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Completing the Cervical Cancer Screening Cycle Data Online Form

Figure 30: Cervical Cancer Screening Cycle Data online form.

Pap Test

PREVIOUS Pap Test: Select the appropriate response from the drop-down list.

• Yes – Date known: Select if a previous Pap test was done and date of test is known.
• Yes – Date unknown but within last 5 yrs: Select if previous Pap test was done within the last 5 years.
• Yes – Date unknown but more than 5 yrs: Select if previous Pap test was done, but not within the last 5 years.
• No – Select if a previous Pap test was not done.
• Unknown – The recipient doesn’t know: Select if it is unknown to the recipient as to whether she had a previous Pap test.
• Unknown – The recipient wasn’t asked/recorded: Select if the recipient was not asked or if response was not recorded.
• Unknown – The recipient refused to answer: Select if the recipient refused to answer.

Date of PREVIOUS Pap Test:

• Enter the month and year of the previous Pap test using the following format: MM/YYYY.
• If the month of the previous Pap test is not known, enter the year and leave the month blank.

Note: One measure of the program’s success is the number of “never or rarely screened” recipients who receive a cervical cancer screening. “Rarely screened” means five or more years between screenings. To help track the program’s performance, ask if it has been more than five years since her last Pap test.

Reason for CURRENT Pap Test: Select reason for starting a cervical cancer screening cycle from the drop-down list.

• Routine Pap test: Select if the current Pap test was performed as part of a routine screening schedule.
• Pap test for management of previous abnormal result: Select if the current Pap test was performed for management of a cervical abnormality detected prior to this cycle.
• Pap test not done. Diagnostic work-up and/or HPV test only: Select if the current Pap test was not performed and recipient goes directly for diagnostic procedures or HPV testing.
• Pap test not paid by CDP. Client referred for diagnostics only: Select if the current Pap test was not paid by CDP: EWC (e.g., FPACT) and the recipient was enrolled into CDP: EWC for diagnostic procedures.

Cervical Diagnostic Referral Date: If the current Pap test was NOT performed, enter the date of the HPV test or first diagnostic test, whichever was done first. Enter the date using the following format: MM/DD/YYYY.

Date of CURRENT Pelvic Exam: If a pelvic exam was performed, enter the date using the following format: MM/DD/YYYY.

Specimen Adequacy: Select the appropriate response from the drop-down list.

• Satisfactory: Select if the cytology report states that the Pap test was satisfactory or adequate.
• Unsatisfactory: Select if the cytology report states that the Pap test was an unsatisfactory or inadequate specimen (e.g., a specimen with no epithelial cells or excessive blood cells).
  • Select Short-Term Follow-up in the Additional Procedures Needed to Complete Cervical Cycle field and submit repeat Pap test using a new Cervical Cancer Screening Cycle Data form.

Specimen Type: Select specimen type from the drop-down list to document the type of Pap testing provided.

• Conventional Smear
• Liquid Based
• Other
• Unknown

CURRENT Pap Test Result: Select the Pap test result that best corresponds to the reported Pap test result from the drop-down list.

• Negative for intraepithelial lesion or malignancy
• Atypical squamous cells of undetermined significance (ASC-US)
• Low grade SIL (LSIL) including HPV changes
• Atypical squamous cells, cannot exclude HSIL (ASC-H)
• High grade SIL (HSIL)
• Squamous Cell Carcinoma
• Atypical Glandular Cells (AGC)
• AGC - Neoplastic
• Adenocarcinoma In Situ (AIS)
• Adenocarcinoma
• Other
  • Example of an appropriate entry for “Other” Pap Test Results is Endometrial cells

Date of CURRENT Pap Test: Enter the date the Pap test was performed using the following format: MM/DD/YYYY.

• Use the date the Pap test was performed, not the date of the results.
• A Pap test (initial or follow-up) starts a new screening cycle and is reported using a new Cervical Cancer Screening Cycle Data form.

CURRENT HPV Test Result: Select the following from the drop-down list:

• Test Not Done
• Positive
• Negative

Note: HPV DNA testing is a CDP: EWCcovered procedure if it is used in triage and/or follow-up of an abnormal result from the screening examination, or for surveillance at one year following an abnormal Pap test without evidence of CIN on the colposcopy-directed biopsy.  HPV DNA testing is not covered as a screening test.  Providers should specify the high-risk HPV DNA panel; screening for low-risk genotypes HPV is not permitted

For more information, please see CDP: EWCprogram manual for Primary Care Providers (PCPs).

Date of CURRENT HPV Test: Enter the date the HPV test was performed using the following format: MM/DD/YYYY.

Additional Procedures Needed to Complete Cervical Cycle

Additional Procedures Needed to Complete Cervical Cycle: Select one from the drop-down list.

• Not needed or planned – Routine Rescreen:
  • Select this if the screening Pap test and pelvic exam were normal.
• Submit next cervical screening (Pap test and pelvic exam) using a new Cervical Cancer Screening Cycle Data form.
• Not needed or planned – Short Term Follow-Up:
  • Select this when additional diagnostic procedures/exams are required after a planned delay (e.g., repeat Pap test in 3 to 6 months).
  • Submit next procedure(s) using a new Cervical Cancer Screening Cycle Data form.
• Needed or planned – Immediate Work-Up:
  • Select this when additional diagnostic procedures are required without delay to rule out cervical cancer.

Complete and submit cervical cancer diagnostic procedures, work-up status, final diagnosis and treatment status, as required.

Cervical Diagnostic Procedures

Complete Cervical Diagnostic Procedures if there were abnormal cervical screening results and/or “Immediate Work-up” is selected in the Additional Procedures Needed to Complete Cervical Cycle field.

Type of Procedure: Select type of diagnostic procedure performed from the drop-down list.

1. Colposcopy without Biopsy: If colposcopy without biopsy was performed, enter the date.
2. Colposcopy with Biopsy and/or ECC: If colposcopy with biopsy and/or ECC was performed, enter the date.
3. Loop Electrosurgical Excision Procedure (LEEP): If LEEP was performed, enter the date.
4. Cold Knife Cone (CKC): If CKC was performed, enter the date.
5. Endocervical curettage alone (ECC): If a stand-alone ECC was performed, enter the date.

Date of Procedure: Enter the date the diagnostic procedure was performed, not the date of the results. All dates should be entered using the following format: MM/DD/YYYY.

Add: Double Click the Add button after selecting each diagnostic procedure from the drop-down list and entering date of diagnostic procedure. The procedure will not be saved if the Add button is not clicked.

Note: Report all diagnostic procedures performed. Multiple entries including the same procedure are allowed.

Remove: Highlight the procedure you would like to remove from the list then click Remove.

Other Cervical Procedure Performed: Enter only one diagnostic procedure that can provide a diagnosis of cancer or not cancer as an “Other Cervical Diagnostic Procedure.” Select the procedure performed, even if not covered by CDP: EWC. If a diagnostic procedure not listed above was performed, select applicable option below:

• Excision of endocervical polyps
• Endometrial biopsy (EMB)
• Biopsy of other structure (e.g., vagina, vulva) – Report only for recipient who does not have a cervix.
• Other gynecologic consults
• Other – Please Specify

 Specify “Other” Procedure: Enter a description of the other diagnostic procedure performed.

• Please report any “Other Cervical Diagnostic Procedures” even though they may not be covered by CDP: EWC.
• Do not enter the following as “Other Cervical Cancer Diagnostic Procedure,” as they are already listed on the form:
• Colposcopy without biopsy
• Colposcopy with biopsy and/or ECC, LEEP, CKC, ECC alone

Note: ECC and EMB are covered when done as the initial evaluation for Pap test result of AGC-Atypical Endometrial Cells. For more information, please seecan detect.

• Do not enter the following as an “Other Cervical Cancer Diagnostic Procedure:”
• Pap Test results
• Cervicography
• HPV testing
• Pelvic ultrasound
• Cervical CT scan
• Cryosurgery
• Hysterectomy
• Laser
• Cautery

Date of Other Procedure: Enter the date the other diagnostic procedure was performed, not the date of the results. All dates should be entered using the following format: MM/DD/YYYY.

Cervical Work-up Status and Final Diagnosis Information

Complete Cervical Cancer Work-up Status if the cervical screening results were abnormal and/or Immediate Work-up was selected in the Additional Procedures Needed to Complete Cervical Cycle field.

Work-up Status: Select the appropriate work-up status from the drop-down list.

• Work-up complete: Select this if no further immediate diagnostic procedures are needed to determine the diagnosis. It is also appropriate to select Work-up complete if the recipient is advised to return for further evaluation (e.g., repeat Pap test) in 3 to 6 months, after current diagnostic procedures.
  • If work-up is complete, enter the date of this work-up status. Use the date of the diagnostic procedure used to complete the work-up and not the date of the report or of data entry.
• Lost to follow-up: Select this if the recipient is considered lost to follow-up before the definitive diagnostic procedures were performed. Three attempts must be made to contact the recipient (two phone calls and certified letter sent). The third attempt must be by certified letter. Attempts to contact the recipient must be documented in her medical record.
• Work-up refused: Select this if the recipient refused to have diagnostic procedures performed, acquired insurance, moved out of the area, or changed PCP for any reason.
• Died before work-up complete: Select this if the recipient died before the diagnostic procedure(s) was performed.

Note: If work-up was not complete (recipient was lost to follow-up, work-up refused, or died before work-up completed), enter the date this was determined as the date of this work-up status.

Date of Work-up Status: Enter the date of this work-up status using the following format: MM/DD/YYYY. Use the date of the final diagnostic procedure as the date of this work-up status.

Complete Cervical Final Diagnosis only when the Work-up Status is Work-up Complete

Final Diagnosis: Select the diagnosis from the drop-down list that most closely documents the reported result of the cervical final diagnosis. The final diagnosis of cervical cancer is usually determined by a pathology report from histologic examination of tissue/cells. Select a Cervical Cancer Final Diagnosis when cervical cancer diagnosis status was “Work-up complete.”

Note: Do not submit a repeat Pap test result in the final diagnosis field.

• Normal / Benign reaction/inflammation:
  • Select this if the colposcopic examination is normal and the entire squamocolumnar junction is seen.
  • Select this if the biopsy results are negative and the endocervical curettage is negative.
• HPV / Condylomata/Atypia: Select this when the cytology report notes cellular changes associated with the HPV and no higher-grade atypia.
• CIN I / mild dysplasia (biopsy diagnosis): Select this when the pathology report notes findings consistent with a mild dysplasia or cervical intraepithelial neoplasia (CIN I).
• CIN II / moderate dysplasia (biopsy diagnosis): Select this if the pathology report indicates findings consistent with a moderate dysplasia or cervical intraepithelial neoplasia (CIN II).
  • Data for Cervical Cancer Treatment Status is required.
• CIN III / severe dysplasia/CIS or AIS of cervix (biopsy diagnosis): Select this if the pathology report indicates findings consistent with severe dysplasia, cervical intraepithelial neoplasia (CIN III), Carcinoma in situ (CIS) or Adenocarcinoma in situ (AIS).
  • Data for Cervical Cancer Treatment Status is required.
• Invasive Cervical Carcinoma (biopsy diagnosis): Select this if the pathology report indicates Adenocarcinoma, Invasive Adenocarcinoma, or squamous cell carcinoma of the cervix.
  • Data for Cervical Cancer Treatment data is required.
• Low grade SIL (biopsy diagnosis): Select this if the pathology report indicates low-grade squamous intraepithelial lesion
• High grade SIL (biopsy diagnosis): Select this if the pathology report indicates high-grade squamous intraepithelial lesion
  • Data for Cervical Cancer Treatment Status is required.
• Other: Select this if the pathology report indicates a different cancer or if the result is not listed above.
• Specify “Other” Final Diagnosis: Enter a description of the other final diagnosis in the space provided.
  • Enter the following diagnoses as an “Other” cervical cancer final diagnosis:
    • Cervical polyps
    • Vaginal intraepithelial neoplasia (VAIN) – Report only for recipient who does not have a cervix
    • Other cancers of the endometrium, vagina, ovaries or vulva (including primary and metastatic disease) – Report only for recipient who does not have a cervix

Note: Do not enter a repeat Pap test result as an “Other” cervical cancer final diagnosis.

Date of Final Diagnosis: Enter the date of this diagnosis using the following format: MM/DD/YYYY.  Use the date of the definitive diagnostic procedure performed as the date of the final diagnosis.

Cervical Cancer Treatment Information

Complete Cervical Treatment Status if Cervical Cancer Final Diagnosis is CIN II, CIN III / Carcinoma in situ / Adenocarcinoma in situ, HSIL or invasive cervical carcinoma.

Treatment Status:

• Treatment started: Select this if the recipient accepted a referral for treatment and the clinic staff can verify from either the recipient or treatment facility that treatment has been initiated – regardless of recipient’s insurance status.
• Lost to follow-up: Select this if the recipient did not begin treatment and the clinic staff cannot locate the recipient. Three attempts must be made to contact the recipient. The third attempt must be by certified letter. Attempts to contact recipient must be documented in the recipient’s medical record.
• Treatment refused: Select this if the recipient refused treatment. If the recipient only receives
  non-standard or alternative treatments, select Treatment refused.
• Treatment not needed: Select this if the medical provider and recipient agree that treatment would adversely affect the recipient’s quality of life (with late or end-stage cancers) and that treatment is not recommended or needed at this time.
• Died before treatment started: Select this if the recipient died before beginning treatment.

Date of Treatment Status: Enter the date when treatment was initiated or other treatment status was determined using the following format: MM/DD/YYYY.

Patient enrolled in BCCTP. Check ONLY when you have completed the BCCTP enrollment process. See DETEC HELP or Recipient Eligibility form for a list of BCCTP qualifying diagnoses. If the cervical diagnosis is not listed on the drop-down list, contact a BCCTP manager at 1-800-824-0088 for information on how to proceed.

Print

Click the Print button at the bottom of the online DETEC – Cervical Cancer Screening Cycle form to print a copy of it.

When you click the Print button the following message will pop-up:
 
Note: The information below reflects only data that has been saved. Be sure to save/submit the recipient information before printing.

Note: The Print button prints only what is visible on the screen. There is a Print button on every DETEC screen. Use the Print button found at the bottom of the screen to print Cervical Cancer Screening Cycle form.

Editing Records

This is applicable for both Breast Cancer Screening Cycle and Cervical Cancer Screening Cycle online forms.

Issues With This Cycle

Both Breast and Cervical Cancer Screening Cycle Data screens have an option for data entry staff to “Check Data” prior to submission. When the Check Data button is clicked, three types of errors may be detected.

• Warnings
• Case Management Errors
• Save Errors

All warnings, “Case Management” errors, and “Save Errors” will be listed in the Issues With This Cycle box that will appear at the top of the Breast and Cervical Cancer Screening Cycle forms if there are errors. A cycle with “Case Management” errors may be submitted, but the cycle will appear in the navigation bar with an exclamation () next to it. CM fee is not paid for the recipient until all errors are resolved. Once errors are resolved, the exclamation () will no longer appear next to that cycle record in the left column navigation bar.

A cycle cannot be saved if any “Save Errors” are detected. These errors must be resolved before the record can be submitted.

To enter additional data or correct data on previously submitted screening cycle form:

• In the left column navigation bar, click the cycle you want to either provide additional data for or correct previously entered data.
• Correct or enter additional data to cycle form that displays previously submitted data.
• Click the Check Data button to check for any data entry errors.
• Cycles that are locked will not be accessible to enter additional data or to correct data.
• Click the Delete Cycle button to delete cycle previously entered. A pop-up box requesting a reason to delete a cycle will appear (Figure 32). After entering reason, click the Confirm button. A message will display that the record was successfully deleted (Figure 33).
• Click the Submit button to save the edits to the screening record. A message will display that the record was successfully submitted (Figure 31).
• Click the Cancel button to exit out of the data entry screen without saving OR to return to the Recipient Information page.
• Click the Print button to print a copy of data submitted for the specific DETEC screen.

Figured 31: Record successfully edited

Figure 32: Pop-up box for delete cycle reason

Figure 33: Record successfully deleted