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  2. CQM-4818

Add surgical follow up visit to eligible encounters

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    • EP/EC eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None

    Description

      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:

      The American Society of Plastic Surgeons (ASPS) asked the measure developer to consider adding 99024 to the allowable encounter codes for the Preventive Care and Screening: Tobacco Use Screening and Cessation Intervention measure. Currently the measure requires 2 qualified encounters or one preventive encounter to qualify for the initial population. For many surgeons, although they may see the patient multiple times, they cannot always bill a second office visit, as pre-op and post-op visits are included in the global billing for the procedure. 99024 is a follow-up visit, non-payment CPT code required in 9 states. Adding this code would allow surgeons in those states to report this measure, with 99024 representing the second visit. ASPS advocates for more states to require reporting this code, as well, so hopefully this would eventually broaden reporting of this measure.

      Proposed Solution:

      We are adding an additional direct reference CPT code 99024 - "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" to the "Preventive Visit During Measurement Period" definition to incorporate postoperative follow-up visits based on feedback from implementers.

      Initial Population

      exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate

      where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18)

      and ( Count("Qualifying Visit During Measurement Period")>= 2

      or exists "Preventive Visit During Measurement Period" )

       

      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"] 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 PreventiveEncounter.relevantPeriod during day of "Measurement Period"

      Rationale for Change:
      Adding this code would allow surgeons in the 9 states that require surgeons' use of it to report this measure. ASPS advocates for more states to require reporting this code, as well, so hopefully this would eventually broaden reporting of this measure.

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            khancock Mathematica EC eCQM Team
            khancock Mathematica EC eCQM Team
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            Dates

              Created:
              Updated: