• Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention


    Updated March 2019. Additions in red.

    Reporting Options: 

    • IRIS Registry EHR: groups and individuals
    • IRIS Registry manual entry: groups and individuals
    • EHR through your vendor (if offered): groups and individuals
    • Claims-based reporting: small practices only (group and individual)

    Measure Type: Process 

    NQS Domain: Community/Population Health

    Meaningful Measure Area: Prevention and Treatment of Opioid and Substance Use Disorders

    2019 additions in red

    Instructions: This measure now includes three parts.  According to CMS, you are to use all codes that are applicable.  This means you may have one or more that apply to your patient.  This measure is to be submitted once per performance period for patients, aged 18 years and older, who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user.

    For the purposes of the measure, the most recent denominator eligible encounter should be used to determine if the numerator action for each of the submission criteria was performed within the 24 month look back period from the date of the denominator eligible encounter.

    Definitions

    • Tobacco use – Includes any type of tobacco
    • Tobacco-cessation intervention – Includes brief counseling (3 minutes or less), and/or pharmacotherapy. Note: For the purpose of this measure, brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) qualifies for the numerator. Written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies do not qualify for the numerator.

    There are three reporting components for this measure. Be sure to append as many codes as applicable to your patient:

    • Part 1: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months
    • Part 2: Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention
    • Part 3: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

    To Which Patients Does the Measure Apply?

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

    Part 1: Patients screened one or more times (no intervention)

    2019 additions in red

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

    Diagnosis Codes

    This measure does not require a specific diagnosis to be submitted during the encounter.

    CPT Codes

    90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96150, 96151, 96152, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

    2019 deletion of CPT codes 96160, 96161

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: * Signifies that this CPT Category I code is a non-covered service under the PFS. These non-covered services will not be counted in the denominator population for claims-based measures.

    How to Report the Measure, Claims and IRIS Registry Manual Reporting

    Numerator: Patients who were screened for tobacco use at least once within 24 months 

    Numerator note: In the event that a patient is screened for tobacco use and tobacco status is unknown, submit G9905. Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter for all submission criteria.

    HCPCS Codes

    • Performance met (patient included in numerator and denominator): G9902 Patient screened for tobacco use AND identified as a tobacco user
      G9903 Patient screened for tobacco use AND identified as a tobacco non-user
    • Denominator exception (patient not included in numerator or denominator): G9904 Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
    • Performance not met (patient not included in numerator, but included in denominator): G9905 Patient not screened for tobacco use, reason not given

    Part 2: Patients screened and a user who received intervention

    2019 additions in red

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

    This includes all eligible instances when G9902 is submitted for Performance Met (patient screened for tobacco use and identified as a tobacco user) in the numerator of Part 1.

    Diagnosis Codes

    This measure does not require a specific diagnosis to be submitted during the encounter.

    CPT Codes

    90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96150, 96151, 96152, 96160, 96161, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

    2019 deletion of CPT codes 96160, 96161

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: *Signifies that this CPT Category I code is a non-covered service under the PFS. These non-covered services will not be counted in the denominator population for claims-based measures.

    How to Report the Measure, Claims and IRIS Registry Manual Reporting

    Numerator: Patients who received tobacco cessation intervention

    Numerator note: This measure defines tobacco cessation counseling as lasting 3 minutes or less. Services typically provided under CPT codes 99406 and 99407 satisfy the requirement of tobacco cessation intervention, as these services provide tobacco cessation counseling for 3-10 minutes.

    If a patient received these types of services, submit G-code G9906. Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter for all submission criteria.

    HCPCS Codes

    Patient screened for tobacco use AND identified as a tobacco user that are utilized in submission of Performance Met Patient Screened for Tobacco Use, Identified as a Tobacco User in the numerator for submission part 1 should also submit G9902 when appropriate.

    • Performance met (patient included in numerator and denominator): G9906 Patient received tobacco cessation intervention (counseling and/or pharmacotherapy)
    • Denominator exception (patient not included in numerator or denominator):G9907 Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason)
    • Performance not met (patient not included in numerator, but included in denominator): G9908 Patient did not receive tobacco cessation intervention (counseling and/or pharmacotherapy), reason not given

    Part 3: Patients screened one or more times, with intervention if a user

    2019 additions in red

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

    Diagnosis Codes

    This measure does not require a specific diagnosis to be submitted during the encounter.

    CPT Codes

    90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96150, 96151, 96152, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

    2019 deletion of CPT codes 96160, 96161

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: * Signifies that this CPT Category I code is a non-covered service under the PFS. These non-covered services will not be counted in the denominator population for claims-based measures.

    How to Report the Measure, Claims and IRIS Registry Manual Reporting

    Numerator: 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

    Numerator note: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation intervention, or if tobacco status is unknown, submit 4004F with 8P. This measure defines tobacco cessation counseling as lasting 3 minutes or less. Services typically provided under CPT codes 99406 and 99407 satisfy the requirement of tobacco cessation intervention, as these services provide tobacco cessation counseling for 3-10 minutes. If a patient received these types of services, submit CPT II 4004F. Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter for all submission criteria.

    HCPCS Codes

    • Performance met (patient included in numerator and denominator): 4004F Patient received tobacco cessation intervention (counseling and/or pharmacotherapy)
      1036F Current tobacco non-user
    • Denominator exception (patient not included in numerator or denominator): 4004F 1P Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
      G9909 Documentation of medical reason(s) for not providing tobacco cessation intervention if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
    • Performance not met (patient not included in numerator, but included in denominator): 4004F 8P Tobacco screening not performed OR tobacco cessation intervention not provided, reason not otherwise specified 

    IRIS Registry EHR Reporting

    Instructions: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user.

    These rates are reported:

    1. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months.
    2. Percentage of patient s aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention.
    3. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user.

    These are the required elements to be documented at least once a year to meet the measure performance requirements.

    • Screened for tobacco use at least once within 24 months (documentation of screening and identifying non-tobacco users will count toward performance).
    • If tobacco smoker, received advice to quit smoking.

    How CMS Scores Your Performance

    No scoring benchmark currently exists for this QCDR measure.

    If 19 or fewer physicians each report the measure or 20 physicians do not report the measure on at least 60 percent of qualifying patients, and a minimum of 20 patients, you will earn 3 out of 10 points toward your total quality score. Choose measures assuming you’ll only earn 3 points.

    If at least 20 physicians report the measure on at least 60 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2019 reporting year.

    Copyright

    The measures are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license or distribution of the measures for commercial gain, or incorporation of the measures into a product or service that is sold, licensed or distributed for commercial gain.

    Commercial uses of the measures require a license agreement between the user and the American Medical Association [on behalf of the Physician Consortium for Performance Improvement®] or the American Academy of Ophthalmology.

    Neither the AMA, the Academy, PCPI nor its members shall be responsible for any use of the measures. The AMA’s and PCPI’s significant past efforts and contributions to the development and updating of the measures is acknowledged.

    The Academy is solely responsible for the review and enhancement (“maintenance”) of the measures as of May 15, 2014.

    The Academy encourages use of the measures by other health care professionals, where appropriate.