ASPS29: Avoidance of Opioid Prescriptions for Closure and Reconstruction After Skin Cancer Resection+

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High Priority: Yes; Opioid-related Measure
NQF Number: N/A

Percentage of procedures in patients, aged 18 and older with a diagnosis of skin cancer, who had intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection where opioid/narcotic therapy* was prescribed as first line therapy (as defined by a prescription in anticipation of or at time of surgery) for post-operative pain management by the reconstructing surgeon. (Inverse measure)

Denominator:

All procedures in patients aged 18 and older with a diagnosis of skin cancer where intermediate layer and/or complex linear closures OR reconstruction after skin cancer resection were performed.

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
• 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, 151, 13152
• OR
• Strata 2:
  • CPT® for Encounter Reconstruction
    • 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061
    • 15100,15120
    • 15200, 15220, 15240, 15260
    • 15570, 15572, 15574, 15576
    • 15730, 15740,
    • 67971, 67973, 67974, 67975
  • and
  • ICD-10 Codes for most common skin cancers:
    • C43-C44
    • D03-D04
• 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:

1. Location exclusion due to high tension closure and anticipated exceptional postsurgical pain (lower extremity, scalp, ear, genitals, perineum, lip, and nail unit).
2. Surgical procedures associated with anticipated exceptional post surgical pain

a. flaps greater than 30 square cm*

b. split thickness skin grafts greater than 10 square cm*

c. paramedian forehead flap*

d. composite graft*

*These exclusions apply only to strata 2 (Reconstruction)

Denominator Exceptions:

1. Medical reason exception for patients who cannot take non-opioid pain medications (patients with chronic kidney disease, COPD, allergy to non-steroidal anti-inflammatory medications and acetaminophen or documented contraindication to non-steroidal anti-inflammatory medications and acetaminophen, cirrhosis/liver disease).
2. Number of surgical sites – greater than 3 skin cancer sites treated or reconstructed in one day of service).

Numerator:

Patients who were prescribed opioid/narcotic therapy* as first line treatment (as defined by a prescription in anticipation of or at time of surgery) for post-operative pain management by the reconstructing surgeon. (Inverse measure)

*List of narcotic/opioid medications included: morphine, oxycodone, fentanyl, oxymorphone, hydromorphone, buprenorphine, meperidine, codeine, butorphanol, tramadol, levorphanol, sufentanil, pentazocine, tapentadol, hydrocodone

Numerator Exclusions:

None

Measure Classifications:

• Measure Type: Process
• National Quality Strategy (NQS) domain: Patient Safety
• Meaningful Measure Area: Prevention and Treatment of Opioid and Substance Use Disorders
• Care Setting(s): Ambulatory Care: Hospital
• 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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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.