Brief Description of Measure:

CMS138: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Three rates are reported:

a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period

b. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention

c. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user

Description of Issue:

During the last annual update cycle, a suggestion was made to consider adding codes to support nutritionists and dieticians as MIPS eligible clinicians. As part of a comprehensive patient assessment, registered dietitian nutritionists (RDNs) often screen for tobacco use, as tobacco use is a lifestyle factor that may impact a patient’s health. Smoking contributes to the development of chronic diseases and a nutritionist will want to understand how tobacco use may impact a patient’s ability to care for oneself. As recognized providers of Annual Wellness Visits, RDNs may also perform tobacco use screening. Adding a new encounter value set will broaden usage of this measure to dieticians and nutritionists.

Proposed Solution:
We are adding the following dietician visit codes to the denominator for this measure to the "Preventive Visit During Measurement Period"-   CPT - 97802, 97803 and 97804  and HCPCS G-codes - G0270 and G0271.
New value set created:
“Nutrition Services” (2.16.840.1.113883.3.464.1003.1006)    
 
CURRENT LOGIC:
Preventive Visit During Measurement Period
( ["Encounter, Performed": "Annual Wellness Visit"]
  union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Preventive Care Services - Group Counseling"]
  union ["Encounter, Performed": "Preventive Care Services - Other"]
  union ["Encounter, Performed": "Preventive Care Services-Individual Counseling"]
  union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) PreventiveEncounter
  where PreventiveEncounter.relevantPeriod during "Measurement Period"

PROPOSED LOGIC:
Preventive Visit During Measurement Period
( ["Encounter, Performed": "Annual Wellness Visit"]
    union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"]
    union ["Encounter, Performed": "Preventive Care Services - Group Counseling"]
    union ["Encounter, Performed": ""Unlisted preventive medicine service"Preventive Care Services - Other "]
    union ["Encounter, Performed": "Preventive Care Services-Individual Counseling"]
    union ["Encounter, Performed": " Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure” 
    union [“Encounter, Performed’: “Nutrition Services"]
    union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) PreventiveEncounter
 where Global.”NormalizeInterval”(PreventiveEncounter.relevantPeriod, PreventiveEncounter.relevantDatetime)  during "Measurement Period"
Rationale for Change:
As part of a comprehensive patient assessment, registered dietitian nutritionists (RDNs) often screen for tobacco use, as tobacco use is a lifestyle factor that may impact a patient’s health. Smoking contributes to the development of chronic diseases and a nutritionist will want to understand how tobacco use may impact a patient’s ability to care for oneself. As recognized providers of Annual Wellness Visits, RDNs may also perform tobacco use screening. Adding a new encounter value set will broaden usage of this measure to dieticians and nutritionists.