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Billing, collection and practice management for anesthesia and pain management groups.


MIPS/PQRS Anesthesia Measures: Part II – Anesthesiology Smoking Abstinence

Published on June 20, 2017

MIPS/PQRS Anesthesia Measures:  Common Mistakes and How to Avoid Them

Part II – Anesthesiology Smoking Abstinence

Over the past several years, we have found that certain measures which apply to anesthesia can be confusing and misleading to providers.  To simplify the process, most billing companies develop PQRS forms (similar to superbills) for providers to mark.  The measures most commonly documented/marked in error are:

  • #424 Perioperative Temperature Management. 
  • #404 Anesthesiology Smoking Abstinence
  • #430 Prevention of Post-Operative Nausea and Vomiting
  • #426 & #427 Post-Anesthesia Transfer of Care to PACU or ICU

Anesthesiology Smoking Abstinence is very frequently documented incorrectly on PQRS forms by providers.  However, knowing a few key pieces of information will help you determine the correct way to document these.  There are denominators (common factors) that include or exclude the patient in the population, these include: current smoker, aged 18 and older, having elective surgery, who received instructions not to smoke prior to surgery.  There are also numerators (the condition that is to be met) in this case, the patient abstaining from smoking the day of surgery.

The most common mistake in marking PQRS forms that we see in this measure is that the provider will either mark the denominator and not the numerator, or mark the numerator and not the denominator.  It is important to remember that both the denominator and numerator are required to report correctly.

Denominators:  Common factors which include the patient in the population.

  • All patients aged 18 or older.
  • Current smoker.  This includes: cigarettes, cigars, pipes, e-cigarette and marijuana.  G9642
  • Patient undergoing an elective procedure (i.e. not an emergent procedure). G9643
  • Patient received instructions from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery. G9497

Numerators:  Condition to be met.

  • The patient abstained from smoking on the day of surgery. G9644.
  • The patient did not abstain from smoking on the day of surgery. G9645

Documentation requirements: Documentation that the patient was instructed not to smoke prior to surgery should be clearly indicated in the preoperative records.  This may include a preoperative workup done in person, or a preoperative phone call.  The information should be signed with date and time by the anesthesiologist or proxy.  The patient should be questioned prior to surgery regarding abstinence and his/her response documented in the medical record with signature, time and date of the anesthesiologist or proxy.

*Billing offices do not normally receive the medical record documentation of this measure so it is very important that the PQRS forms are correctly marked.  Marking either the denominator or the numerator, but not both is a conflict and cannot be reported accurately. 


By: Heather E. Golfos, CPC, CANPC

Coding Department Manager