NQF 0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Measure: Record the percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.
Numerator: The number of patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation intervention if identified as a tobacco user.
Denominator: All patients aged 18 years and older seen for at least two visits OR at least one preventive visit during the measurement period.
Exception: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason).
NQS Domain: Population/Public Health

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient, who is at least 18 years old, for at least 2 visits OR at least 1 preventive visit during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*: 

At least one of the following:  

• One or more Preventive Visit or Face-to-Face Encounter Codes during the measurement period

Valid Preventive Visit Encounter Codes: 

CPT: 
CodeDescription
99385Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
99386Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
99387Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
99397Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
99411Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
99412Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
99420Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal)
99429Unlisted preventive medicine service
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

 

SNOMED: 
CodeDescription
12843005Subsequent hospital visit by physician (procedure)
18170008Subsequent nursing facility visit (procedure)
19681004Nursing evaluation of patient and report (procedure)
87790002Follow-up inpatient consultation visit (procedure)
90526000Initial evaluation and management of healthy individual (procedure)
185349003Encounter for "check-up" (procedure)
185463005Visit out of hours (procedure)
185465003Weekend visit (procedure)
207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
270427003Patient-initiated encounter (procedure)
270430005Provider-initiated encounter (procedure)
308335008Patient encounter procedure (procedure)
390906007Follow-up encounter (procedure)
406547006Urgent follow-up (procedure)
439708006Home visit (procedure)

Valid Face-to-Face Interaction Codes:

• Two or more office visit codes during the measurement period
CPT:  
CodeDescription
90791Psychiatric diagnostic evaluation
90792Psychiatric diagnostic evaluation with medical services
90832Psychotherapy, 30 minutes with patient and/or family member
90834Psychotherapy, 45 minutes with patient and/or family member
90837Psychotherapy, 60 minutes with patient and/or family member
90845Psychoanalysis
92002Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92004Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
92012Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92014Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
96150Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment
96152Health and behavior intervention, each 15 minutes, face-to-face; individual
97003Occupational therapy evaluation
97004Occupational therapy re-evaluation
99201Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99203Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99205Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.

Required Data Elements for the Numerator*: 

• Smoking history documented in the Smoking Button (in a note)

AND, if the patient is a tobacco user, at least ONE of the following must also be documented:  

• Cessation Materials/Counseling Provided Documented in the Smoking Button (in a note)

• Medication for Tobacco Use Cessation Pharmacotherapy within the 24 months prior to the end of the measurement period
  • {11 (varenicline 0.5 MG Oral Tablet) / 42 (varenicline 1 MG
    Oral Tablet) } Pack
  • {14 (24 HR Nicotine 0.292 MG/HR Transdermal Patch) / 14
    (24 HR Nicotine 0.583 MG/HR Transdermal Patch) / 28 (24
    HR Nicotine 0.875 MG/HR Transdermal Patch) } Pack
  • {56 (varenicline 1 MG Oral Tablet) } Pack
  • 12 HR Bupropion Hydrochloride 100 MG Extended Release
    Oral Tablet
  • 12 HR Bupropion Hydrochloride 150 MG Extended Release
    Oral Tablet
  • 12 HR Bupropion Hydrochloride 200 MG Extended Release
    Oral Tablet
  • 168 HR Clonidine 0.00417 MG/HR Transdermal Patch
  • 168 HR Clonidine 0.00833 MG/HR Transdermal Patch
  • 168 HR Clonidine 0.0125 MG/HR Transdermal Patch
  • 200 ACTUAT Nicotine 0.5 MG/ACTUAT Nasal Inhaler
  • 24 HR Bupropion hydrobromide 174 MG Extended Release Oral
    Tablet
  • 24 HR Bupropion hydrobromide 348 MG Extended Release
    Oral Tablet
  • 24 HR Bupropion hydrobromide 522 MG Extended Release
    Oral Tablet
  • 24 HR Bupropion Hydrochloride 150 MG Extended Release
    Oral Tablet
  • 24 HR Bupropion Hydrochloride 300 MG Extended Release
    Oral Tablet
  • 24 HR Nicotine 0.292 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.313 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.458 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.583 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.625 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.875 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.917 MG/HR Transdermal Patch
  • 24 HR Nicotine 0.938 MG/HR Transdermal Patch
  • Nicotine 2 MG Chewing Gum
  • Nicotine 2 MG Oral Lozenge
  • Nicotine 4 MG Chewing Gum
  • Nicotine 4 MG Oral Lozenge
  • Nicotine 4 MG/ACTUAT Inhalant Solution
  • Nortriptyline 10 MG Oral Capsule
  • Nortriptyline 2 MG/ML Oral Solution
  • Nortriptyline 25 MG Oral Capsule
  • Nortriptyline 50 MG Oral Capsule
  • Nortriptyline 75 MG Oral Capsule
  • topiramate 100 MG Oral Tablet
  • topiramate 15 MG Oral Capsule
  • topiramate 200 MG Oral Tablet
  • topiramate 25 MG Oral Capsule
  • topiramate 25 MG Oral Tablet
  • topiramate 50 MG Oral Tablet
  • varenicline 0.5 MG Oral Tablet
  • varenicline 1 MG Oral Tablet
  • EXCEPTION DETAILS: 

    This measure makes an exception for patients who were not screened for tobacco use due to a documented medical reason.  In order to meet the requirements for this exception, the appropriate information must be documented in the chart (at least one of the following):

    • Tobacco Screening Not Performed for Medical Reasons documented in the Smoking Button (in a note)

    smoking button - screening not performed

    • Limited Life Expectancy Diagnosis (SNOMED) Code that starts during or before (but does not end prior to) the measurement end date
    SNOMED:  
    CodeDescription
    27143004Patient status determination, pre-terminal (finding)
    170969009Prognosis bad (finding)
    162607003Terminal illness - early stage (finding)
    162608008Terminal illness - late stage (finding)
    300936002Terminal illness (finding)

    *ADDITIONAL INFORMATION: 

    •  In order for successful calculation of this measure, the most recent version of ChartMaker Clinical 2016 must be used.

    •  The codes used for the numerator must be documented within the last 24 months prior to the measurement END date.

    •  The additional fields in the smoking button are optional

    •  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

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