AQI 71: Ambulatory Glucose Management

MEASURE DESCRIPTION:

Percentage of diabetic patients, aged 18 years and older, who receive an office-based or ambulatory surgery whose blood glucose level is appropriately managed throughout the perioperative period.

The measure will consist of four performance rates:

**AQI71a: Percentage of patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery whose blood glucose level is tested prior to the start of anesthesia.

**AQI71b: Percentage of patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level ≥180 mg/dL (10.0 mmol/L) who received insulin prior to anesthesia end time.

**AQI71c: Percentage of patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who received insulin perioperatively and who received a follow-up blood glucose level check following the administration of insulin and prior to discharge.

**AQI71d: Percentage of patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level ≥180 mg/dL (10.0 mmol/L) who received education on managing their glucose in the postoperative period prior to discharge.

NOTE: The overall measure score will be calculated as an average of the performance rates of parts A, B, C and D. In order to be scored on this measure, clinicians must have at least one eligible case reported for each sub-metric: AQI71a, AQI71b, AQI71c, and AQI71d.

NQS DOMAIN/MEANINGFUL MEASURES AREA:
Effective Clinical Care/Healthcare Associated Infections

MEASURE TYPE:
Process

HIGH PRIORITY STATUS:
No

INVERSE MEASURE:
No

INSTRUCTIONS:

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. Registry codes are used to report the numerator of the measure.

RATIONALE:

Diabetes mellitus has been shown to be an important risk factor for surgical site infection and other surgical complications. With increasingly complex procedures being performed in an ambulatory setting, perioperative glucose management is an important aspect of ambulatory anesthesia care. For diabetic patients, preoperative testing of blood glucose levels can provide an important indicator for their intraoperative insulin and care management needs. Despite the importance of glucose testing, evidence shows that it is not consistently performed in the ambulatory setting. Improved preoperative glucose testing can help anesthesia providers better anticipate and manage the needs of their diabetic patients throughout the perioperative period.

**AQI 71a - Ambulatory Point-of-Care Glucose Testing**

MEASURE DESCRIPTION-AQI71a:

Percentage of patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery whose blood glucose level is tested prior to the start of anesthesia.

DENOMINATOR-AQI71a: 

All patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery

Denominator Definition: Office-based and ambulatory surgery is defined as a therapeutic or diagnostic procedure performed in a healthcare facility that does not require an overnight stay (less than 24 hours of care)

• Denominator Criteria (Eligible Cases) AQI71a:

  All patients, aged 18 years and older

  AND

  Diagnosis of diabetes mellitus: 11A41

  AND

  ICD-10CMcode: E10.10, E10.3291, E10.3399, E10.3513, E10.3542, E10.36, E10.49, E10.638, E11.21, E11.3293, E11.3412, E11.3521, E11.3549, E11.37X2, E11.52, E11.649, E13.29, E13.3311, E13.3419, E13.3523, E13.3552, E13.37X9, E13.610, E13.69, E10.11, E10.3292, E10.3411, E10.3519, E10.3543, E10.37X1, E10.51, E10.641, E11.22, E11.3299, E11.3413, E11.3522, E11.3551, E11.37X3, E11.59, E11.65, E13.311, E13.3312, E13.3491, E13.3529, E13.3553, E13.39, E13.618, E13.8, E10.21, E10.3293, E10.3412, E10.3521, E10.3549, E10.37X2, E10.52, E10.649, E11.29, E11.3311, E11.3419, E11.3523, E11.3552, E11.37X9, E11.610, E11.69, E13.319, E13.3313, E13.3492, E13.3531, E13.3559, E13.40, E13.620, E13.9, E10.22, E10.3299, E10.3413, E10.3522, E10.3551, E10.37X3, E10.59, E10.65, E11.311, E11.3312, E11.3491, E11.3529, E11.3553, E11.39, E11.618, E11.8, E13.3211, E13.3319, E13.3493, E13.3532, E13.3591, E13.41, E13.621, E10.29, E10.3311, E10.3419, E10.3523, E10.3552, E10.37X9, E10.610, E10.69, E11.319, E11.3313, E11.3492, E11.3531, E11.3559, E11.40, E11.620, E11.9, E13.3212, E13.3391, E13.3499, E13.3533, E13.3592, E13.42, E13.622, E10.311, E10.3312, E10.3491, E10.3529, E10.3553, E10.39, E10.618, E10.8, E11.3211, E11.3319, E11.3493, E11.3532, E11.3591, E11.41, E11.621, E13.00, E13.3213, E13.3392, E13.3511, E13.3539, E13.3593, E13.43, E13.628, E10.319, E10.3313, E10.3492, E10.3531, E10.3559, E10.40, E10.620, E10.9, E11.3212, E11.3391, E11.3499, E11.3533, E11.3592, E11.42, E11.622, E13.01, E13.3219, E13.3393, E13.3512, E13.3541, E13.3599, E13.44, E13.630, E10.3211, E10.3319, E10.3493, E10.3532, E10.3591, E10.41, E10.621, E11.00, E11.3213, E11.3392, E11.3511, E11.3539, E11.3593, E11.43, E11.628, E13.10, E13.3291, E13.3399, E13.3513, E13.3542, E13.36, E13.49, E13.638, E10.3212, E10.3391, E10.3499, E10.3533, E10.3592, E10.42, E10.622, E11.01, E11.3219, E11.3393, E11.3512, E11.3541, E11.3599, E11.44, E11.630, E13.11, E13.3292, E13.3411, E13.3519, E13.3543, E13.37X1, E13.51, E13.641, E10.3213, E10.3392, E10.3511, E10.3539, E10.3593, E10.43, E10.628, E11.10, E11.3291, E11.3399, E11.3513, E11.3542, E11.36, E11.49, E11.638, E13.21, E13.3293, E13.3412, E13.3521, E13.3549, E13.37X2, E13.52, E13.649, E10.3219, E10.3393, E10.3512, E10.3541, E10.3599, E10.44, E10.630, E11.11, E11.3292, E11.3411, E11.3519, E11.3543, E11.37X1, E11.51, E11.641, E13.22, E13.3299, E13.3413, E13.3522, E13.3551, E13.37X3, E13.59, E13.65

  AND
  
  

  Off Campus-Outpatient Hospital, On Campus – Outpatient Hospital, Ambulatory Surgical Center, and Office-Based Setting: Place of Service Codes 11, 19, 22 or 24
  
  AND

  Patient encounter during the reporting period (CPT): 00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00164, 00170, 00172, 00174, 00176, 00300, 00320, 00322, 00400, 00402, 00404, 00410, 00450, 00454, 00520, 00522, 00524, 00530, 00532, 00534, 00537, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00790, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00851, 00870, 00872, 00873, 00902, 00906, 00910, 00912, 00914, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01202, 01250, 01260, 01320, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01464, 01470, 01472, 01474, 01480, 01520, 01610, 01620, 01622, 01630, 01634, 01638, 01670, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01758, 01760, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01930, 01937, 01938, 01939, 01940, 01941, 01942, 01965, 01966, 01991, 01992

• Denominator Exclusions-AQI71a:

  Procedure <30 minutes duration: 11A45

NUMERATOR-AQI71a:

Patients who received a blood glucose test prior to the start of anesthesia

Numerator Definitions: A multidisciplinary consult should include documentation of a discussion of the frailty screening result and can include consultation initiated by the anesthesiologist or other qualified anesthesia provider with surgery, geriatrics, hospital medicine, palliative care, or other appropriate specialty to help manage the perioperative care of a frail patient.

Numerator Options-AQI71a:

• Performance Met: 

  Patient received a blood glucose test prior to start of anesthesia (11A51)

  OR

  Performance Not Met: 

  Patient did NOT receive a glucose test prior to start of anesthesia (11A52)

**AQI 71b - Ambulatory Hyperglycemia Control**

MEASURE DESCRIPTION-AQI71b:

DENOMINATOR-AQI71b: 

All patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level >180 mg/dL (10.0 mmol/L)

Denominator Definition: Office-based and ambulatory surgery is defined as a therapeutic or diagnostic procedure performed in a healthcare facility that does not require an overnight stay (less than 24 hours of care)

• Denominator Criteria (Eligible Cases)-AQI71b:

  All patients, aged 18 years and older

  AND

  Diagnosis of diabetes mellitus: 11A41

  AND

  ICD-10CM code:(see official documentation for list of ICD codes)
  
  AND
  Off Campus-Outpatient Hospital, On Campus – Outpatient Hospital, Ambulatory Surgical Center, and Office-Based Setting: Place of Service Codes 11, 19, 22 or 24
  
  AND
  Experienced a blood glucose level >180 mg/dL (10.0 mmol/L) prior to anesthesia end time: 11A44
  
  AND
  Patient encounter during the reporting period (CPT): 00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00164, 00170, 00172, 00174, 00176, 00300, 00320, 00322, 00400, 00402, 00404, 00410, 00450, 00454, 00520, 00522, 00524, 00530, 00532, 00534, 00537, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00790, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00851, 00870, 00872, 00873, 00902, 00906, 00910, 00912, 00914, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01202, 01250, 01260, 01320, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01464, 01470, 01472, 01474, 01480, 01520, 01610, 01620, 01622, 01630, 01634, 01638, 01670, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01758, 01760, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01930, 01937, 01938, 01939, 01940, 01941, 01942, 01965, 01966, 01991, 01992

• Denominator Exclusions-AQI71b:

  Procedure <30 minutes duration: 11A45

NUMERATOR-AQI71b:

Patients who received insulin prior to anesthesia end time.

• Numerator Options-AQI71b:

Performance Met:  Patient received insulin prior to anesthesia end time. (11A53)

OR

Performance Not Met:  Patient did NOT receive insulin prior to anesthesia end time. (11A54)

OR

Denominator Exception: Documentation that insulin was not given because patient had severe comorbidities and glucose concentrations between 180 mg/dL and 250 mg/dL (10-13.9 mmol/L). (11A82)

**AQI 71c - Follow-up Glucose Check for Patients Receiving Insulin**

MEASURE DESCRIPTION-AQI71c:

DENOMINATOR-AQI71c: 

All patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who received insulin perioperatively.

Denominator Definition: Office-based and ambulatory surgery is defined as a therapeutic or diagnostic procedure performed in a healthcare facility that does not require an overnight stay (less than 24 hours of care)

• Denominator Criteria (Eligible Cases)-AQI71c:

  All patients, aged 18 years and older

  AND

  Diagnosis of diabetes mellitus: 11A41

  AND

  ICD-10CM code:(see official documentation for list of ICD codes)
  
  AND
  Off Campus-Outpatient Hospital, On Campus – Outpatient Hospital, Ambulatory Surgical Center, and Office-Based Setting: Place of Service Codes 11, 19, 22 or 24
  
  AND
  Patient received insulin perioperatively: 11A55

  
  AND
  Patient encounter during the reporting period (CPT): 

  00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00164, 00170, 00172, 00174, 00176, 00300, 00320, 00322, 00400, 00402, 00404, 00410, 00450, 00454, 00520, 00522, 00524, 00530, 00532, 00534, 00537, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00790, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00851, 00870, 00872, 00873, 00902, 00906, 00910, 00912, 00914, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01202, 01250, 01260, 01320, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01464, 01470, 01472, 01474, 01480, 01520, 01610, 01620, 01622, 01630, 01634, 01638, 01670, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01758, 01760, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01930, 01937, 01938, 01939, 01940, 01941, 01942, 01965, 01966, 01991, 01992

• Denominator Exclusions-AQI71c:

  Procedure <30 minutes duration: 11A45

NUMERATOR-AQI71c:

Patients who received a follow-up blood glucose level check following the administration of insulin and prior to discharge.

• Numerator Options-AQI71c:

Performance Met: Patient received a follow-up blood glucose level check following the administration of insulin and prior to discharge. (11A56)

OR

Performance Not Met: Patient did NOT receive a follow-up blood glucose level check following the administration of insulin and prior to discharge. (11A57)

**AQI 71d - Hyperglycemia Management Patient Education**

MEASURE DESCRIPTION-AQI71d:

DENOMINATOR-AQI71d: 

All patients, aged 18 years and older, with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level >180 mg/dL (10.0 mmol/L).

Denominator Definition: Office-based and ambulatory surgery is defined as a therapeutic or diagnostic procedure performed in a healthcare facility that does not require an overnight stay (less than 24 hours of care)

• Denominator Criteria (Eligible Cases)-AQI71d:

  All patients, aged 18 years and older

  AND

  Diagnosis of diabetes mellitus: 11A41

  AND

  ICD-10CM code:(see official documentation for list of ICD codes)
  
  AND
  Off Campus-Outpatient Hospital, On Campus – Outpatient Hospital, Ambulatory Surgical Center, and Office-Based Setting: Place of Service Codes 11, 19, 22 or 24
  
  AND
  Experienced a blood glucose level >180 mg/dL (10.0 mmol/L) prior to anesthesia end time: 11A44

  
  AND
  Patient encounter during the reporting period (CPT): 

  00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00164, 00170, 00172, 00174, 00176, 00300, 00320, 00322, 00400, 00402, 00404, 00410, 00450, 00454, 00520, 00522, 00524, 00530, 00532, 00534, 00537, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00790, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00851, 00870, 00872, 00873, 00902, 00906, 00910, 00912, 00914, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01202, 01250, 01260, 01320, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01464, 01470, 01472, 01474, 01480, 01520, 01610, 01620, 01622, 01630, 01634, 01638, 01670, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01758, 01760, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01930, 01937, 01938, 01939, 01940, 01941, 01942, 01965, 01966, 01991, 01992

• Denominator Exclusions-AQI71d:

  Procedure <30 minutes duration: 11A45

NUMERATOR-AQI71d:

Patients who received education on managing their glucose in the postoperative period prior to discharge.

Numerator Note: To meet this measure, the anesthesiologist or other member of the care team must provide both oral and written education. Provision of written materials alone is not sufficient.

• Numerator Options-AQI71d:

Performance Met: Patient received education on managing their glucose in the postoperative period prior to discharge. (11A58)

OR

Performance Not Met: Patient did NOT receive education on managing their glucose in the postoperative period prior to discharge. (11A59)