Pulmonology Coding Alert

Question: How can our practice benefit from Physician Quality Reporting Initiative's (PQRI) smoking cessation measure?

Alaska Subscriber

Answer: To earn your PQRI bonus, your office must report on the percentage of patients aged 18 years and older who are smokers and who received advice to quit smoking. You should report this measure for a minimum of once per reporting period for all Medicare patients seen during the reporting period, (whether or not they use tobacco). You don't need any diagnosis for this measure.

Why this measure is important: Performing interventions to control smoking makes sense because smoking is the leading preventable cause of death in the U.S. In addition, clinical interventions are known to be effective in increasing cessation rates. Recommended physician guidelines include: (1) repeated advice and support at all or most visits, and (2) delivery of cessation assistance and follow-up at all or most visits.

Include in the numerator patients who received advice to quit smoking. Remember, you must report the correct combination of numerator code(s) on the claim form to properly report this measure. This means you would use multiple numerator codes.

Eligible: Identify tobacco smokers receiving cessation intervention. Two G codes are required on the claim form to submit this category: G8455 (Current tobacco smoker) and G8402 (Tobacco [smoke] use cessation intervention, counseling).

Non-eligible: If the patient is not qualified for this measure, report G8456 (Current smokeless tobacco user) for the smokeless tobacco user, or G8457 (Tobacco non-user) for the non-tobacco user.

Tobacco smokers not advised to quit, reason not specified. You would use G8455 (Current tobacco smoker) and G8403 (Tobacco [smoke] use cessation intervention not counseled). To establish the denominator: Include all patients aged 18 years and older. A CPT E/M service code is required to identify patients for denominator inclusion, such as 99201-99205 (New patient office or outpatient services), 99211-99215 (Established patient office or other outpatient services), 99217-99220 (Hospital observation services).