American Cancer Society Statistics:

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, with the lifetime risk of developing it about 1 in 20.

Estimates for the number of colorectal cancer cases in the United States for 2013 are:

·         102,480 new cases of colon cancer 

·         40,340 new cases of rectal cancer 

Colorectal cancer is expected to cause about 50,830 deaths during 2013.

Good News: The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping in both men and women for more than 20 years. There are now more than 1 million survivors of colorectal cancer in the United States.

Causes of Colorectal Cancer:

Being overweight or obese raises the risk both of being diagnosed and dying from this disease.  Most cases of colorectal cancer start as a non-cancerous growth called a polyp. 

Studies have found that people who are overweight or obese are more likely to develop these polyps, and higher weights are associated with higher polyp risk.

A diet that is high in red meat and processed meat (like luncheon meats and hot dogs) increases the risk of developing the disease.

Hereditary factors play a significant role in colorectal cancer risk.

Note:  Medicare defines high risk of developing colorectal cancer as someone who has one or more of the following risk factors:

·         Close relative(sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp,

·         Family history of adenomatous polyposis,

·         Family history of hereditary nonpolyposis colorectal cancer,

·         Personal history of adenomatous polyposis,

·         Personal history of colorectal cancer, or

·         Personal history of inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.

Colorectal Cancer Prevention: Education, screening and early detection saves lives.  

Education:  Encourage patients to lower their risk for colorectal cancer by not smoking, maintaining a healthy weight and exercising.  Recommend that your patients eat more vegetables, fruits, and whole grains, and less red meat (beef, lamb, or pork) and less processed meat (hot dogs and some luncheon meat). Men should limit alcohol to no more than 2 drinks a day, and women to no more than 1 drink a day.

Screening:  Talk with your patients about the importance of getting screened for the disease.  Regular screening can find precancerous polyps so they can be removed before they turn into cancer.  The American Cancer Society recommends regular colon cancer screening for most people starting at age 50. People with a family history of the disease or other risk factors should talk with their doctor about beginning screening at a younger age. 

Medicare beneficiaries age 50 and over are covered for colorectal cancer screenings services and should be encouraged to take full advantage.  Covered services vary based upon the patient’s individual risk category.  (See chart below)

Early detection:   The earlier colorectal cancer is diagnosed, the greater the chance the treatment will be the most effective.  Early detection typically means the cancer is discovered at its earliest pathological stage, Stage I or IIA.  Five-year survival Statistics from National Cancer Institute's SEER database for cases diagnoses from 1998-2000 are:

Rectal Cancer:  Stage I 74% and Stage IIA 65%

Colon Cancer:  Stage I 74% and Stage IIA 67%

The most advanced stage, Stage IV only sees about a 6% five-year survival rate for both.

Advances in current treatment methods have had significant effects on survival rates.  If diagnoses at the localized stage level, the five-year survival rate for people with colorectal cancer is 90%. If the cancer has spread to nearby lymph nodes or organs, the five-year survival rate is 70%. If the cancer has spread to distant parts of the body, the five-year survival rate is 12%.

Follow this link to the American Cancer Society dedicated web page for Colorectal Cancer Information: http://www.cancer.org/cancer/colonandrectumcancer/index

Coverage Information for Medicare beneficiaries

Non-high Risk Patients

Screening Test	Frequency	HCPCS/CPT Code	Diagnosis
Fecal Occult Blood Test (FOBT)	Every year	G0328-immunoassay 1-2 simultaneous OR 82270 by peroxidase activity, qualitative	Contact your local Medicare Contractor for Guidance.
Flexible Sigmoidoscopy	Every 4 years (if following a screening colonoscopy, then after at least 119 months)	G0104	Contact your local Medicare Contractor for Guidance.
Colonoscopy	Every 10 years (if following sigmoidoscopy, then after at least 47 months)	G0121	Contact your local Medicare Contractor for Guidance.
Barium Enema	As an alternative to flexible sigmoidoscopy	G0106	Contact your local Medicare Contractor for Guidance.

High Risk Patients

Screening Test	Frequency	HCPCS/CPT Code	Diagnosis
Fecal Occult Blood Test (FOBT)	Every year	G0328-immunoassay 1-2 simultaneous OR 82270 by peroxidase activity, qualitative	Contact your local Medicare Contractor for Guidance.
Flexible Sigmoidoscopy	Every 4 years	G0104	Contact your local Medicare Contractor for Guidance.
Colonoscopy	Every 2 years (if following a sigmoidoscopy, then after at least 47 months)	G0105	Contact your local Medicare Contractor for Guidance.
Barium Enema	As an alternative to colonoscopy	G0120	Contact your local Medicare Contractor for Guidance.

Medicare beneficiary financial responsibility will be:

Codes G0104, G0105, G0121, G0328 and 82270: $0 out of pocket (deductible and coinsurance waived)

Codes G0106 and G0120: 20% co-insurance based on Medicare allowed amount (deductible waived)

Codes 10000-69999 furnished for same date/encounter as colorectal cancer screening services will also not be subject to deductible.  

Billing Note:  Apply modifier –PT to at least one code in this range to indicate this scenario.