CMS info on PQRS measures we adopted in 2017
TRANSFER OF CARE
Performance Met: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used (G9655)
1. Identification of patient
2. Identification of responsible practitioner (PACU nurse or advanced practitioner)
3. Discussion of pertinent medical history
4. Discussion of the surgical/procedure course (procedure, reason for surgery, procedure performed)
5. Intraoperative anesthetic management and issues/concerns.
6. Expectations/Plans for the early post-procedure period.
7. Opportunity for questions and acknowledgement of understanding of report from the receiving PACU team
PONV
Performance Met: Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and intraoperatively (4558F)
Definition:
Anti-emetics Therapy – The recommended first- and second-line classes of pharmacologic anti-emetics for PONV prophylaxis in patients at moderate to severe risk of PONV include (but are not limited to):
• NK-1 Receptor Antagonists
• 5-Hydroxytryptamine (5-HT3) Receptor Antagonists
• Glucocorticoids
• Phenothiazines
• Phenylethylamines
• Butyrophenones
• Antihistamines
• Anticholinergics
All patients, aged 18 years and older, who undergo any procedure including surgical, therapeutic or diagnostic under an inhalational general anesthetic, AND who have three or more risk factors for PONV
Definition: PONV Risk factors The following are Risk factors for Post-Operative Nausea and Vomiting:
• Female gender
• History of PONV
• History of motion sickness
• Non-smoker
• Intended administration of opioids for post-operative analgesia. This includes use of opioids given intraoperatively and whose effects extend into the post anesthesia care unit (PACU) or post-operative period, or opioids given in the PACU, or opioids given after discharge from the PACU.
TEMP
Percentage of patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time
Performance Met: At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (4559F)
OR
Medical Performance Exclusion: Documentation of one of the following medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (e.g., Emergency cases, Intentional hypothermia, etc.) (4559F with 1P)
OR
Performance Not Met: At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (4559F with 8P)
SMOKING ABSTINENCE
The percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure
INSTRUCTIONS
This measure is to be reported each time an elective surgery, diagnostic, or pain procedure is performed under anesthesia during the reporting period. There is no diagnosis associated with this measure. It is anticipated that clinicians who provide the listed anesthesia services as specified in the denominator coding will submit this measure.
Measure Reporting via Registry:
CPT codes, HCPCS codes, and patient demographics are used to identify patients who are included in the measures denominator. The listed numerator options are used to report the numerator of the measure.
The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data. There are no allowable performance exclusions for this measure.
DENOMINATOR
All patients aged 18 years and older who are evaluated in preparation for elective surgical, diagnostic, or pain procedure requiring anesthesia services in settings that include routine screening for smoking status prior to the day of the surgery or procedure with instruction to abstain from smoking on the day of surgery or procedure
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
Current cigarette smokers: G9642
AND
Elective surgery: G9643
AND
Seen pre-operatively by anesthesiologist or proxy prior to the day of surgery: G9497
NUMERATOR
Current cigarette smokers and who abstained from smoking prior to anesthesia on the day of surgery or procedure.
Definition:
Abstinence – Defined by either patient self-report or an exhaled carbon monoxide level of < 10 ppm.
Numerator Options:
Performance Met: Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure (G9644)
OR
Performance Not Met: Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure (G9645)“[/vc_column_text][/vc_column][/vc_row]
ADVANCED DIRECTIVE (CARE PLAN) measure
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
INSTRUCTIONS
This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure. This measure may be reported by clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
This measure is appropriate for use in all healthcare settings (eg, inpatient, nursing home, ambulatory) except the emergency department. For each of these settings, there should be documentation in the medical record(s) that advance care planning was discussed or documented.
DENOMINATOR
All patients aged 65 years and older
DENOMINATOR NOTE: *Clinicians indicating the Place of Service as the emergency department will not be included in this measure.
NUMERATOR
Patients who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Numerator Instructions: If patients cultural and/or spiritual beliefs preclude a discussion of advance care planning, report 1124F.
NUMERATOR NOTE: The CPT Category II codes used for this measure indicate: Advance Care Planning was discussed and documented. The act of using the Category II codes on a claim indicates the provider confirmed that the Advance Care Plan was in the medical record (that is, at the point in time the code was assigned, the Advance Care Plan in the medical record was valid) or that advance care planning was discussed. The codes are required annually to ensure that the provider either confirms annually that the plan in the medical record is still appropriate or starts a new discussion.
The provider does not need to review the Advance Care Plan annually with the patient to meet the numerator criteria, documentation of a previously developed advanced care plan that is still valid in the medical record meets numerator criteria.
Definition:
Documentation that Patient did not Wish or was not able to Name a Surrogate Decision Maker or Provide an Advance Care Plan May also include, as appropriate, the following:
That the patients cultural and/or spiritual beliefs preclude a discussion of advance care planning, as it would be viewed as harmful to the patient’s beliefs and thus harmful to the physician-patient relationship.
Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Advance Care Planning Discussed and Documented
Performance Met: CPT II 1123F: Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record
OR
Performance Met: CPT II 1124F: Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
OR
Advance Care Planning not Documented, Reason not Otherwise Specified
Append a reporting modifier (8P) to CPT Category II code 1123F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
Performance Not Met: 1123F with 8P: Advance care planning not documented, reason not otherwise specified