CMS 138v7: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients who meet the following criteria will be included in the denominator:

• Age must be ≥ 18 years at the beginning of the Measurement Period

  AND

• Must have at least two encounters or at least one preventive care encounter during the Measurement Period finalized by the EC/EP

Encounter Codes Eligible for Denominator 1

CPT: 96152, 96150, 96151, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625

Preventive Care Encounter Codes Eligible for Denominator 1

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Patients who meet the following criteria will be included in the denominator:

• Age must be ≥ 18 years at the beginning of the Measurement Period

  AND

• Were screened for tobacco use and identified as a tobacco user

  AND

• Must have at least two encounters or at least one preventive care encounter during the Measurement Period finalized by the EC/EP

Encounter Codes Eligible for Denominator 2

CPT: 96152, 96150, 96151, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625

Preventive Care Encounter Codes Eligible for Denominator 2

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Screening and Identification as a Tobacco User

Screening for tobacco use is documented in the Past History tab of the patient encounter.

1. Go to Encounter > Past History > Structured > Social History
2. Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
3. Select the appropriate patient status from the Smoking Status list or select Y or N for Smokeless Tobacco Use
   1. If populating the Smoking status field, click OK to save

• Selecting Current every day smoker, Current some day smoker, Heavy tobacco smoker, or Light tobacco smoker from Smoking Status identifies a patient as a tobacco user
• Selecting Y for Smokeless Tobacco Use identifies a patient as a tobacco user

Patients who meet the following criteria will be included in the denominator:

• Age must be ≥ 18 years at the beginning of the Measurement Period

  AND

• Must have at least two encounters or at least one preventive care encounter during the Measurement Period finalized by the EC/EP

Encounter Codes Eligible for Denominator 3

CPT: 96152, 96150, 96151, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 92002, 92004, 92012, 92014, 90791, 90792, 90832, 90834, 90837, 90845, 92521, 92522, 92524, 92540, 92557, 92625

Preventive Care Encounter Codes Eligible for Denominator 3

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

A patient will be counted as an exception for Denominator 1 if there is documentation of a medical reason for not screening for tobacco use.

To document an exception from the Tobacco Cessation Intervention flowsheet:

1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
2. Click Add New Flowsheet
3. Select the Tobacco Cessation Intervention flowsheet and click Add
4. Click Add Column
5. Select a Value from the Patient excluded due to the following reason list
6. Click OK to save

A patient will be counted as an exception for Denominator 2 if there is documentation for not providing tobacco cessation intervention.

To document an exception from the Orders/Procedure tab:

1. Go to Encounter > Orders/Procedure > Orders/Referrals
2. Click Add to add one of the following eligible codes:
   1. CPT: 99406, 99407
3. Order Status must be Not Performed
4. Not Performed Reason must be Medical contraindication, Procedure contraindication, or Treatment not tolerated
5. Click Add to save

A patient will be counted as an exception for Denominator 3 if there is documentation for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users.

Exceptions for Denominator 3 can be performed using the steps outlined in Denominator Exception 1 and Denominator Exception 2.

A patient will be counted in Numerator 1 if they were screened for tobacco use at least once during the Measurement Period or in the 12 months before the start of the Measurement Period. If a patient received multiple screenings, the most recent screening will be counted toward the numerator.

Tobacco Use Screening

1. Go to Encounter > Past History > Structured > Social History
2. Select the hardcoded Smoking status node or the hardcoded Smokeless Tobacco Use node
3. Select the appropriate patient status from the Smoking Status list or select Y or N for Smokeless Tobacco Use
   1. If populating the Smoking status field, click OK to save

Note

Selecting a Smoking Status of Unknown if ever smoked is equivalent to not performing a screening, and patients with this status will not be counted in the numerator

Tip

If a tobacco use screening was already documented during a previous visit, and there have been no changes to the patient’s tobacco use status, selecting the Social History checkbox from Areas Reviewed in Past History will continue to count the patient toward the numerator on subsequent eligible encounters.

A patient will be counted in Numerator 2 if they received tobacco cessation intervention on the day they were identified to be a tobacco user or any time before the end of the Measurement Period.

Tobacco Cessation Interventions

Document an Intervention from the Tobacco Cessation Intervention Flowsheet

1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
2. Click Add New Flowsheet
3. Select the Tobacco Cessation Intervention flowsheet and click Add
4. Click Add Column
5. Select Done for Advised to quit, Referral for Cessation Counseling, or Pharmacological therapy or populate a value for Other Intervention
6. Click OK to save

Procedure Codes

To document tobacco cessation counseling as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99406, 99407

Order Status must be marked as Complete in order to count toward the numerator.

Medication

To prescribe a medication for pharmacological therapy, go to Encounter > Medications > Manage/Prescribe Meds > Prescribe a Medication. A comprehensive list of eligible tobacco use cessation medications can be located here.

A patient will be counted in Numerator 3 if they were screened for tobacco use at least once during the Measurement Period or in the 12 months before the start of the Measurement Period AND if they received tobacco cessation intervention on the day they were identified to be a tobacco user or any time before the end of the Measurement Period if identified as a tobacco user.

Numerator 3 can be met by following the steps for Tobacco Use Screening outlined in Numerator 1 and for documenting Tobacco Cessation Interventions outlined in Numerator 2.