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2020 MIPS Measure #424: Perioperative temperature management

Quality ID

424

NQF

2671

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Anesthesiology

Measure Description

Percentage of patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time

 

Instructions

This measure is to be submitted each time any procedure including surgical, therapeutic or diagnostic is performed under general or neuraxial anesthesia during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the listed anesthesia services as specified in the denominator coding will submit this measure.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

All patients, regardless of age, who undergo surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer

Denominator Instructions:

The anesthesia time used for this measure should be the time recorded in the anesthesia record.

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Patient procedure during the performance period (CPT): 00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00326, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00834, 00836, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01935, 01936, 01951, 01952, 01961, 01962, 01963, 01965, 01966

AND

Anesthesia of 60 minutes duration or longer: 4255F

AND NOT

DENOMINATOR EXCLUSIONS:

Monitored Anesthesia Care (MAC): G9654

OR

Peripheral Nerve Block (PNB): G9770

 

Numerator

Patients for whom at least one body temperature greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) was achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time

Numerator Options:

Performance Met: At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (G9771)

OR

Denominator Exception: Documentation of one of the following medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (e.g., Emergency cases, Intentional hypothermia, etc.) (G9772)

OR

Performance Not Met: At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) not achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time, Reason Not Given (G9773)

 

Rationale

A drop in core temperature during surgery, known as perioperative hypothermia, can result in numerous adverse effects, which can include adverse myocardial outcomes, subcutaneous vasoconstriction, increased incidence of surgical site infection, and impaired healing of wounds. The desired outcome, reduction in adverse surgical effects due to perioperative hypothermia, is affected by maintenance of normothermia during surgery.

Unintended perioperative hypothermia occurs in up to 20% of surgical patients. An observational cohort study in a pediatric setting found that more than 50% of children experienced intraoperative hypothermia. Pediatric patients undergoing major surgery were at greater risk of intraoperative hypothermia.


Clinical Recommendation Statements

Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second Edition; American Society of PeriAnesthesia Nurses (ASPAN), 2010

Preadmission/Preoperative Recommendations

Assessment: Assess for risk factors for perioperative hypothermia (Class I, Level C); Measure patient temperature on admission (Class I, Level C); Determine patient’s thermal comfort level (Class I, Level C); Assess for signs and symptoms of hypothermia (Class I, Level C); Document and communicate all risk factor assessment findings to all members of the anesthesia/surgical team (Class I, Level A)

Interventions: Implement passive thermal care measures (Class I, Level B); Maintain ambient room temperature at or above 24 degrees Celsius (Class I, Level C); Institute active warming for patients who are hypothermic (Class IIb, Level B); Consider preoperative warming to reduce the risk of intra/postoperative hypothermia (Class IIb, Level B)

Intraoperative Recommendations

Assessment: Identify patient’s risk factors for unplanned preoperative hypothermia (Class I, Level C); Frequent intraoperative temperature monitoring should be considered in all cases (Class I, Level C); Assess for signs and symptoms of hypothermia (Class IIb, Level C); Determine patient’s thermal comfort level (Class IIb, Level C); Document and communicate all risk factor assessment findings to all members of the anesthesia/surgical team (Class I, Level A)

Interventions: Limit skin exposure to lower ambient environmental temperatures (Class I, Level C); Initiate passive warming measures (Class I, Level C); Maintain ambient room temperature from 20-25 degrees Celsius based on Association of periOperative Registered Nurses (AORN) and architectural recommendations (Class I, Level C); Patients undergoing a procedure with an anticipated anesthesia time greater than 30 minutes (Class I, Level C) and/or who are hypothermic preoperatively (Class I, Level A), and/or patients at risk for hypothermia (Class I, Level C) or at increased risk for suffering its complications (Class I, Level C) – Forced air warming should be implemented (Class I, Level A); There is evidence to suggest that alternative active warming measures may maintain normothermia when used alone or in combination with forced air warming (Class IIb, Level B). These warming measures include: Warmed IV fluids (Class IIa, Level B), Warmed irrigation fluids (Class IIb, Level B), Circulating water garments (Class IIb, Level B), Circulating water mattresses (Class IIb, Level B), Radiant heat (Class IIb, Level B), Gel pad surface warming (Class IIa, Level B), Resistive heating (Class IIa, Level B) (ASPAN, 2010)

Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery; American College of Cardiology/American Heart Association Task Force on Practice Guidelines, 2014

Maintenance of normothermia may be reasonable to reduce perioperative cardiac events in patients undergoing noncardiac surgery (Class IIb Recommendation, Level of Evidence B)

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