ASPS28: Continuation of Anticoagulation Therapy in the Office-based Setting for Closure and Reconstruction After Skin Cancer Resection Procedures+

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High Priority: Yes; Patient Safety
NQF Number: N/A

Percentage of procedures in patients, aged 18 and older with a diagnosis of skin cancer, on prescribed anticoagulation therapy, who had intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection performed in the office-based setting where anticoagulant therapy was continued prior to surgery.

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

Denominator:
All procedures in patients aged 18 and older with a diagnosis of skin cancer, on prescribed anticoagulation therapy, who underwent:

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).

• Age > 18 years;
• AND
• On prescribed anticoagulant therapy to include aspirin (ASA), clopidogrel, dipyridamole, prasugrel, ticagrelor, ticlopidine, warfarin, dabigatran, rivaroxaban, apixaban, edoxaban, bertrixaban
• 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, , 13150, 13151, 13152,
• OR
• Strata 2:
  • CPT® for Encounter Reconstruction
    • 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061
    • 15050, 15100,15120
    • 15200, 15220, 15240, 15260
    • 15570, 15572, 15574, 15576
    • 15740
    • 40525, 40527
  • 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 )/(denominator 1 + denominator 2), not the average of the performance rates

Denominator Exclusions:

None

Denominator Exceptions:

• Medical reason exceptions such as consultation with managing physician which resulted in medication modification.
• Patients who are taking aspirin (ASA) without a prescriber’s recommendation/prescription.
• Patient taking warfarin, with a supratherapeutic INR.

Numerator:

Patients for whom anticoagulant therapy was continued prior to surgery.

Numerator Exclusions:

None

Measure Classifications:

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

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The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Neither the AAO-HNSF nor its members shall be responsible for any use of the Measures. The AAO-HNSF and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.