In order for the Clinical Quality Measure report to generate, the following must be documented in the relevant patient's chart:

1.  The patient must be at least 18 years of age or older at the start of the reporting period have have at least two face-to-face encounters with the provider during the reporting period.

2.  Documentation of tobacco cessation intervention in the Summary Tobacco field.  Inserting the shortcut code, "TOBmu" will insert three pick lists including the pick list for "Tobacco cessation" that will provide a list of criteria from which to document tobacco cessation intervention (CPT 4000F, 4001F.  Note: 4000F-8P will not increase the numerator.)

3. Documentation that the patient is a tobacco user.  This can be done using one of the following methods:

a.  Documentation in the Summary Interventions field OR the encounter Plan field must include any one of the following CPT codes listed below:

1034F or 1035F*.  

*Inserting the shortcut code, "PQRIqui"  in the encounter Plan field or the Summary Interventions field will insert the pick list, "Tobacco cessation QM" that will provide a list of criteria from which to document the above CPT codes.

OR

b.  Documentation by the presence of one of the following ICD9 codes in the Summary Active Problems field OR encounter Assessment field:

305.1 OR 305.10.  

Numerator Calculation:

The numerator for this measurement is calculated based on the following:

1.  The number of patients in the denominator who have documentation of tobacco cessation intervention in the Summary Tobacco field using one of the following codes: CPT 4000F or 4001F. (Note: 4000F-8P (Tobacco use cessation interven, not counsel - reason NOS) will not increase the numerator.)

Denominator Calculation:

The denominator for this measurement is calculated based on the following:

1.  The number of patients that were at least 18 by the start of the reporting period and have had at least two face-to-face encounters with the physician during the reporting period;

2.  And has a confirmation of being a tobacco user, which can be accomplished by the presence of ICD-9 305.1 or 305.10 in the Assessment or Active Problems fields; OR this can also be accomplished by the documentation of CPT 1034F or 1035F in the encounter Plan or Summary Interventions fields.  (Note: CPT 1036F (Tobacco non-user) will not increase the denominator.)

All of the items listed in the above steps need to be documented as structured data (as detailed above) in order to allow the user to capture the numerator, denominator and percentage for this quality measure.  

For information on how to export the numerator, denominator and percentage for each Clinical Quality Measure, click here.

For more information on reporting clinical quality measures, click here.