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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
226 0026 Process Yes Community / Population Health Claims

Measure Description

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

Instructions

This measure is to be submitted once per performance period for patients seen during the performance period. This measure is intended to reflect the quality of services provided for preventive screening for tobacco use. For the purposes of the measure, the 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.

NOTE: No note related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.


THERE ARE THREE SUBMISSION CRITERIA FOR THIS MEASURE:

  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 patients 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

NUMERATOR (SUBMISSION CRITERIA 1):

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

 

NUMERATOR (SUBMISSION CRITERIA 2):

Patients who received tobacco cessation intervention

 

NUMERATOR (SUBMISSION CRITERIA 3):

All patients aged 18 years and older

Definition (Submission Criteria 1)

Tobacco Use – Includes any type of tobacco

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.

 

Definition (Submission Criteria 2)

Tobacco Use 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.

 

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.

 

Definition (Submission Criteria 3)

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.

 

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.

Numerator Quality-Data Coding Options

NUMERATOR (SUBMISSION CRITERIA 1):

Denominator Exception: G9904:
Tobacco Use Screening not Performed for Medical Reasons:

(One G-code [G9904] is required on the claim form to submit documented circumstances when the action described in the numerator is not performed for medical reasons.)

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)

 

NUMERATOR (SUBMISSION CRITERIA 2):

Denominator Exception: G9907:
Patient Identified as Tobacco User Did Not Receive Tobacco Cessation Intervention for Medical Reasons:

(Two G-codes [G9902 & G9907] are required on the claim form to submit documented circumstances when the action described in the numerator is not performed for medical reasons.)

Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason)

 

NUMERATOR (SUBMISSION CRITERIA 3):

Denominator Exception: 4004F with 1P:
Tobacco Screening not Performed OR Tobacco Cessation Intervention not Provided for Medical Reasons:

Append a modifier (1P) to CPT Category II code 4004F OR submit a G-code (G9909) to submit documented circumstances that appropriately exclude patients from the denominator.

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)

OR

Denominator Exception: 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)

NUMERATOR (SUBMISSION CRITERIA 1):

Performance Met: G9902:
Patient Screened for Tobacco Use, Identified as a Tobacco User or Tobacco Non-User

Patient screened for tobacco use AND identified as a tobacco user

OR

Performance Met: G9903:

Patient screened for tobacco use AND identified as a tobacco non-user

 

NUMERATOR (SUBMISSION CRITERIA 2):

Performance Met: G9906:
Patient Identified as Tobacco User Received Tobacco Cessation Intervention

Patient received tobacco cessation intervention(counseling and/or pharmacotherapy)

 

NUMERATOR (SUBMISSION CRITERIA 3):

Performance Met: CPT II 4004F:
Patient Identified as Tobacco User Received Tobacco Cessation Intervention

Patient received tobacco cessation intervention(counseling and/or pharmacotherapy)

OR

Performance Met: CPT II 1036F:

Patient Screened for Tobacco Use and Identified as a Tobacco Non-User

 

Current tobacco non-user

NUMERATOR (SUBMISSION CRITERIA 1):

Performance Not Met: G9905:
Tobacco Use Screening not Performed, Reason Not Given

(One G-code [G9905] is required on the claim form to submit circumstances when the action described in the numerator is not performed and the reason is not given.)

Patient not screened for tobacco use, reason not given

 

NUMERATOR (SUBMISSION CRITERIA 2):

Performance Not Met: G9908:
Patient Identified as Tobacco User Did Not Receive Tobacco Cessation Intervention, Reason Not Given

(Two G-codes [G9902 & G9908] are required on the claim form to submit circumstances when the action described in the numerator is not performed and the reason is not given.)

Patient did not receive tobacco cessation intervention(counseling and/or pharmacotherapy), reason not given

 

NUMERATOR (SUBMISSION CRITERIA 3):

Performance Not Met: 4004F with 8P:
Tobacco Screening not Performed OR Tobacco Cessation Intervention not Provided, Reason Not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 4004F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Tobacco screening not performed OR tobacco cessation intervention not provided, reason not otherwise specified

Numerator Note: No data available

Denominator

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: ALL PATIENTS WHO WERE SCREENED FOR TOBACCO USE

All patients aged 18 years and older

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the PFS
(Physician Fee Schedule). These non-covered services will not be counted in the denominator population
for claims-based measures.

AND

Patient encounter during the performance period (CPT or HCPCS): 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

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

 

Option 2 – Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 2: ALL PATIENTS WHO WERE IDENTIFIED AS A TOBACCO USER AND WHO RECEIVED TOBACCO CESSATION INTERVENTION

All patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user

DENOMINATOR NOTE *Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These non-covered services will not be counted in the denominator population for claims-based measures

AND

All eligible instances when (G9902) 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 criteria one

AND

Patient encounter during the performance period (CPT or HCPCS): 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
WITHOUT
Telehealth Modifier:
GQ, GT, 95, POS 02

 

Option 3 – Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 3: ALL PATIENTS WHO WERE SCREENED FOR TOBACCO USE AND, IF IDENTIFIED AS A TOBACCO USER, RECEIVED TOBACCO CESSATION INTERVENTION OR IDENTIFIED AS A TOBACCO NON-USER

 

All patients aged 18 years and older

 

DENOMINATOR NOTE *Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These non-covered services will not be counted in the denominator population for claims-based measures

 

AND

Patient encounter during the performance period (CPT or HCPCS): 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
WITHOUT
Telehealth Modifier:
GQ, GT, 95, POS 02

 

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