226. 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 within 24 months and who received cessation intervention if identified as a tobacco user.

This measure is to be submitted a minimum of 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 this implementation 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. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who provided the measure-specific denominator coding.

There are three performance criteria for this measure:

  • Criterion 1. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months
  • Criterion 2. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention
  • Criterion 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

The denominator of submission criterion 2 is a subset of the resulting numerator for submission criterion 1, as submission criterion 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, submission criteria 1 and 3 are applicable, but submission criterion 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the age and encounter requirements will only be submitted for submission criteria 1 and 3, whereas data submitted for submission criterion 2 will be for a subset of patients who meet the age and encounter requirements, as the denominator has been further limited to those who were identified as tobacco users.

Screen the patient for tobacco use:

  1. Open the Clipboard.
    1. Open the Patient Chart.
    2. Tap the More action bar icon and select Clipboard.
  2. Tap Edit.
  3. Tap Social History.
  4. Select a Smoking Status.

    If the status is former smoker or nonsmoker, the measure is met; otherwise, compete the following steps.

  5. Tap Mark Reviewed.
  6. Open the Ocular Exam.
  7. Select a tobacco use disorder Diagnosis.
  8. Select a counseling Plan.
  9. Select the Smoking Cessation Counseling section check box.

  10. Tap Done.
  11. Document the rest of the exam and Finalize.

Alternatively, code quality with a special plan:

  1. Open the Ocular Exam.
  2. Select a Diagnosis and Plan.
  3. Tap Special Plans and select MIPS.
  4. From Popular Plans, select MIPS Quality.
  5. Tap the More tab.
  6. Select TOB.
  7. Select the appropriate procedure from the Quality 226 drop-down.
  8. Tap Done.
  9. Document the rest of the exam and Finalize.

Screen the patient for tobacco use:

  1. In a patient’s exam record in ExamWRITER, click the Patient Hx - ROS tab.
  2. Click the Patient History category bar.
  3. Select the Social [MU] check box and click Process.
  4. Record the patient’s tobacco use status using the check box at the top of the Social History window and the options in the Tobacco Use [MU] box. If the patient is a tobacco user, you must select the patient’s tobacco use and the Counseling Intervention Performed check box.

  5. Click Process.

Eyefinity products and documentation refer to the MIPS quality numbers. Other measure numbering systems are listed here for your reference.

Quality 226
NQF 0028e
CMS 138
  • Claims
  • EHR (ExamWRITER only)
  • Registry (Eyefinity EHR only)
  • AAO IRIS

Reporting methods vary by measure and EHR system. For more information about how different measures and reporting methods are scored, refer to the topic that corresponds with your EHR:

Patients aged 18 years or older;

AND

Who had at least two visits during the measurement period:

90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350,

OR who had at least one preventive visits during the measurement period:

99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

CPT codes listed with an asterisk (*) are noncovered services under the Physician Fee Schedule and will not be counted toward the denominator in claims-based reporting.

Denominator Exclusions

Telehealth modifier:

GQ, GT, 95, POS 02

Denominator Exceptions

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

G9904

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

AND who received tobacco cessation intervention if identified as a tobacco user.

Performance Met

Patient screened for tobacco use AND identified as a tobacco user:

G9902

OR

Patient screened for tobacco use AND identified as a tobacco nonuser:

G9903

Performance Not Met

Patient not screened for tobacco use, reason not given:

G9905

To satisfy the intent of this measure, a patient must have at least one tobacco use screening during the 24-month period. If a patient has multiple tobacco use screenings during the 24-month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.

Patients aged 18 years or older;

AND identified as a tobacco User in Numerator 1:

G9902

AND

Who had at least two visits during the measurement period:

90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

OR who had at least one preventive visits during the measurement period:

99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

CPT codes listed with an asterisk (*) are noncovered services under the Physician Fee Schedule and will not be counted toward the denominator in claims-based reporting.

Denominator Exclusions

Telehealth modifier:

GQ, GT, 95, POS 02

Denominator Exceptions

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

G9907

Patients identified as a tobacco users who received tobacco cessation intervention.

Performance Met

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

G9906

Performance Not Met

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

G9908

Patients aged 18 years or older;

AND

Who had at least two visits during the measurement period:

90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

OR who had at least one preventive visits during the measurement period:

99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

CPT codes listed with an asterisk (*) are noncovered services under the Physician Fee Schedule and will not be counted toward the denominator in claims-based reporting.

Denominator Exclusions

Telehealth modifier:

GQ, GT, 95, POS 02

Denominator Exceptions

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

4004F with 1P

OR

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):

G9909

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

AND who received tobacco cessation intervention if identified as a tobacco user.

Performance Met

Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user:

4004F

OR

Current tobacco nonuser:

1036F

Performance Not Met

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

4004F with 8P