Measure Description
Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second-generation cephalosporin prophylactic antibiotic who had an order for a first OR second-generation cephalosporin for antimicrobial prophylaxis
Instructions
This measure is to be submitted each time a procedure is performed during the performance period for patients who undergo surgical procedures with the indications for a first or second-generation cephalosporin prophylactic antibiotic. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the listed surgical procedures 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 quality-data codes 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 surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second- generation cephalosporin prophylactic antibiotic.
Denominator Instructions:
CPT Category I procedure codes billed by surgeons performing surgery on the same patient, submitted with modifier 62 (indicating two surgeons, i.e., dual procedures) will be included in the denominator population, therefore both surgeons will be fully accountable for the clinical action described in the measure.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of service
AND
Patient procedure during the performance period (CPT): Listed below are surgical procedure codes with indications for first or second-generation cephalosporin prophylactic antibiotic
Table 1: Surgical procedure codes with indications for first or second-generation cephalosporin prophylactic antibiotic
SURGICAL PROCEDURE | CPT CODE |
Integumentary | 15733, 15734, 15736, 15738, 15830, 15832, 15833, 15834, 15835,15836, 15837, 19300, 19301, 19302, 19303, 19305, 19306, 19307, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 21601, 21602, 21603 |
Spine | 22325, 22510, 22511, 22513, 22514, 22586, 22612, 22630, 22800,22802, 22804, 63030, 63042 |
Hip Reconstruction | 27125, 27130, 27132, 27134, 27137, 27138 |
Trauma (Fractures) | 27235, 27236, 27244, 27245, 27269, 27758, 27759, 27766, 27769,27792, 27814 |
Knee Reconstruction | 27440, 27441, 27442, 27443, 27445, 27446, 27447 |
Vascular | 27880, 27881, 27882, 27884, 27886, 27888, 33877, 33880, 33881,33883, 33886, 33889, 33891, 34701, 34702, 34703, 34704, 34705,34706, 34707, 34708, 34710, 34830, 34831, 34832, 34841, 34842,34843, 34844, 34845, 34846, 34847, 34848, 35011, 35013, 35081,35082, 35091, 35092, 35102, 35103, 35131, 35141, 35142, 35151,35152, 35206, 35266, 35301, 35363, 35371, 35372, 35512, 35521,35522, 35523, 35525, 35533, 35537, 35538, 35539, 35540, 35556,35558, 35565, 35566, 35570, 35571, 35583, 35585, 35587, 35601,35606, 35612, 35616, 35621, 35623, 35626, 35631, 35632, 35633,35634, 35636, 35637, 35638, 35642, 35645, 35646, 35647, 35650,35654, 35656, 35661, 35663, 35665, 35666, 35671, 36830, 36902,36905, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231,37246, 37248, 37617 |
Spleen and Lymph Nodes | 38100, 38101, 38115, 38120, 38571, 38572, 38700, 38720, 38724,38740, 38745, 38760, 38765, 38770, 38780 |
Esophagus | 43020, 43030, 43045, 43100, 43101, 43107, 43108, 43112, 43113,43116, 43117, 43118, 43121, 43122, 43123, 43124, 43130, 43135,43279, 43280, 43281, 43282, 43300, 43305, 43310, 43312, 43313,43314, 43320, 43325, 43327, 43328, 43330, 43331, 43332, 43333,43334, 43335, 43336, 43337, 43340, 43341, 43351, 43352, 43360,43361, 43400, 43405, 43410, 43415, 43420, 43425, 43496 |
Stomach | 43500, 43501, 43502, 43510, 43520, 43605, 43610, 43611, 43620,43621, 43622, 43631, 43632, 43633, 43634, 43640, 43641, 43644,43645, 43651, 43652, 43653, 43800, 43810, 43820, 43825, 43830,43832, 43840, 43843, 43845, 43846, 43847, 43848, 43850, 43855,43860, 43865, 43870, 43880 |
Small Intestine | 44005, 44010, 44020, 44021, 44050, 44055, 44100, 44120, 44125,44126, 44127, 44130, 44132, 44133, 44135, 44136 |
Colon | 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151,44155, 44156, 44157, 44158, 44160, 44180, 44186, 44187, 44188,44202, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212,44227, 44300, 44310, 44312, 44314, 44316, 44320, 44322, 44340,44345, 44346, 44602, 44603, 44604, 44605, 44615, 44620, 44625,44626, 44640, 44650, 44660, 44661, 44680, 44700 |
Rectum | 45000, 45020, 45110, 45111, 45112, 45113, 45114, 45116, 45119,45120, 45121, 45123, 45126, 45130, 45135, 45136, 45150, 45160,45171, 45172, 45395, 45397, 45400, 45402, 45540, 45541, 45550,45560, 45562, 45563, 45800, 45805, 45820, 45825 |
Biliary | 47400, 47420, 47425, 47460, 47480, 47562, 47563, 47564, 47570,47600, 47605, 47610, 47612, 47620, 47700, 47701, 47711, 47712,47715, 47720, 47721, 47740, 47741, 47760, 47765, 47780, 47785,47800, 47801, 47802, 47900 |
Pancreas | 48000, 48001, 48020, 48100, 48102, 48105, 48120, 48140, 48145,48146, 48148, 48150, 48152, 48153, 48154, 48155, 48500, 48510,48520, 48540, 48545, 48547, 48548, 48554, 48556 |
Abdomen, Peritoneum & Omentum | 27080, 27158, 27202, 27280, 27282, 49000, 49002, 49010, 49020,49040, 49060, 49203, 49204, 49205, 49215, 49250, 49320,49321, 49322, 49323, 49405, 49406, 49407, 49505, 49507 |
Renal Transplant | 50320, 50340, 50360, 50365, 50370, 50380 |
Neurological Surgery | 22551, 22554, 22558, 22600, 22612, 22630, 22633, 61154, 61313,61315, 61510, 61512, 61518, 61548, 61697, 61700, 61750, 61751,61867, 62223, 62230, 63015, 63020, 63030, 63042, 63045, 63046,63047, 63056, 63075, 63081, 63267, 63276 |
Cardiothoracic Surgery | 33120, 33130, 33140, 33202, 33250, 33251, 33256, 33261, 33305,33315, 33321, 33322, 33335, 33365, 33366, 33390, 33391, 33404,33405, 33406, 33410, 33440, 33411, 33413, 33416, 33422, 33425,33426, 33427, 33430, 33460, 33463, 33464, 33465, 33475, 33496,33510, 33511, 33512, 33513, 33514, 33516, 33533, 33534, 33535,33536, 33542, 33545, 33548, 33886, 35211, 35241, 35271 |
General Thoracic Surgery | 0236T, 0505T, 21627, 21632, 21740, 21750, 21825, 31760, 31766,31770, 31775, 31786, 31805, 32096, 32097, 32098, 32100, 32110,32120, 32124, 32140, 32141, 32150, 32215, 32220, 32225, 32310,32320, 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488,32491, 32505, 32800, 32810, 32815, 32900, 32905, 32906, 32940,33020, 33025, 33030, 33031, 33050, 33300, 33310, 33320, 33361,33362, 33363, 33364, 34051, 35021, 35216, 35246, 35276, 35311,35526, 37616, 38381, 39000, 39010, 39200, 39220, 39545, 39561,64746 |
Foot & Ankle | 27702, 27703, 27704, 28192, 28193, 28291, 28415, 28420, 28445,28465, 28485, 28505, 28525, 28531, 28555, 28585, 28615, 28645,28675, 28705, 28715, 28725, 28730, 28735, 28737 |
Laryngectomy | 31400, 31420 |
Mediastinum and Diaphragm | 39501, 39540, 39541, 39545, 39560, 39561 |
Bariatric | 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846,43847, 43848, 43886, 43887, 43888 |
Meckel’s Diverticulum and Appendix | 44800, 44820, 44850, 44900, 44950, 44960, 44970 |
Liver | 47100, 47120, 47122, 47125, 47130, 47140, 47141, 47142, 47350,47370, 47371, 47380, 47381 |
Gynecologic Surgery | 58150, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263,58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58294, 58951, 58953, 58954, 58956 |
General Surgery | 23470, 23472, 23473, 23474, 23616, 24363, 24370, 24371, 38531,60505 |
Numerator
Surgical patients who had an order for a first OR second-generation cephalosporin for antimicrobial prophylaxis
Numerator Instructions:
There must be documentation of an order (written order, verbal order, or standing order/protocol) for a first OR second-generation cephalosporin for antimicrobial prophylaxis OR documentation that a first OR second-generation cephalosporin was given.
NUMERATOR NOTE: In the event surgery is delayed, as long as the patient is redosed (if clinically appropriate) the numerator coding should be applied.
G9197 is provided for antibiotic ordered or antibiotic given. Submit G9197 if a first or second-generation cephalosporin was given for antimicrobial prophylaxis.
Numerator Options:
Performance Met: Documentation of order for first OR second- generation cephalosporin for antimicrobial prophylaxis (G9197)
OR
Denominator Exception: Documentation of medical reason(s) for not ordering a first OR second-generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s)) (G9196)
OR
Performance Not Met: Order for first OR second-generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given (G9198)
Rationale
Presence of antibiotics in the blood and tissue during and after surgery can prevent infection. Cephalosporins are currently the drug of choice for antimicrobial prophylaxis due to their broad-spectrum effect and low occurrence of adverse reactions.
Clinical Recommendation Statements
For most procedures, cefazolin is the drug of choice for prophylaxis because it is the most widely studied antimicrobial agent, with proven efficacy. It has a desirable duration of action, spectrum of activity against organisms commonly encountered in surgery, reasonable safety, and low cost. (ASHP, 2013)
Cephalosporins and carbapenems should not be used for surgical prophylaxis in patients with documented or presumed IgE mediated penicillin allergy (e.g., anaphylaxis, urticaria, bronchospasm) (ASHP, 2013).
Cephalosporins and carbapenems can safely be used in patients with an allergic reaction to penicillins that is not an IgE mediated reaction or is not exfoliative dermatitis (Stevens-Johnson syndrome, toxic epidermal necrolysis), a life- threatening hypersensitivity reaction that can be caused by b-lactam antimicrobials and other medications. Patients should be carefully questioned about their history of antimicrobial allergies to determine whether a true allergy exists before selection of agents for prophylaxis. Patients with allergies to cephalosporins, penicillins, or both have been excluded from many clinical trials. Alternatives to b-lactam antimicrobials are provided in Table 2 [of the guideline] based mainly on the antimicrobial activity profiles against predominant procedure-specific organisms and available clinical data (ASHP, 2013).