MEASURE DESCRIPTION:
The percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure
NQS DOMAIN/MEANINGFUL MEASURE AREA:
Effective Clinical Care/Prevention and Treatment of Opioid and Substance Use Disorders
MEASURE TYPE:
Intermediate Outcome
HIGH PRIORITY STATUS:
Yes
INSTRUCTIONS:
This measure is to be submitted each time an elective surgery, diagnostic, or pain procedure is performed under anesthesia during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the listed anesthesia services as specified in the denominator coding will submit this measure.
MEASURE SUBMISSION TYPE:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
DENOMINATOR:
All patients aged 18 years and older who are evaluated in preparation for elective surgical, diagnostic, or pain procedure requiring anesthesia services and identified as a current smoker prior to the day of the surgery or procedure with instruction from anesthesiologist or proxy to abstain from smoking on the day of surgery or procedure.
Denominator Note: Preoperative smoking cessation instruction can be performed by an anesthesiologist or proxy, including but not limited to a surgeon, nursing staff, or other preoperative care team member, as part of preoperative evaluation.
- Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of service
AND
Patient procedure during the performance period (CPT):
00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01402, 01404, 01420, 01430, 01432, 01482, 01484, 01486, 01490, 01500, 01638, 01650, 01652, 01654, 01656, 01742, 01744, 01756, 01758, 01760, 01840, 01842, 01844, 01850, 01852, 01932, 01933, 01935, 01936, 01951, 62320, 62321, 62322, 62323, 62324, 64415, 64416, 64417, 64418, 64420, 64450, 64455, 64461, 64463, 64479, 64517, 64520, 64530, 0228T, 0230T, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01670, 01680, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01860, 01916, 01920, 01922, 01924, 01925, 01926, 01930, 01931, 01952, 01958, 01960, 01961, 01966, 01991, 01992, 27095, 27096, 62325, 62326, 62327, 64400, 64405, 64408, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64483, 64486, 64487, 64488, 64489, 64490, 64493, 64505, 64510
AND
Current smoker (e.g. cigarette, cigar, pipe, e-cigarette or marijuana): G9642
AND
Elective surgery: G9643
AND
Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery: G9497
NUMERATOR:
Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
Numerator Definitions:
Abstinence - Defined by either patient self-report or an exhaled carbon monoxide level of < 10 ppm.
-
Numerator Options:
Performance Met: Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure (G9644)
OR
Performance Not Met: Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure (G9645)
RELEVANT FIELDS:
- Date of service
- Date of birth
- ASA CPT code
- Smoker status
- Elective case
- Received cessation instructions
- Smoked on day of procedure
RATIONALE:
Each year, approximately 10 million cigarette smokers require surgery and anesthesia in the U.S. Smoking is a significant independent risk factor for perioperative heart, lung, and wound-related complications. There now is good evidence that perioperative abstinence from smoking reduces the risk of heart, lung, and wound-related perioperative complications, and that the perioperative period represents a “teachable moment” for smoking cessation that improves long-term abstinence rates. While a longer duration of abstinence is associated with a greater benefit for patients, even just abstinence on the morning of surgery is associated with reduced levels of nicotine and carbon monoxide levels and a reduced risk of myocardial ischemia and surgical site infections. Evidence shows that perioperative tobacco cessation interventions can 1) increase perioperative abstinence rates in surgical patients who smoke and 2) decrease the rate of perioperative complications. Recent reviews identified a range of effective interventions, from brief counseling to the use of behavioral therapy and pharmacotherapy, that physicians who care for surgical patients (e.g., anesthesiologists and surgeons) can incorporate into their practices to improve perioperative smoking abstinence. Unfortunately, evidence also suggests that few of these physicians take advantage of the opportunity to intervene, and that many surgical patients still smoke even on the morning of surgery. If more surgical patients get help to quit smoking around the time of surgery, this will both reduce the rate of smoking-related perioperative complications such as wound infection, and lead to long-term improvements in health, as the average smoker gains 6-8 life years if they quit. Thus, this measure on abstinence on the morning of surgery not only directly affects acute surgical risk, but also serves as a marker for the provision of effective preoperative tobacco use interventions.
REPORTING CODES: