(2024) Electronic Clinical Quality Measures
Description
Percentage of patients aged 12 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.
Three rates are reported:
a. Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period
b. Percentage of patients aged 12 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
c. Percentage of patients aged 12 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
Guidance
Two or more visits require to establish that the eligible clinician has an existing relationship with the patient for certain types of encounters.
To satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.
If a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.
As noted above in the 2021 USPSTF recommendation statement, the current evidence is insufficient to recommend electronic cigarettes (e-cigarettes) for tobacco cessation. However, as noted above in the Definition section, the 2021 USPSTF recommendation also references the US Food and Drug Administration definition of tobacco, which includes e-cigarettes, hookah pens, and other electronic nicotine delivery systems. Therefore, the measure does consider the use of e-cigarettes and other electronic nicotine delivery systems to be tobacco use.
If a patient's tobacco use status is unknown, the patient does not meet the screening requirement and does not meet the numerator for populations 1 or 3. Instances where tobacco use status of "unknown" include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer.
To promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.
This measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received a tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3).
By separating this measure into various reporting rates, the eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance.
The denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users.
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Initial Population
All patients aged 12 years and older were seen for at least two visits or at least one preventive visit during the measurement period.
Date of birth information can be entered in DrChrono in the patient chart under the Demographics tab with the Patient's Date of Birth.
With at least 2 visits or 1 preventative visit during the measurement period
CPT and HCPCS codes
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, 97161, 97162, 97163, 97164, 99411, 99412, 90845, 92521, 92522, 92523, 92524, 92540, 92557, 92625, G0438, G0439
CPT and HCPCS codes can be entered into the billing section for the encounter. Below is an example from the appointment window.
Denominator 1
Equals initial population
Denominator Exclusions
Exclude patients who are in hospice care for any part of the measurement period.
Denominator Exceptions
None
Numerator 1
Patients who were screened for tobacco use at least once during the measurement period.
Tobacco Screening LOINC codes can be entered into the Assessment section in the CQMs tab of the patient's chart to document the screening. Click +New.
| 39240-7 | Tobacco use status CPHS |
| 68535-4 | Have you used tobacco in the last 30 days [SAMHSA] |
| 68536-2 | Have you used smokeless tobacco product in the last 30 days [SAMHSA] |
| 72166-2 | Tobacco smoking status |
Enter or search for the code. Select the appointment and Create.
Numerator Exclusions
Not Applicable
Numerator Exceptions
None
Denominator 2
Equals the Initial Population who were screened for tobacco use during the measurement period and identified as a tobacco user.
SNOWMED Codes to identify tobacco use
| 82302008 | Pipe smoker (finding) |
| 713914004 | User of smokeless tobacco (finding) |
| 428041000124106 | Occasional tobacco smoker (finding) |
| 449869005 | Uses moist tobacco daily (finding) |
| 228499007 | Finding relating to moist tobacco use (finding) |
| 228514003 | Chews plug tobacco (finding) |
| 56771006 | Heavy smoker (over 20 per day) (finding) |
| 228494002 | Snuff user (finding) |
| 449868002 | Smokes tobacco daily (finding) |
| 110483000 | Tobacco user (finding) |
| 450811000124104 | Cigarette smoker (5-9 cigarettes/day) (finding) |
| 228517005 | Chews fine-cut tobacco (finding) |
| 428071000124103 | Heavy tobacco smoker (finding) |
| 160605003 | Heavy cigarette smoker (20-39 cigs/day) (finding) |
| 230060001 | Light cigarette smoker (finding) |
| 81703003 | Chews tobacco (finding) |
| 228516001 | Chews loose-leaf tobacco (finding) |
| 230063004 | Heavy cigarette smoker (finding) |
| 228504007 | User of moist powdered tobacco (finding) |
| 230062009 | Moderate cigarette smoker (finding) |
| 266920004 | Trivial cigarette smoker (less than one cigarette/day) (finding) |
| 228515002 | Chews Twist Tobacco (finding) |
| 65568007 | Cigarette smoker (finding) |
| 428061000124105 | Light tobacco smoker (finding) |
| 160606002 | Very heavy cigarette smoker (40+ cigs/day) (finding) |
| 160604004 | Moderate cigarette smoker (10 -19 cigs/day) (finding) |
| 230064005 | Very heavy cigarette smoker (finding) |
| 59978006 | Cigar smoker (finding) |
| 230065006 | Chain smoker (finding) |
| 77176002 | Smoker (finding) |
| 160619003 | Rolls own cigarettes (finding) |
| 228518000 | Chews products containing tobacco (finding) |
| 56578002 | Moderate smoker (20 or less per day) (finding) |
| 450821000124107 | Cigarette smoker (1 - 4 cigarettes/day) (finding) |
| 230059006 | Occasional cigarette smoker (finding) |
| 449867007 | Uses moist tobacco occasionally (finding) |
| 160603005 | Light cigarette smoker (1 - 9 cigs/day) (finding) |
Denominator 2 Exclusions
Exclude patients who are in hospice care for any part of the measurement period.
Denominator 2 Exceptions
None
Numerator 2
Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period.
The intervention can be achieved through counseling or pharmacotherapy.
| 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | CPT |
| 99407 | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes | CPT |
| 171055003 | Pregnancy smoking education (procedure) | SNOMEDCT |
| 185795007 | Stop smoking monitoring verbal invite (procedure) | SNOMEDCT |
| 185796008 | Stop smoking monitoring telephone invite (procedure) | SNOMEDCT |
| 225323000 | Smoking cessation education (procedure) | SNOMEDCT |
| 225324006 | Smoking effects education (procedure) | SNOMEDCT |
| 310429001 | Smoking monitoring invitation (procedure) | SNOMEDCT |
| 315232003 | Referral to stop-smoking clinic (procedure) | SNOMEDCT |
| 384742004 | Smoking cessation assistance (regime/therapy) | SNOMEDCT |
| 395700008 | Referral to smoking cessation advisor (procedure) | SNOMEDCT |
| 449841000124108 | Referral to tobacco use cessation clinic (procedure) | SNOMEDCT |
| 449851000124105 | Referral to tobacco use cessation counselor (procedure) | SNOMEDCT |
| 449861000124107 | Referral to tobacco use cessation counseling program (procedure) | SNOMEDCT |
| 449871000124100 | Referral to tobacco use quit line (procedure) | SNOMEDCT |
| 702388001 | Tobacco use cessation education (procedure) | SNOMEDCT |
| 710081004 | Smoking cessation therapy (regime/therapy) | SNOMEDCT |
| 711028002 | Counseling about tobacco use (procedure) | SNOMEDCT |
| 713700008 | Smoking cessation drug therapy (regime/therapy) | SNOMEDCT |
CPT codes can be added to the billing section of the visit. Below is an example from the appointment window.
SNOMEDCT codes can be entered in the Intervention section of the CQMs tab of the patient's chart. Click +New.
Next, enter the code directly or search for it. Select the appointment, ordered or performed, and click Create.
Medications prescribed will be documented in the patient's chart when the prescription is sent.
Numerator 2 Exclusions
Not Applicable
Numerator 2 Exceptions
None
Denominator 3
Denominator 3 Exclusions
Exclude patients who are in hospice care for any part of the measurement period.
Denominator 3 Exceptions
None
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.
Numerator 3 Exclusions
Not Applicable
Numerator 3 Exceptions
None