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Chapter 6 Enter a Cervical Cycle

This section contains the following information:

Collecting Data

See the following sections.

Enter Data for a New Cervical Screening

To enter a new cervical cycle:
  1. For new clients, in the Actions menu, click New Cervical Screening.
    For existing clients, click Cervical Screening.

    2. The New Client Cervical Screening Cycle or Cervical Screening Cycle screen appears. Information from the previous cycle, if available, will be visible.

    note You cannot open a new cycle if a previous cycle is still open. You have to close the previous cycle before you can open a new one.



  2. Start filling in information from the current cycle.

    3. The date of the last cervical cycle is in the left hand menu under "Cervical Health", "Cycle 1 - Open".

  3. Review the contents of the form.

    4. Use Tab to move from one field to the next.

  4. Fill in the fields as described in the following tables.
  5. Click Save. The new cervical screening cycle is saved.
  6. Complete the pelvic examination section of the form.
  7. Click Save to save and close the new cervical screening cycle.

For clinic use only

Use the following field guidelines when entering data.

Field name
Description
Notes
Cervical Cycle No
The number assigned to each cervical cycle that is inputted into the Web Data System.
This number is automatically generated by the system.
Cycles are numbered in the order they are entered into the system.
Comments
Enter any comments or notes about this client's cycle.
 
Reason no BREAST services were provided
Select one of the following choices:
  • Patient refused
  • Not eligible
  • Patient needs breast services only
  • Service already done by another provider
If this field is filled out, then a breast cycle cannot be started for this eligibility period.

Cervical History

Clinical history data for clients allows the BCCP to assess outreach to the "rarely or never screened," which is one of the program priority populations. "Rarely screened" is generally defined as not screened in five or more years.

To enter cervical history data:

Pelvic Exam

BCCP pays for a pelvic exam on an annual basis, however, after a woman has a total of three normal (negative) Pap tests within a five-year period, the Pap test is only covered every three years.

To enter pelvic exam data:
  1. Enter data using the following field guidelines.

    2. Field name
    Description
    Notes
    Pelvic exam Performed?
    Has a pelvic exam been conducted on the client?
    This is a required field.
    Reason Pelvic not performed:
    Select one of the following choices:
    • Normal pelvic exam within recommended screening period months
    • Patient refused
    • Unable to perform at this time
    This is a required field if the answer to the question above is "No".
    Date of Pelvic
    Enter the date in MM/DD/YYYY format. For example, 01/01/2008.
    This field is required unless no pelvic was performed.
    This date cannot be a future date.
    Pelvic Exam Result
    Select one of the following choices:
    • Normal
    • Abnormal NOT suspicious for cancer
    • Abnormal suspicious for cancer
    This field is required unless no pelvic was performed.

  2. Click Save.

    3. Upon a successful Save in this section, a new cervical cycle is created by the data system.

    After the cervical cycle is saved, you must proceed to the Pap Test section; as a cycle can only be closed if both Pelvic and Pap sections are completed.

Pap Test

Screening and funding guidelines. After a woman has a total of three normal (negative) Pap tests within a five-year period, the Pap test is only covered every three years. Providers who use Liquid-Based Technology for Pap tests are encouraged to only perform screening Pap tests every other year (or every three years after three consecutive normal Pap tests in a five-year period). Screening reimbursement for Liquid-Based Technology Pap tests is limited to the Medicare rate for conventional Pap tests at this time.

Women with Hysterectomies. A woman who meets all of the eligibility requirements and has had a complete hysterectomy is eligible for cervical cancer screening services only if the hysterectomy was due to cervical cancer or neoplasia. The Pap test is covered by BCCP if a cervical stump is present or the client has a history of abnormal Pap tests. The Pap test is not covered when no cervical stump is present or there is no history of abnormal Pap tests showing CIN 2 or higher. (If the woman is uncertain of either the reason for her hysterectomy or if the cervical stump is present, the program will cover a pelvic exam and an initial Pap test, if indicated).

To enter Pap test data:
  1. Enter data using the following field guidelines.

    2. Field name
    Description
    Notes
    Pap Performed
    Select one of the following choices:
    • Yes - at this agency
    • Yes - at another non-BCC program funded agency; patient referred in for diagnostic evaluation
    • No
    This is a required field.
    Reason Pap not Performed
    Select one of the following choices:
    • Normal Pap test within recommended period (1-3 years)
    • Hysterectomy, no cervical stump, no history of CIN II or worse (per CE 1-7-08)
    • Pap test not done. Patient proceeded directly for diagnostic work-up or HPV test
    • Unknown
    • Patient refused
    If No was chosen in Pap Performed, then this field is required.
    Indication for Pap
    Select one of the following choices:
    • Routine Pap test
    • Patient had a previous abnormal test
    • Unknown
    If Yes ordered by this agency is selected in Pap Performed, then this field is required.
    If the Pap was ordered by another agency, then attempt to find out this information and enter it.
    Date of Pap
    Enter the date in MM/DD/YYYY format. For example, 01/01/2008.
    If Yes ordered by this agency is selected in Pap Performed, then this field is required.
    If the Pap was ordered by another agency, then attempt to find out this information and enter it.
    This date must be after the date of the Prior Pap, if that date is known and not greater than the enrollment date.
    This date cannot be a future date.
    Specimen Type
    Select one of the following choices:
    • Conventional smear
    • Liquid-based
    • Other
    • Unknown
    If Yes ordered by this agency is selected in Pap Performed, then this field is required.
    If the Pap was ordered by another agency, then attempt to find out this information and enter it.
    Adequacy
    Select one of the following choices:
    • Satisfactory
    • Unsatisfactory
    • Unknown
    • Specimen rejected
    If Yes ordered by this agency is selected in Pap Performed, then this field is required.
    If the Pap was ordered by another agency, then attempt to find out this information and enter it.
    Pap Result
    Select one of the following choices:
    • Negative for intraepithelial lesion or malignancy
    • Atypical squamous cells of undetermined significance (ASC-US)
    • Low grade SIL (including HPV changes)
    • Atypical squamous cells cannot exclude HSIL (ASC-H)
    • High grade SIL (with features suspicious for invasion)
    • Squamous Cell Carcinoma
    • Abnormal Glandular Cells (including Atypical, Endocervical adenocarcinoma in situ, and Adenocarcinoma)
    • Other
    • Result pending
    • Result unknown, presumed abnormal, Pap test performed by a different provider.
    If Yes ordered by this agency is selected in Pap Performed, then this field is required.
    If the Pap was ordered by another agency, then attempt to find out this information and enter it.
    If Pap test was "Other", test result description
    List another Pap test result that is not already found in the choices under Pap result.
    If Other was chosen in the question above, then this field is required.

  2. Click Save.

    3. A cycle can only be closed if both Pelvic and Pap sections are completed.

Follow-up Information for Pelvic Exam AND Pap Test

After screening procedures are completed, indicate if the client should proceed with routine screening or if additional diagnostic procedures are required to rule out the possibility of cervical cancer. If additional procedures are recommended, indicate all that apply.

To enter follow-up information:
  1. Enter data using the following field guidelines.

    2. Field name
    Description
    Notes
    Follow-up Recommendation
    Select one of the following choices:
    • Routine screening
    • Short term follow-up
    • Additional diagnostic procedures
    If Result pending was chosen in Pap result, or if neither a Pelvic nor a Pap were done at this agency, then this field is not required. Otherwise, this field is required.
    Short-term follow-up months
    Select one of the following choices:
    • 2 to 4 months
    • 6 months
    • 12 months
    If Short-term follow-up was chosen in the question above, then this field is required.
    Additional diagnostics procedures
    Select one of the following choices:
    • Colposcopy without biopsy
    • Colposcopy with biopsy and/or ECC
    • Endocervical curettage (ECC) alone
    • HPV test
    • Gynecological consultation
    • Other procedure not covered by BCC program
    If Additional diagnostic procedures was chosen in the Follow-up Recommendation above, then this field is required.
    Select all that apply. Hold Ctrl while selecting more than one item from the list.

  2. Click Save to close the cervical cycle, or proceed to Additional Procedures.

Additional Procedures

Providers are expected to provide follow-up to women with abnormal screening results to help ensure timely and complete follow-up within 60 days.

Care coordination

Care Coordination Services conclude when one of the following is met:

When a client concludes cancer treatment, is released by the treating physician to return to a schedule of routine screening, and continues to meet BCCP eligibility requirements, then she can re-enroll in the program and receive its services.

Identifying clients that require follow-up

Through the use of tracking and follow-up systems, providers are responsible for identifying women who have abnormal breast and cervical cancer screening findings and require diagnostic services.

Abnormal cervical screening results that require follow-up and tracking include:

To enter additional procedure data:
  1. Enter cervical diagnostic data using the following field instructions:

    2. Field name
    Description
    Notes
    Date of Procedure
    Enter the date in MM/DD/YYYY format. For example, 01/01/2008.
    This field is required if a procedure has been chosen.
    This date must be on or after the client's current enrollment date.
    Procedure service location
    The location(s) at which any additional procedures were conducted on the client.
    This field is required if a procedure has been chosen.
    Procedure Type
    Select one of the following choices:
    • Colposcopy without biopsy
    • Colposcopy with biopsy and/or ECC
    • Loop Electrosurgical Excision Procedure (LEEP)
    • Cold Knife Cone (CKC)
    • Endocervical curettage (ECC) alone
    • HPV test
    • Gynecological consultation
    • Other procedure
    If Additional procedures is chosen in the previous procedure's Follow-up Recommendation, then this field is required.
    Other procedure type
    List any other procedures performed on the client that are not already found in the choices under Procedure Type.
    If Other procedure was chosen in Procedure Type, then this field is required.
    Result
    Select one of the following choices:
    • Normal/benign
    • Cancer
    • Need additional diagnostic work-up
    This field is required if a procedure (other than HPV test) has been chosen under Procedure Type.
    If Cancer has been chosen, then enter information in Final Imaging Outcome and Final Diagnosis and Treatment. Also, refer this client to BCCM.
    If Need additional diagnostic work-up is chosen, then enter another Additional procedure.
    HPV Test Result
    Select one of the following choices:
    • Positive
    • Negative
    • Unknown
    This field is required if a HPV test has been chosen under Procedure Type.
    Follow-up recommendation
    Select one of the following choices:
    • Routine screening
    • Short term follow-up
    • Additional diagnostic procedures
    • Final diagnosis and treatment
    This field is required if a procedure has been chosen.
    Short-term follow-up months
    Enter up to 12 months.
    If Short-term follow-up was chosen in the question above, then this field is required.
    Additional diagnostic procedures
    Select one of the following choices:
    • Colposcopy without biopsy
    • Colposcopy with biopsy and/or ECC
    • Endocervical curettage (ECC) alone
    • HPV test
    • Gynecological consultation
    • Other procedure not covered by BCC program
    If Additional diagnostic procedures was chosen in the Follow-up Recommendation above, then this field is required.

  2. Add another procedure by clicking Add.

    3. Up to eight Additional Procedures may be entered in each cycle.

To update Additional Procedure Data:
To delete Additional Procedure Data:

Final Diagnosis and Treatment

At the conclusion of each cycle, the BCCP provider must reach a conclusion to either diagnose or rule out the possibility of cervical cancer. The BCCP needs to track and report this data, including treatment start date.

Treatment

The BCCP is required to ensure that follow-up of clients with abnormal results occurs and that treatment is initiated for clients with a diagnosis of cancer. The Breast and Cervical Cancer Treatment Act provides Medicaid coverage for breast or cervical cancer treatment to eligible clients screened or diagnosed in the BCCP. The Act allows BCCP to determine presumptive Medicaid eligibility for clients, to facilitate cancer treatment, in the Breast and Cervical Cancer Medical (BCCM) Program in Oregon.

After a cervical biopsy, if a client is diagnosed with one of the following, contact the BCCP state office immediately to begin enrollment into BCCM:

Treatment Requirements

According to the BCCP federal funding requirements, fewer than 30 days may pass between final diagnosis of diagnosis of CIN 2 or higher, or invasive cancer of the cervix, and the initiation of treatment.

To enter final diagnosis and treatment data:
  1. Enter diagnosis and treatment data using the following guidelines:

    2. Field name
    Description
    Notes
    Date of final diagnosis
    Enter the date in MM/DD/YYYY format. For example, 01/01/2008.
    This cannot be a future date.
    If any selection other than Pending is made in Status of final diagnosis, then this field is required.
    Status of final diagnosis
    Select one of the following choices:
    • Complete
    • Pending
    • Lost to follow up
    • Work-up refused
    • Deceased
    • None of the above
    This is a required field.
    Final diagnosis
    • Select one of the following choices:
    • Normal/Benign reaction/inflammation
    • HPV/Condylomata/ Atypia
    • CIN I/mild dysplasia (biopsy diagnosis)
    • CIN II/moderate dysplasia (biopsy diagnosis)
    • CIN III/severe dysplasia/Carcinoma in situ (Stage 0) (biopsy diagnosis)
    • Invasive cervical carcinoma (biopsy diagnosis)
    • Other
    If Complete is chosen in Status of final diagnosis, then this field is required.
    If CIN II, CIN III, or Invasive cervical carcinoma are selected, then refer this client to BCCM.
    "Other" Final diagnosis
    List another final diagnosis that is not already found in the choices under Final diagnosis.
    If Other was chosen in the question above, then this field is required.
    Stage of tumor
    Select one of the following choices:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
    • Summary Local
    • Summary Regional
    • Summary Distant
    • Unknown/Unstaged
    If Invasive Cervical Cancer is chosen in Final diagnosis, then this field is required.
    Treatment status
    Select one of the following choices:
    • Treatment started
    • Treatment pending
    • Lost to follow-up
    • Treatment refused
    • Treatment not needed
    If CIN II, CIN III, or Invasive cervical carcinoma is chosen in Final diagnosis, then this field is required.
    Date of treatment
    Enter the date in MM/DD/YYYY format. For example, 01/01/2008.
    If Treatment started is chosen in Treatment status, then this field is required.
    If Lost to follow-up, Treatment refused, or Treatment not needed is chosen in Treatment status, then enter the date of the client's last diagnostic procedure.
    This cannot be a future date.
    treatment: Client referred to BCCM?
    Was the client referred to the Breast and Cervical Cancer Medical Program? Select Yes or No.
    If CIN II, CIN III, Invasive cervical carcinoma, or Other is chosen in Final diagnosis, then this field is required.

  2. Click Save. A dialog box appears asking if you would like to Close this Cervical Cycle, or Save Cycle.

    3. The message Final diagnosis and treatment section has been saved successfully appears when you save the cycle.

    Once the cervical cycle is saved, the message reading Client cycle information has been saved successfully! appears.

Use a Cervical Voucher for Referrals

The BCCP Web Data System provides voucher forms for providers to use when they refer a client to another provider. The vouchers can be printed from within the Web Data System with the client's name, address, and BCCP identification number filled out.

To print a cervical voucher:
  1. On any of the screen in the Client section of the system, click Cervical Voucher in the Vouchers section on the left side of the screen.



    2. The File Download dialog box appears.

  2. Click Open.

    3. The Cervical Voucher form opens. The system fills in the patient name, BCCP ID number, date of birth, address and phone number fields.

  3. Print the voucher.
  4. Fill in the remaining required fields.

Delete a Cycle

You can delete the most recent cycle from a client record if no claims have been entered into the system and submitted for the cycle. You cannot delete a cycle that has been closed and is not the most recent.

To delete a cycle:
  1. Open the Client Cervical Screening Cycle page for the cycle to be deleted by clicking one of the links in the list.



  2. Scroll to the bottom of the page.
  3. Click Delete Cycle.

Open a Closed Cycle

You can reopen the most recent closed cycle if it becomes necessary. You cannot open cycles that have been closed if they are not the most recent.

To open a closed cycle:
  1. Select the most recent closed breast cycle from the list.
  2. Scroll to the bottom of the page.
  3. Click Open Cycle.

    4. The message Client cycle has been opened successfully apears.

Edit a Cycle

You can edit the most recent cycle recorded for a client without reopening it.

To edit a cycle:
  1. Select the most recent breast cycle from the list.
  2. Scroll to the bottom of the page.
  3. Click Edit Cycle.

Close a Cycle

You can close a cycle when you save it if all the data that the BCCP requires has been entered.

To close a cycle:
  1. On the Client Cervical Screening Cycle page, click Save. The following dialog box appears.



  2. Click Close this Cervical cycle.
  3. Click Continue.

    4. The message Client cycle has been closed successfully apears.

Enter Data for a New Breast Screening
Submit a Claim

Related Topics

Enter Data for a New Breast Screening
Submit a Claim
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Oregon Breast and Cervical Cancer Program
http://www.healthoregon.org/bcc
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