ASPS27: Avoidance of Post-operative Systemic Antibiotics for Office-based Closures and Reconstruction After Skin Cancer Procedures+

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High Priority: Yes; Appropriate Use
NQF Number: N/A

Percentage of procedures in patients aged 18 and older with a diagnosis of skin cancer who underwent intermediate layer or complex linear closure or reconstruction after skin cancer resection in the office-based* setting who were prescribed post-operative systemic antibiotics to be taken immediately following reconstruction surgery (inverse measure).

This measure is stratified by intermediate layer or complex linear closure or reconstructive procedures.

Denominator:

All patients aged 18 and older with a diagnosis of skin cancer who underwent intermediate layer or complex linear closure or reconstruction after skin cancer resection in the office-based* setting.

Strata 1: Intermediate layer or complex linear closures after skin cancer resection.
Strata 2: Reconstruction after skin cancer resection.
Strata 3: Intermediate layer and complex linear closures AND reconstruction after skin cancer resection in the officebased setting (Weighted average of Strata 1 and 2).

*Office based: not billed with an ASC or inpatient facility code

• Age > 18 years;
• AND
• Strata 1:
  • CPT for Encounter Intermediate layer and complex linear closures
    • 12031, 12032, 12034, 12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13100, 13101, , 13120, 13121, , 13131, 13132, , 13151, 13152
• OR
• Strata 2:
  • CPT® for Encounter Reconstruction
    • 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061
    • 15050, 15100,15120
    • 15200, 15220, 15240, 15260
    • 15740
  • and
  • ICD-10 Codes for most common skin cancers:
    • C43-C44
    • D03-D04
  • and
  • Place of Service Code: 11 (office)
• Strata 3: FOR REPORTING
• Strata 1 + Strata 2; Calculate as (numerator 1 + numerator 2 + numerator 3)/(denominator 1 + denominator 2 + denominator 3), not the average of the performance rates.

Denominator Exclusions:

• Surgical sites at intrinsically high risk of infection – lower extremities and intertriginous areas (groin, genitalia, perianal, axilla).
• Surgical reconstructions at intrinsically higher risk of infection –

a. flaps greater than 30 square cm*
b. full thickness skin grafts greater than 20 square cm*
c. multistage interpolation flaps*
d. wedge reconstructions of ear
e. reconstructions requiring 2 or more repair types (flap and graft)*
f. cartilage or composite graft*
g. repair of exposed cartilage or bone
*These exclusions apply only to strata 2 (Reconstruction)

• Codes for exclusion of skin cancer on lower legs, for which procedures have a higher risk of infection.
  • ICD-10 Codes:
    • BCC – C44.711, C44.712, C44.71
    • SCC – C44.721, C44.722, C44.729
    • MM – C43.70, C43.71, C43.72
    • MMIS – D03.70, D03.71, D03.72
    • SCCIS – D04.70, D04.71, D04.72
• Cartilage grafts: 21230, 21235, 20910, 20912

Denominator Exceptions:

Medical reason exceptions include patients with a history of:

1. Lymphedema I89.0, I89.1, I89.8, I89.9
2. History of immunosuppressive medications Z92.24
3.  Immunodeficiency syndromes D82.0, D82.1, D82.2, D82.3, D82.4, D82.8, D82.9
4. HIV B20
5. Underlying disease with high risk of surgical site infection – chronic inflammatory skin disease (such as psoriasis and atopic dermatitis) or documented staph aureus carrier
6. Clinical evidence of infection at the surgical site at time of reconstruction, defined as:

• • Purulent drainage, with or without laboratory confirmation, from the surgical site
  • Pathogenic organisms isolated from culture of fluid or tissue from the surgical site
  • At least one of the following signs or symptoms of infection at the surgical site: pain or tenderness, localized swelling, redness, or heat.
  • An existing antibiotic prescription from another provider based on the diagnosis of infection at the surgical site.
  • Underlying disease with high risk of surgical site infection – chronic inflammatory skin disease (such as psoriasis and atopic dermatitis) or documented staph aureus carrier status or patient history of 3 or more surgical site infections, presence of lymphedema, history of immunodeficiency or immunosuppression

Numerator:

Patients who were prescribed post-operative systemic antibiotics to be taken immediately following surgery (inverse measure).

Numerator Exclusions:

None

Measure Classifications:

• Measure Type: Process
• National Quality Strategy (NQS) domain: Effective Clinical Care
• Meaningful Measure Area: Appropriate Use of Healthcare
• Care Setting(s): Ambulatory Care: Clinician Office/Clinic
• Includes Telehealth: No
• Calculation: 3rd Performance Rate
  • Inverse measure: Yes
  • Continuous measure: No
  • Proportional measure: Yes
  • Ratio measure: No
  • Risk Adjusted measure: No

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