CMS138v9 – Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

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

Patients aged 18 years and older seen for at least two medical visits or at least one preventive medical visit during the measurement period.

Patients who were screened for tobacco use at least once within 12 months.

Patients aged 18 years and older seen for at least two medical visits or at least one preventive medical visit during the measurement period and identified as a tobacco user.

Patients who received tobacco cessation intervention.

Patients aged 18 years and older seen for at least two medical visits or at least one preventive medical visit during the measurement period.

Patients who were screened for tobacco use at least once within 12 months and who received tobacco cessation intervention if identified as a tobacco user.

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

– DENOMINATOR EXCEPTIONS 2

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

– DENOMINATOR EXCEPTIONS 3

Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (eg, limited life expectancy, other medical reason).

For Denominator 1:

All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period are included in the denominator. To record the encounters, navigate to Patient > Provider Notes > Create eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

• Office Visit
• Psychoanalysis
• Annual Wellness Visit

For Denominator 2:

All patients aged 18 years and older seen for at least two medical visits or at least one preventive medical visit during the measurement period and identified as a tobacco user.

To record the encounters, navigate to Patient > Provider Notes > Create eSuperbill.

To document identification as a tobacco user, use the workflow Patient > Clinical > History > Social to land on ‘Tobacco’ tab and select the ‘Smoking Status’ of the patient from the drop-down. Select any of the following options from the ‘Smoking Status’ dropdown to identify patient as Tobacco User:

• Current Smoker
• Current Every day smoker
• Current Some day smoker
• Smoker Current status unknown
• Heavy tobacco smoker
• Light tobacco smoker

Once done click ‘Save’.

For Denominator 3:

It has the same criteria as Denominator 1.

For Numerator  1:

Patients who were screened for tobacco use at least once within 12 months and identified as smoker or non-smoker qualify for the numerator. To document this criteria, use the workflow Patient > Clinical > History > Social to land on ‘Tobacco’ tab and set the ‘Smoking Status’ of the patient from the drop-down. Once done, click on the ’Save’ button.

User can select any of the following options from the ‘Smoking Status’ dropdown to identify a patient as Tobacco Non-User:

• Former Smoker
• Never Smoker
• Unknown if ever smoked
• Exposed to tobacco smoke at home
• Exposed to tobacco smoke at work
• Exposed to tobacco smoke in public places
• Does not chew tobacco

User can select any of the following options from the ‘Smoking Status’ dropdown to identify a patient as Tobacco User:

• Current Smoker
• Current Every day smoker
• Current Some day smoker
• Smoker Current status unknown
• Heavy tobacco smoker
• Light tobacco smoker

For Numerator 2:

Patients satisfying any of the following criteria are included in numerator 2.

• Patients who received tobacco cessation counselling during the measurement period. To document tobacco cessation counseling, navigate to Patient > Clinical > Evaluations.

The intervention codes: 225323000, 315232003, 384742004, 395700008 can also be recorded using the workflow Patient > Clinical > History > Social. Identify the patient as Tobacco User from the ‘Smoking Status’ dropdown. Then select an intervention from the ‘Cessation Counselling’ dropdown. Once done, click on the ’Save’ button.

• Patients who had tobacco cessation pharmacotherapy ordered during the measurement period. To prescribe medication to a patient, navigate to Patient > Clinical> Medications and open the ‘Prescriptions’ tab. Then, click on the ‘+ Add’ button.

Add the prescription, then click ‘Save’.

• Patients who were already receiving pharmacotherapy for tobacco cessation at the time of encounter. To record medication, navigate to Patient > Clinical> Medications, click on the ‘+ Add’ button to search for the desired medication. 

Record the medication dosage then click ‘Save’.

 For Numerator  3:

Numerator 3 includes any one of the following:

• Patients who were screened for tobacco use and identified as a tobacco non user. To document this criteria, use workflow Patient > Clinical > History > Social to identify patient as tobacco non-user.
• Patients who were identified as tobacco users and received tobacco cessation counselling.
  • To identify the patient as tobacco user, use the workflow Patient > Clinical > History > Social.
  • To document Intervention, use workflow Patient > Clinical > Evaluations.
  • The intervention codes: 225323000, 315232003, 384742004, 395700008 can also be recorded using the workflow Patient > Clinical > History > Social. Identify the patient as Tobacco User from the ‘Smoking Status’ dropdown. Then select an intervention from the ‘Cessation Counselling’ dropdown. Once done, click on the ’Save’ button.
• Patients who were identified as tobacco users and had tobacco cessation pharmacotherapy ordered.
  • To identify the patient as tobacco user, use the workflow Patient > Clinical > History > Social.
  • To order tobacco cessation pharmacotherapy, use the workflow Patient > Clinical > Prescription.
• Patients who were identified as tobacco users and were already receiving tobacco cessation pharmacotherapy at the time of encounter.
  • To identify the patient as tobacco user, use the workflow Patient > Clinical > History > Social.
  • To document tobacco cessation pharmacotherapy, use the workflow Patient > Clinical > Medications.

For Denominator Exception 1:

Include all patients with a documentation of medical reason(s) for not screening for tobacco use.

• To document a medical reason for not screening for tobacco use, navigate to Patient > Clinical > Evaluations. Set the ‘Status’ as Not Performed. Then, from the ‘Reason’ dropdown, select the medical reason.

• To document limited life expectancy, navigate to Patient > Clinical > Evaluation. 

For Denominator Exception 2:

Include all patients with a documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason). Satisfy any of the following condition to include in denominator exception 2 criteria.

• To document a medical reason for not counselling a tobacco user, navigate to Patient > Clinical > Evaluations. Set the ‘Status’ to ‘Not Performed’ and select any medical reason from the dropdown.
• To record a medical reason for not ordering tobacco cessation pharmacotherapy, navigate to Patient > Clinical > Medication. Select the medication and click the ‘Discontinue’ button. From the ‘Reason, drop-down, select a reason and then click ‘Save’.

• To document limited life expectancy, navigate to Patient > Clinical > Evaluations and set the ‘Status’ as ‘Active’.

For Denominator Exception 3:

Include all patients with a documentation of medical reason(s) for not screening for tobacco use or for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)

• To document a medical reason for not screening for tobacco use, navigate to Patient > Clinical > Evaluations. Set the ‘Status’ as Not Performed. Then, from ‘Reason’ dropdown, select the medical reason.
• To document a medical reason for not counselling a tobacco user, navigate to Patient > Clinical > Evaluations. Set the ‘Status’ to ‘Not Performed’ and select any medical reason from the dropdown.
• To record a medical reason for not ordering tobacco cessation pharmacotherapy, navigate to Patient > Clinical > Medication
• To document limited life expectancy, navigate to Patient > Clinical > Evaluations and set the ‘Status’ as ‘Active’.