AQI 18: Coronary Artery Bypass Graft (CABG): Prolonged Intubation - Inverse Measure

NQS DOMAIN:
Effective Clinical Care

MEASURE TYPE:
Outcome

HIGH PRIORITY STATUS:
Yes

INVERSE MEASURE:
Yes

INSTRUCTIONS:
This measure is to be reported each time an isolated CABG procedure is performed during the reporting period. It is anticipated that qualified anesthesia providers and eligible clinicians who provide services for isolated CABG will submit this measure. This measure is intended to reflect the quality of services provided for isolated CABG or isolated reoperation CABG patients.

Measure Reporting via the Qualified Clinical Data Registry
CPT codes and patient demographics are used to identify patients who are included in the measure’s denominator. The measure must capture both the surgical and related anesthesia code. G-codes are used to report the numerator of the measure.

DENOMINATOR:
All patients, aged 18 years and older, undergoing isolated CABG surgery

Denominator Definition: Isolated CABG refers to CABG using arterial and/or venous grafts only.

• Denominator Criteria (Eligible Cases):

  Patient aged 18 years and older on date of encounter

  AND

  Patient encounter during the reporting period (CPT): 

  33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
  
  AND

  00566, 00567

  OR

  Patient encounter during the reporting period (CPT):
  
  33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
  
  AND
  
  Patient encounter during the reporting period (CPT): 33530
  
  AND
  
  00562

• Denominator Exclusions:

  Organ donors as designated by ASA Physical Status 6

  Procedure reduced or discontinued prior to initiation of CPB as indicated on the claim by Modifier 52 or Modifier 53

NUMERATOR:
Patients who require intubation > 24 hours following exit from the operating room.

• Numerator Options:

  Performance Met: Prolonged postoperative intubation (>24 hrs) required (G8569)

  OR

  Performance Not Met: Prolonged postoperative intubation (>24 hrs) not required (G8570) 

RELEVANT FIELDS:

• Date of Service

• Date of Birth

• ASA CPT Code

• Isolated CABG Surgery

• Intubation (>24 hrs) required

RATIONALE:

Prolonged intubation and/or prolonged ventilation following coronary artery bypass graft (CABG) surgery is associated with increased mortality and morbidity.1 A review of the literature suggests several predictors associated with prolonged ventilation following CABG including increased incidence of pneumonia and pulmonary atelectasis, history of hypertension, COPD, kidney disease and endocarditis among others.2 Most complications were associated with prolonged length of stay in the ICU and hospital and increased resource use.

REPORTING CODES: