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WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
MEASURE DESCRIPTION
This measure assesses the percentage of patients whose tobacco status is tobacco free during the last 12
months [Measurement Period].
Disclaimer: Measures reported by WCHQ healthcare organizations represent a specific aspect of care in relation to an evidencebased standard, but are not clinical guidelines and do not establish standards of care. All providers should have an individual care
plan established with their patient.
GENERAL INFORMATION/RATIONALE
In an effort to align with National Quality Form (NQF) endorsed diabetes measures, and referencing the
2013 American Diabetes Association (ADA) guidelines, the following goals for people with diabetes are
measured by the WCHQ:
 Tobacco-Free Status
A large body of evidence from epidemiological, case-control and cohort studies provides convincing
documentation of the causal link between cigarette smoking and health risks. Studies of individuals with
diabetes consistently demonstrate that smokers have a heightened risk of CVD, premature death, and
increased rate of microvascular complications of diabetes. Smoking may have a role in the development of
type 2 diabetes. The ADA supports the recommendation to advise all patients not to smoke or use tobacco
products and to include smoking cessation counseling and other forms of treatment as a routine
component of diabetes care.
References:
Reference: Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical
Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May
2008. Retrieved May 7, 2008 from, http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
DEFINITIONS
12 Months: Measurement Period
24 Months: Measurement Period + Prior Year
Office Visit: Office visit in an outpatient, non-urgent care setting
PCP: For WCHQ measure purposes, a primary care provider is defined as any General Practice, Internal
Medicine, Family Medicine, Pediatrics provider with the following degree types (MD, DO, PA, and NP),
and any other practitioners identified by the healthcare system as primary care practitioners. The rationale
for the additional practitioner(s) must be documented and must be applied consistently across all
preventive care and chronic care measures by the organization.
 Measure Specific Specialist: As part of the denominator population for this measure visits to an
Endocrinologist qualify as office visits for the denominator population.
Age Range 18-75: Patients born between 01/01/1941 and 01/01/1998.
DENOMINATOR DESCRIPTION
Patients with diabetes 18-75 years of age and alive as of the last day of the MP. A minimum of two
diabetes coded office visits and must be seen by a PCP / Endocrinologist for two office visits in 24 months
and one office visit in 12 months. Gestational Diabetes (code 648.8) is excluded.
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
1
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
Patients whose age at the beginning of the one year measurement period is at least 18 and whose age at
the end of the measurement period is less than 76 and are alive as of the last day of the Measurement
Period. Expired patients for whom a specific date of expiration cannot be found are excluded from the
denominator population
The rationale for the denominator population is built from the following criteria:
[Question 1] – Is this a patient with the disease or condition?
[Question 2] – Is this a patient whose care is managed within the physician group?
[Question 3] – Is this a patient currently managed in our system?
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
2
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
ENCOUNTER DATA
Patients eligible for inclusion in the denominator include:
[Question 1] – Is this a patient with the disease, or condition?
Those who had a minimum of two diabetes coded (including any diagnoses coded for the
visit) – (Table D-1) office visits (Table D-2), with any provider (MD, DO, PA, NP) in the
Physician Group with different dates of service in an ambulatory setting during the last 24
Months [Measurement Period + Prior Year], and
[Question 2] – Is this a patient whose care is managed within the physician group?
Patients who had at least two office visits (Table D-2), regardless of diagnosis code, on
different dates of service, to a PCP and/or Endocrinologist in the past 24 months. If the
Endocrinologist is not considered a PCP, at least one of the two office visits must be to a
PCP.
[Question 3] – Is this a patient current in our system?
Those who had at least one office visit (Table D-2), regardless of diagnosis code, with a
PCP and/or an Endocrinologist during the last 12 Months [Measurement Period].
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
3
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
NUMERATOR DESCRIPTIONS
TOBACCO FREE (Figure D-3) – Most recent smoking status is tobacco free during the
measurement period.
The number of patients in the denominator whose most recent tobacco documentation status with
any provider within the 12 month measurement period is Tobacco Free.
Tobacco Use Definition:
 Cigarette
 Cigar
 Pipe Smoking
 Smokeless Tobacco (Chewing Tobacco, Snuff, etc.)
Tobacco Use Status can be identified by any of the following criteria:
1. Documentation stating that the patient has been asked if they are one of the following during
the Measurement Period with the numerator compliant goal of Tobacco-Free:
1. Tobacco-Free (see examples below):
a. Former tobacco user
b. Never used
c. Non-tobacco user
d. Passive smoker
2. Non Tobacco-Free
a. Current tobacco user
3. No Documentation: The subset of denominator patients who did not have
documentation of tobacco status during the last 12 Months [Measurement Period]
ICD-9, CPT, HCPCS and CPT-II Codes indicating tobacco use status during the Measurement
Period) from billing or encounter data only. Do not use the problem list for these codes. (Table D-8)
INTERNALLY DEVELOPED CODES – DATA TRANSLATION/MAPPING REQUIREMENTS
If a medical group utilizes internally generated codes to identify specific services or events required
for a given WCHQ performance measure, the group may translate or map the information to the
WCHQ performance measurement specifications. The medical group must assure that the
internally generated code matches the clinical specificity of the standard (ICD-9, CPT) codes
included in the WCHQ performance measurement specifications.
In order to use internally developed codes for WCHQ performance measure reporting, the medical
group needs to document the translation/mapping to the codes in the specifications. This
documentation should include the internally generated code, a description of the internally
developed code, any additional clinical information for the internally developed code, and the
equivalent standard code with description from the WCHQ performance measurement
specifications. Once the translation/ mapping documentation is established, the medical group’s
WCHQ performance measurement team must review the mapping on a yearly basis and document
that internally developed codes have not changed and are being used in the manner described in
the translation/ mapping document.
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
4
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
The medical group must have documented processes in place for adding codes to the medical
group’s administrative data system and procedures to implement the internally developed codes.
MEDICAL RECORD REVIEW FOR NUMERATOR INCLUSION/DENOMINATOR EXCLUSION
If appropriate, and/or when necessary, every organization may complement their electronic capture
of patient medical history with electronic or manual record review. The following criteria apply only
to data captured/reviewed during medical record review.
For WCHQ Chronic Condition Measures, proof of Numerator compliance requires:
 Date status was recorded
 Tobacco status
Denominator Exclusion
For all WCHQ Measures, proof of Denominator exclusion requires:
 Existence of exclusion criteria.
This data may be retrieved, in whole or in part, from any of the following:
 Notation in Progress Note
 Notation in Medical History or Surgical History
 Flag/Field in Electronic Medical Record
 Documentation in patient chart
FIELDS REQUIRED FOR MEASURE VALIDATION
Validation of this measure will require patient level data files for Administrative Data and/or for
Manual Review. The following indicates fields needed for validation, which may be helpful to
consider when querying the measure:
Denominator Data File fields:
1.
2.
3.
4.
5.
Patient Identifier (can be medical record number or other ID)
Office Visit Dates
Provider Specialty
Patient Date of Birth
Diabetes Diagnosis Codes
Numerator Data File fields:
1. Most Recent Tobacco Status
 Patient Identifier (De-Identified)
 Tobacco Status
 Encounter Date of Service Associated with Tobacco Status
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
5
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
Appendix A
Primary Payer
In keeping with the changing atmosphere of quality measurement and reporting, WCHQ would like
for participating organizations to include the primary payer source with their data submissions for
the ambulatory care measures.
The primary payer source should be identified in the denominator upon answering the question, “Is
this patient current in our system?” Once it has been determined that a patient is current because
of a visit to their physician within the specified time period (12 months for chronic care measures
and 24 months for preventive care measures), the payer should be “pulled” into the query. The
primary payer should be the payer at the most recent office visit within the measurement period.
There will be four categories of primary payer that will need to be submitted to WCHQ via the data
submission tool: Medicare FFS, Medicaid (all types), Commercial (including Medicare HMO) and
Uninsured/Self-Pay. The raw numbers for the denominator and numerator should be included for
all three types of data submission, total population, hybrid, and sample.
Rationale
Opportunities exist for WCHQ to collect and report data on specific populations, like the Medicare
population, through grant applications to begin to understand the disparities in quality of care. The
purpose of this is to begin to understand the challenges of putting in additional data elements and
complexities of data display for public reporting. At this time, the primary payer information will not
be publicly reported.
Definitions:
Commercial: All plans not Medicaid or Medicare FFS (Includes VA, DoD, etc.)
FFS Medicare: FFS plans, not Medicare HMO (Medicare Railroad is FFS Medicare)
Medicaid: All Medicaid plans including those managed by commercial plans
Uninsured: Self-pay individuals
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
6
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
APPENDIX B
TABLE D-1: Diagnosis Codes to Identify Patients with Diabetes
ICD-9-CM
Description
Diagnosis Codes
250.xx
Diabetes mellitus
250.00
Diabetes mellitus without mention of complication, type ii or unspecified type,
not stated as uncontrolled
250.01
Diabetes mellitus without mention of complication, type i [juvenile type], not
stated as uncontrolled
250.02
Diabetes mellitus without mention of complication, type ii or unspecified type,
uncontrolled
250.03
Diabetes mellitus without mention of complication, type i [juvenile type],
uncontrolled
250.10
Diabetes with ketoacidosis, type ii or unspecified type, not stated as
uncontrolled
250.11
Diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled
250.12
Diabetes with ketoacidosis, type ii or unspecified type, uncontrolled
250.13
Diabetes with ketoacidosis, type i [juvenile type], uncontrolled
250.20
Diabetes with hyperosmolarity, type ii or unspecified type, not stated as
uncontrolled
250.21
Diabetes with hyperosmolarity, type i [juvenile type], not stated as
uncontrolled
250.22
Diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled
250.23
Diabetes with hyperosmolarity, type i [juvenile type], uncontrolled
250.30
Diabetes with other coma, type ii or unspecified type, not stated as
uncontrolled
250.31
Diabetes with other coma, type i [juvenile type], not stated as uncontrolled
250.32
Diabetes with other coma, type ii or unspecified type, uncontrolled
250.33
Diabetes with other coma, type i [juvenile type], uncontrolled
250.40
Diabetes with renal manifestations, type ii or unspecified type, not stated as
uncontrolled
250.41
Diabetes with renal manifestations, type i [juvenile type], not stated as
uncontrolled
250.42
Diabetes with renal manifestations, type ii or unspecified type, uncontrolled
250.43
Diabetes with renal manifestations, type i [juvenile type], uncontrolled
250.50
Diabetes with ophthalmic manifestations, type ii or unspecified type, not
stated as uncontrolled
250.51
Diabetes with ophthalmic manifestations, type i [juvenile type], not stated as
uncontrolled
250.52
Diabetes with ophthalmic manifestations, type ii or unspecified type,
uncontrolled
250.53
Diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled
250.60
Diabetes with neurological manifestations, type ii or unspecified type, not
stated as uncontrolled
250.61
Diabetes with neurological manifestations, type i [juvenile type], not stated as
uncontrolled
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
7
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
250.62
250.63
250.70
250.71
250.72
250.73
250.80
250.81
250.82
250.83
250.90
250.91
250.92
250.93
357.2
362.0x
362.01
362.02
362.03
362.04
362.05
362.06
362.07
366.41
648.0x
648.00
648.01
648.02
648.03
648.04
Diabetes with neurological manifestations, type ii or unspecified type,
uncontrolled
Diabetes with neurological manifestations, type i [juvenile type], uncontrolled
Diabetes with peripheral circulatory disorders, type ii or unspecified type, not
stated as uncontrolled
Diabetes with peripheral circulatory disorders, type i [juvenile type], not
stated as uncontrolled
Diabetes with peripheral circulatory disorders, type ii or unspecified type,
uncontrolled
Diabetes with peripheral circulatory disorders, type i [juvenile type],
uncontrolled
Diabetes with other specified manifestations, type ii or unspecified type, not
stated as uncontrolled
Diabetes with other specified manifestations, type i [juvenile type], not stated
as uncontrolled
Diabetes with other specified manifestations, type ii or unspecified type,
uncontrolled
Diabetes with other specified manifestations, type i [juvenile type],
uncontrolled
Diabetes with unspecified complication, type ii or unspecified type, not stated
as uncontrolled
Diabetes with unspecified complication, type i [juvenile type], not stated as
uncontrolled
Diabetes with unspecified complication, type ii or unspecified type,
uncontrolled
Diabetes with unspecified complication, type i [juvenile type], uncontrolled
Polyneuropathy in diabetes
Diabetic retinopathy
Background diabetic retinopathy
Proliferative diabetic retinopathy
Nonproliferative diabetic retinopathy nos
Mild nonproliferative diabetic retinopathy
Moderate nonproliferative diabetic retinopathy
Severe nonproliferative diabetic retinopathy
Diabetic macular edema
Diabetic cataract
Complication of pregnancy, diabetes mellitus, excluding gestational diabetes
Diabetes mellitus of mother complicating pregnancy childbirth or the
puerperium unspecified as to episode of care
Diabetes mellitus of mother with delivery
Diabetes mellitus of mother with delivery with postpartum complication
Antepartum diabetes mellitus
Postpartum diabetes mellitus
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
8
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
Effective 10/01/2015
ICD-10-CM Diagnosis
Codes
Description
E11.9
Type 2 diabetes mellitus without complications
E10.9
Type 1 diabetes mellitus without complications
E11.65
Type 2 diabetes mellitus with hyperglycemia
E10.65
Type 1 diabetes mellitus with hyperglycemia
E11.69
Type 2 diabetes mellitus with other specified complication
E10.10
Type 1 diabetes mellitus with ketoacidosis without coma
E11.00
E11.01
Type 2 diabetes mellitus with hyperosmolarity without nonketotic
hyperglycemic-hyperosmolar coma (NKHHC)
Type 2 diabetes mellitus with hyperosmolarity with coma
E10.69
Type 1 diabetes mellitus with other specified complication
E11.641
Type 2 diabetes mellitus with hypoglycemia with coma
E10.11
Type 1 diabetes mellitus with ketoacidosis with coma
E10.641
Type 1 diabetes mellitus with hypoglycemia with coma
E11.65
Type 2 diabetes mellitus with hyperglycemia
E11.29
Type 2 diabetes mellitus with other diabetic kidney complication
E10.29
Type 1 diabetes mellitus with other diabetic kidney complication
E11.21
Type 2 diabetes mellitus with diabetic nephropathy
E10.21
Type 1 diabetes mellitus with diabetic nephropathy
E11.311
E11.36
Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular
edema
Type 2 diabetes mellitus with unspecified diabetic retinopathy without
macular edema
Type 2 diabetes mellitus with diabetic cataract
E11.39
Type 2 diabetes mellitus with other diabetic ophthalmic complication
E10.311
E10.39
Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular
edema
Type 1 diabetes mellitus with unspecified diabetic retinopathy without
macular edema
Type 1 diabetes mellitus with unspecified diabetic retinopathy without
macular edema
Type 1 diabetes mellitus with other diabetic ophthalmic complication
E11.40
Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E10.40
Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E11.51
Type 2 diabetes mellitus with diabetic peripheral angiopathy without
gangrene
E11.319
E10.319
E10.36
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
9
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
E10.51
E11.618
Type 1 diabetes mellitus with diabetic peripheral angiopathy without
gangrene
Type 2 diabetes mellitus with other diabetic arthropathy
E11.620
Type 2 diabetes mellitus with diabetic dermatitis
E11.621
Type 2 diabetes mellitus with foot ulcer
E11.622
Type 2 diabetes mellitus with other skin ulcer
E11.628
Type 2 diabetes mellitus with other skin complications
E11.630
Type 2 diabetes mellitus with periodontal disease
E11.638
Type 2 diabetes mellitus with other oral complications
E11.649
Type 2 diabetes mellitus with hypoglycemia without coma
E10.618
Type 1 diabetes mellitus with other diabetic arthropathy
E10.620
Type 1 diabetes mellitus with diabetic dermatitis
E10.621
Type 1 diabetes mellitus with foot ulcer
E10.622
Type 1 diabetes mellitus with other skin ulcer
E10.628
Type 1 diabetes mellitus with other skin complications
E10.630
Type 1 diabetes mellitus with periodontal disease
E10.638
Type 1 diabetes mellitus with other oral complications
E10.649
Type 1 diabetes mellitus with hypoglycemia without coma
E11.8
Type 2 diabetes mellitus with unspecified complications
E10.8
Type 1 diabetes mellitus with unspecified complications
E08.42
Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E09.42
E10.42
Drug or chemical induced diabetes mellitus with neurological complications
with diabetic polyneuropathy
Type 1 diabetes mellitus with diabetic polyneuropathy
E11.42
Type 2 diabetes mellitus with diabetic polyneuropathy
E13.42
Other specified diabetes mellitus with diabetic polyneuropathy
E11.359
E08.36
Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
without macular edema
Type 2 diabetes mellitus with moderate nonproliferative diabetic
retinopathy without macular edema
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
without macular edema
Diabetes mellitus due to underlying condition with diabetic cataract
E09.36
Drug or chemical induced diabetes mellitus with diabetic cataract
E10.36
Type 1 diabetes mellitus with diabetic cataract
E13.36
Other specified diabetes mellitus with diabetic cataract
O24.319
Other specified diabetes mellitus with diabetic cataract
E11.329
E11.339
E11.349
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
10
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
O24.32
Unspecified pre-existing diabetes mellitus in childbirth
O24.911
Unspecified diabetes mellitus in pregnancy, first trimester
O24.912
Unspecified diabetes mellitus in pregnancy, second trimester
O24.913
Unspecified diabetes mellitus in pregnancy, third trimester
O24.92
Unspecified diabetes mellitus in childbirth
O24.93
Unspecified diabetes mellitus in the puerperium
TABLE D-2: Office Visit Encounter Codes (Outpatient)
CPT Codes
99201-99205
99212-99215
99241-99245
99347-99350
99384-99387
99394-99397
99401-99404
99411
99412
99420
99429
99488
99495
99496
Description
a
b
Office or OP visit E&M , new patient
Office or OP visit E&M, established patient
Office or other OP consultations
Home visit for evaluation and management of an established patient
Initial preventive medicine E&Mb
Periodic preventive medicine E&Mb
Preventive medicine counseling
Preventive medicine counseling, group
Preventive medicine counseling, group
Risk assessment, admin and interpretation
Unlisted preventive medicine service
Complex chronic care coordination services; first hour of clinical staff time directed
by a physician or other qualified health care professional with one face-to-face visit,
per calendar month.
Transitional Care Management Services (Moderate Complexity)
Transitional Care Management Services (High Complexity)
HCPCS Code
G0344
(deleted 12/31/08)
G0402
(Effective
01/01/09)
G0438
G0439
a
b
Description
Initial preventive physical examination; face-to-face visit services limited to new
beneficiary during the first six months of Medicare enrollment
Initial preventive physical examination; face-to-face visit, services limited to new
beneficiary during the first 12 months of Medicare enrollment
Annual wellness visit; includes a personalized prevention plan of service, initial visit
Annual wellness visit; includes a personalized prevention plan of service,
subsequent visit
outpatient
evaluation and management
TABLE D-8: Codes to Identify Tobacco Use Status
ICD-9 Diagnosis
Codes
305.1
Tobacco Use Disorder
Description
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
11
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
649.0x
Tobacco Use Disorder Complicating Pregnancy
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
F17.200
O99.30
O99.331
O99.332
O99.333
O99.334
O99.335
Description
Nicotine dependence, unspecified, uncomplicated
Smoking (tobacco) complicating pregnancy, unspecified trimester
Smoking (tobacco) complicating pregnancy, first trimester
Smoking (tobacco) complicating pregnancy, second trimester
Smoking (tobacco) complicating pregnancy, third trimester
Smoking (tobacco) complicating childbirth
Smoking (tobacco) complicating the puerperium
CPT Codes
99406
99407
HCPCS Codes
C9801
Added 08/25/2010 and
deleted 12/31/2010.
Replaced with G0436
C9802
Added 08/25/2010 and
deleted 12/31/2010.
Replaced with G0437
D1320
G0436
G0437
G8402
G8403
G8453
G8454
G8455
G8456
G8457
G8686
G8687
G8688
G8690
G8691
G8692
Description
Smoking and Tobacco Use Cessation counseling visit; intermediate, greater than 3
minutes up to 10 minutes
Smoking and Tobacco Use Cessation counseling visit; intensive, greater than 10
minutes
Description
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intermediate, greater than 3 minutes, up to 10 minutes
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intensive, greater than 10 minutes
Tobacco Counseling for the Control and Prevention of Oral Disease
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intermediate, greater than 3 minutes, up to 10 minutes
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intensive, greater than 10 minutes
Tobacco (smoke) use cessation intervention, counseling
Tobacco (smoke) use cessation intervention not counseled
Tobacco use cessation intervention, counseling
Tobacco use cessation intervention not counseled, reason not specified
Current Tobacco Smoker
Current Smokeless Tobacco User
Tobacco Non-User
Currently a tobacco smoker or current exposure to secondhand smoke
Currently a tobacco non-user and no exposure to secondhand smoke
Currently a smokeless tobacco user (e.g. chew, snuff) and no exposure to
secondhand smoke
Current tobacco smoker or current exposure to secondhand smoke
Current tobacco nonuser and no exposure to secondhand smoke
Current smokeless tobacco user (e.g. chew, snuff) and no exposure to secondhand
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
12
WCHQ Ambulatory Measure Specification
WCHQ 7 – Diabetes Care: Tobacco Free
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Population/Public Health
S4995
S9075
S9453
smoke
Smoking Cessation Gum
Smoking Cessation Treatment
Smoking classes, nonphysician provider, per session
CPT Category II
Codes
**1034 F
**1035 F
**4000 F
**4001 F
**4004F
Description
Current Tobacco Smoker
Current Smokeless Tobacco User (eg. chew, snuff)
Tobacco use cessation intervention, counseling
Tobacco use cessation intervention, pharmacological therapy
Patient screened for tobacco use AND received tobacco cessation counseling, if
identified as a tobacco user.
**Codes can be included at the organization’s discretion. If included, the date the
service was performed must be provided. If an 8P modifier is included with the CPT
II code, it does not qualify as numerator compliant.
Diabetes Care: Tobacco Free – QCDR Non-PQRS Measure 2016
This specification is updated annually; refer to previous versions for coding and other changes
13