WCHQ Ambulatory Measure Specification
WCHQ 16 - Adult Tobacco Use: Screening for Tobacco Use
Measurement Period 01/01/2016- 12/31/2016
Process Measure Type
NQS Domain: Population/Public Health
MEASURE DESCRIPTION
This measure assesses the percentage of patients who have their tobacco status documented in the medical record during the last 12 months [Measurement Period].
Disclaimer: Measures reported by WCHQ healthcare organizations represent a specific aspect of care in relation to an evidence-based standard, but are not clinical guidelines and do not establish standards of care. All providers should have an individual care plan established with their patient.
General Information/Rationale
Tobacco use has been cited as the chief avoidable cause of illness and death in our society. Each year in the United States, more than 435,000 deaths are attributed to tobacco use. Smoking-attributable health care expenditures are estimated at $96 billion per year in direct medical expenses and $97 billion in lost productivity.
Epidemiological data suggest that more than 70 percent of the 45 million current smokers in the United States report a desire to quit. It is important for clinicians to know that assessing and treating tobacco use leads to greater patient satisfaction with health care (U.S. DHHS, 2008).
Reference: Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. Retrieved May 7, 2008 from, http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
Definitions
12 Months: Measurement Period
24 Months: Measurement Period + Prior Year
Office Visit: Office visit in an outpatient, non-urgent care setting
Encounter: Any type of visit to any type of service
PCP: For WCHQ measure purposes, a primary care provider is defined as any General Practice, Internal Medicine, Family Practice, Pediatrics (MD, DO, PA, NP) and any other practitioners identified by the healthcare system as primary care practitioners. The rationale for the additional practitioner(s) must be documented and must be applied consistently across all preventive care and chronic care measures by the organization.
Age Range 18-85: Patients born between 01/01/1931 and 01/01/1998.
Denominator Description
Patients whose age at the beginning of the one year measurement period is at least 18 and whose age at the end of the measurement period is less than 86 and are alive as of the last day of the Measurement Period. Expired patients for whom a specific date of expiration cannot be found are excluded from the denominator population
The rationale for the denominator population is built from the following criteria:
[Question 1] – Is this patient eligible?
[Question 2] - Is this patient whose care is managed within the physician group?
[Question 3] – Is this a patient currently managed in our system?
Encounter dataPatients eligible for inclusion in the denominator include:
[Question 1] – Is this patient eligible?
Patient is greater than or equal to 18 and less than or equal to 85 years of age at the
start of the Measurement Period.
[Question 2] – Is this a patient whose care is managed within the physician group?
Patients who had at least two office visits (Table T-1), regardless of diagnosis code, on different dates of service, to a PCP in the past 24 months.
[Question 3] – Is this a patient current in our system?
Those who had at least one office visit (Table T-1), regardless of diagnosis code, with a PCP during the last 12 Months [Measurement Period].
NUMERATOR DESCRIPTIONSSCREENING FOR TOBACCO USE
The number of patients in the denominator who had their tobacco status documented at a minimum of one encounter with any provider during the Measurement Period.
Tobacco Use Definition:
· Cigarette
· Cigar
· Pipe Smoking
· Smokeless Tobacco (Chewing Tobacco, Snuff, etc.)
Tobacco Use Status can be identified by any of the following three criteria:
1. Documentation stating that the patient has been asked if they are one of the following during the Measurement Period:
a. Current tobacco user
b. Former tobacco user
c. Non-tobacco user
2. Documentation indicating that tobacco use was verified (i.e. Yes/No flag) during the Measurement Period regardless of status of tobacco use
3. ICD-9, CPT, HCPCS and CPT-II Codes indicating tobacco use status during the Measurement Period) from billing or encounter data only. Do not use the problem list.
(Table T-2)
Adult Tobacco Use: Screening for Tobacco Use – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous for coding and other changes
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WCHQ Ambulatory Measure Specification
WCHQ 16 - Adult Tobacco Use: Screening for Tobacco Use
Measurement Period 01/01/2015- 12/31/2015
Process Measure Type
NQS Domain: Population/Public Health
Internally Developed Codes – Data Translation/Mapping RequirementsIf a medical group utilizes internally generated codes to identify specific services or events required for a given WCHQ performance measure, the group may translate or map the information to the WCHQ performance measurement specifications. The medical group must assure that the internally generated code matches the clinical specificity of the standard (ICD-9, CPT) codes included in the WCHQ performance measurement specifications.
In order to use internally developed codes for WCHQ performance measure reporting, the medical group needs to document the translation/mapping to the codes in the specifications. This documentation should include the internally generated code, a description of the internally developed code, any additional clinical information for the internally developed code, and the equivalent standard code with description from the WCHQ performance measurement specifications. Once the translation/ mapping documentation is established, the medical group’s WCHQ performance measurement team must review the mapping on a yearly basis and document that internally developed codes have not changed and are being used in the manner described in the translation/ mapping document.
The medical group must have documented processes in place for adding codes to the medical group’s administrative data system and procedures to implement the internally developed codes.
Medical Record Review for Numerator Inclusion/Denominator Exclusion
If appropriate, and/or when necessary, every organization may complement their electronic capture of patient medical history with electronic or manual record review. The following criteria apply only to data captured/reviewed during medical record review.
For WCHQ Adult Tobacco Use Performance Measure, proof of Numerator compliance requires:
· Date tobacco use status is documented or coded (For Screening Numerator)
Denominator Exclusion
For all WCHQ Measures proof of Denominator exclusion requires:
ü Existence of exclusion criteria:
o NOTE: No exclusions apply to this measure
This data may be retrieved, in whole or in part, from any of the following:
· Notation in Progress Note
· Notation in Medical History or Surgical History
· Flag/Field in Electronic Medical Record
· Documentation in patient chart
REQUIRED DATA SUBMISSION FIELDSFields required for data submission for this measure depend upon the methodology used. The fields are as follows:
TOTAL POPULATION METHODOLOGY:
· Population Denominator (N) (Patients greater than or equal to 18 or less than or equal to 85 years of age)
· Numerators
1. The number of eligible patients in the denominator, who have documentation of tobacco use status within the Measurement Period.
2. The number of eligible patients (subset of numerator #1) identified as current Tobacco Users who have documentation of tobacco cessation advice within the Measurement Period.
Upon entry of these numbers, the rate is automatically calculated
FIELDS REQUIRED FOR MEASURE VALIDATIONValidation of this measure will require patient level data files for Administrative Data and/or for Manual Review. The following indicates fields needed for validation, which may be helpful to consider when querying the measure:
Denominator Data File fields:
1. Patient Identifier (does not need to be de-identified)
2. Office Visit Dates
3. Provider Specialty
4. Patient Date of Birth
Numerator Data File fields:
Numerator #1 (Screening for Tobacco Use)
1. Patient Identifier (does not need to be de-identified)
2. Most recent documented status or verification flag or code
3. Encounter date associated with tobacco use status or verification documentation or code
Appendix A
Primary Payer
In keeping with the changing atmosphere of quality measurement and reporting, WCHQ would like for participating organizations to include the primary payer source with their data submissions for the ambulatory care measures.
The primary payer source should be identified in the denominator upon answering the question, “Is this patient current in our system?” Once it has been determined that a patient is current because of a visit to their physician within the specified time period (12 months for chronic care measures and 24 months for preventive care measures), the payer should be “pulled” into the query. The primary payer should be the payer at the most recent office visit within the measurement period.
There will be four categories of primary payer that will need to be submitted to WCHQ via the data submission tool: Medicare FFS, Medicaid (all types), Commercial (including Medicare HMO) and Uninsured/Self-Pay. The raw numbers for the denominator and numerator should be included for all three types of data submission, total population, hybrid, and sample.
Rationale
Opportunities exist for WCHQ to collect and report data on specific populations, like the Medicare population, through grant applications to begin to understand the disparities in quality of care. The purpose of this is to begin to understand the challenges of putting in additional data elements and complexities of data display for public reporting. At this time, the primary payer information will not be publicly reported.
Definitions:
Commercial: All plans not Medicaid or Medicare FFS (Includes VA, DoD, etc.)
FFS Medicare: FFS plans, not Medicare HMO (Medicare Railroad is FFS Medicare)
Medicaid: All Medicaid plans including those managed by commercial plans
Uninsured: Self-pay individuals
Appendix B
table T-1: Office Visit Encounter Codes
CPT Codes / Description99201-99205 / Office or OPa visit E&Mb, new patient
99212-99215 / Office or OP visit E&M, established patient
99241-99245 / Office or other OP consultations
99347-99350 / Home visit for evaluation and management of an established patient
99384-99387 / Initial preventive medicine E&Mb
99394-99397 / Periodic preventive medicine E&Mb
99401-99404 / Preventive medicine counseling
99411 / Preventive medicine counseling, group
99412 / Preventive medicine counseling, group
99420 / Risk assessment, admin and interpretation
99429 / Unlisted preventive medicine service
HCPCS Code / Description
G0344
(Terminated 12/31/08) / Initial preventive physical examination; face-to-face visit services limited to new beneficiary during the first six months of Medicare enrollments
G0402
(Effective 01/01/09) / Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0438 / Annual wellness visit; includes a personalized prevention plan of service, initial visit
G0439 / Annual wellness visit; includes a personalized prevention plan of service, subsequent visit
a outpatient
b evaluation and management
Table T-2: Codes to Identify Tobacco Use Status
ICD-9 Diagnosis Codes / Description305.1 / Tobacco Use Disorder, Tobacco Dependence
649.0x / Tobacco Use Disorder Complicating Pregnancy
Effective 10/01/2015
ICD-10-CM Diagnosis Codes / DescriptionF17.200 / Nicotine dependence, unspecified, uncomplicated
O99.330 / Smoking (tobacco) complicating pregnancy, unspecified trimester
O99.331 / Smoking (tobacco) complicating pregnancy, first trimester
O99.332 / Smoking (tobacco) complicating pregnancy, second trimester
O99.333 / Smoking (tobacco) complicating pregnancy, third trimester
O99.334 / Smoking (tobacco) complicating childbirth
O99.335 / Smoking (tobacco) complicating the puerperium
CPT Codes / Description
99406 / Smoking and Tobacco Use Cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 / Smoking and Tobacco Use Cessation counseling visit; intensive, greater than 10 minutes
HCPCS Codes / Description
C9801
Added 08/25/2010 and deleted 12/31/2010. Replaced with G0436 / Smoking and Tobacco Cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
C9802
Added 08/25/2010 and deleted 12/31/2010. Replaced with G0437 / Smoking and Tobacco Cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
D1320 / Tobacco Counseling for the Control and Prevention of Oral Disease
G0436 / Smoking and Tobacco Cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
G0437 / Smoking and Tobacco Cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
G8402 / Tobacco (smoke) use cessation intervention, counseling
G8403 / Tobacco (smoke) use cessation intervention not counseled
G8453 / Tobacco use cessation intervention, counseling
G8454 / Tobacco use cessation intervention not counseled, reason not specified
G8455 / Current Tobacco Smoker
G8456 / Current Smokeless Tobacco User
G8457 / Tobacco Non-User
G8686 / Currently a tobacco smoker or current exposure to secondhand smoke
G8687 / Currently a tobacco non-user and no exposure to secondhand smoke
G8688 / Currently a smokeless tobacco user (e.g. chew, snuff) and no exposure to secondhand smoke
G8690 / Current tobacco smoker or current exposure to secondhand smoke
G8691 / Current tobacco nonuser and no exposure to secondhand smoke
G8692 / Current smokeless tobacco user (e.g. chew, snuff) and no exposure to secondhand smoke
S4995 / Smoking Cessation Gum
S9075 / Smoking Cessation Treatment
S9453 / Smoking classes, nonphysician provider, per session
CPT Category II Codes / Description
**1034 F / Current Tobacco Smoker
**1035 F / Current Smokeless Tobacco User (eg. chew, snuff)
**4000 F / Tobacco use cessation intervention, counseling
**4001 F / Tobacco use cessation intervention, pharmacological therapy
**4004F / Patient screened for tobacco use AND received tobacco cessation counseling, if identified as a tobacco user.
Adult Tobacco Use Performance Measures – Final 2013
This specification is updated annually; refer to previous for coding and other changes
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