CMS 138v11: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Measure: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement periodif identified as a tobacco user. Three rates are reported:

  1. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period
  2. Percentage of patients aged 18 years and older who were identified as a tobacco user during the measurement period who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period
  3. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator

Denominator 1: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Denominator 2: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period who were screened for tobacco use during the measurement period and identified as a tobacco user

Denominator 3: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Numerator

Numerator 1: Patients who were screened for tobacco use at least once during the measurement period

Numerator 2: Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period

Numerator 3: Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

Denominator Exceptions

None
Denominator Exclusions Exclude patients who are in hospice care for any part of the measurement period

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

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC

CPT: 96156, 96158, 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, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

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

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC

    AND

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

CPT: 96156, 96158, 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, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

Screening for tobacco use is documented in the Past History tab of the patient encounter. The patient must be screened during the Measurement Period.

  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 is ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least two eligible encounters or at least one preventive care encounter during the Measurement Period finalized by the EC

CPT: 96156, 96158, 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, 97161, 97162, 97163, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

CPT: 99395, 99396, 99397, 99411, 99412, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387, 99024, 97802, 97803, 97804

HCPCS: G0438, G0439, G0270, G0271, G0447, S9449, S9452, S9470

Patients who were in hospice care during any part of the Measurement Period will be excluded from the measure.

To document hospice care ambulatory services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

To document hospice care encounter services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9996, G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

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

  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 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

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 during the Measurement Period or in the six months prior to the Measurement Period.

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard
  2. Click Add New Flowsheet
  3. Select the Tobacco Cessation Intervention flowsheet and click Add
  4. Click Add Column
  5. Select Done for Tobacco use cessation education or Referral for cessation counseling
  6. Click OK to save

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.

To document tobacco cessation counseling as a diagnosis, go to Encounter > Assessment and add the following code:

ICD-10: Z71.6

To prescribe a medication for pharmacological therapy, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. 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 AND if they received tobacco cessation intervention during the Measurement Period or in the six months prior to the Measurement Period if identified as a tobacco user.

Numerator 3 can be met by completing the Tobacco Use Screening outlined in Numerator 1 and documenting one of theTobacco Cessation Interventions outlined in Numerator 2.

https://ecqi.healthit.gov/ecqm/ec/2023/cms138v11

 

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