QCDR measure AAD 16
Avoidance of Post-operative Systemic Antibiotics for Office-based Closures and Reconstruction After Skin Cancer Resection Procedures
DESCRIPTION:
Percentage of procedures in patients aged 18 and older with a diagnosis of skin cancer who underwent intermediate layer, complex linear closure, or reconstruction after skin cancer resection in the office-based setting (not billed with an ASC or inpatient facility code) who were prescribed post-operative systemic antibiotics to be taken immediately following reconstruction surgery (inverse measure).
This measure is stratified by intermediate layer, complex linear closure, or reconstructive procedures.
| MEASURE ID: | AAD16 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | N/A |
| High priority: | Yes |
| Topped out: | Yes |
| Telehealth Eligible: | No |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
This measure is based on the preponderance of evidence, that in the office setting, clinicians should not administer routine perioperative systemic antibiotics. Benefits of avoiding antibiotic prophylaxis include cost savings, absence of antibiotic side effects, prevention of drug interactions, reduced time delay prior to reconstruction, avoidance of complications associated with oral or intravenous administration, and lack of contribution to antibiotic resistance.
AAD16 FAQs
Q. Is this measure reportable via claims?
A. No. This measure can only be reported via a registry, such as DataDerm.
Q. Are patient encounters conducted via telehealth allowable?
A. No. Telehealth encounters are not allowable.
Q. What is the numerator?
A. The numerator are patients who were prescribed post-operative systemic antibiotics by the surgeon or assistant to be taken immediately following surgery. This is an inverse measure.
Q. What is the denominator?
A. The denominator is all patients aged 18 and older with a diagnosis of skin cancer who underwent intermediate layer, complex linear closure, or reconstruction after skin cancer resection in the office-based setting.
Q. Are there any exceptions for this measure?
A. Yes. Medical reason exception for patients with any of the below conditions:
Wounds breaching the oral, nasal, genitourinary or anal mucosa
Immunosuppressed patients (such as those on immunosuppressive medications)
Patients with lymphedema
Patients on antibiotics prescribed by another physician
Patients with exposed cartilage/bone
Clinical evidence of infection at time of reconstruction
Q. Are there any exclusions for this measure?
A. Yes, they include:
Surgical sites at intrinsically high risk of infection – lower extremities and intertriginous areas (groin, genitalia, perianal, axilla)
BCC – C44.711, C44.712, C44.719
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
Surgical reconstructions at intrinsically higher risk of infection –
Flaps greater than 30 square cm*
Full thickness skin grafts greater than 20 square cm*
Multistage interpolation flaps8
Wedge reconstructions of ears
Reconstructions requiring 2 or more repair types (flap and graft)*
Cartilage or composite graft (CPT: 21230, 21235, 20910, 20912)*
Repair of exposed cartilage or bone
* These exclusions only apply to strata 2 (Reconstruction)
Q. Is this an inverse measure?
A. Yes, where a lower score indicates higher quality.
Q. As a dermatologist (non-Mohs surgeon) will I be eligible to report AAD16 for MIPS for skin cancer excisions I perform in the office?
A. Yes, dermatologists that are non-Mohs surgeons could report this measure, but it will depend on your patient population and the types of procedures you perform. Measure AAD16 is related to intermediate layer, complex linear, and reconstruction after skin cancer resection procedures, not the malignant excision (11600, etc.) type procedures.
Calculation
The numerator: Patients who were prescribed post-operative systemic antibiotics by the surgeon or assistant to be taken immediately following surgery (inverse measure)
The denominator: All patients aged 18 and older with a diagnosis of skin cancer who underwent intermediate layer, complex linear closure, or reconstruction after skin cancer resection in the office-based setting.
Measure calculation example
Dr. Omar saw 150 patients who underwent reconstruction after skin cancer resection in the office-based setting.
Five of these patients presented for reconstruction after skin cancer resection and received cartilage grafting. These patients are removed from the denominator because they meet exclusion criteria for this measure. The denominator is 145.
Of the remaining 145 patients, Dr. Omar prescribed post-operative antibiotics post-surgery 69 times. This is the numerator.
Quality of patient care = 69/145. Dr. Omar has a score of 47.6% for this measure. This translates to 1 to 1.9 points.
Important note
This is an inverse measure where a lower score indicates higher quality. Physicians must score a perfect 0% to earn the maximum of 10 points available. Clinicians score 3 points even if they report on only one patient. This is applicable only to small practices with 15 providers or fewer.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
| Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
66.31 - 14.34 |
14.33 - 8.79 |
8.78 - 6.72 |
6.71 - 4.63 |
4.62 - 3.04 |
3.03 - 1.53 |
1.52 - 0.67 |
0.66 - 0.01 |
-- |
0 |
Points |
1 - 1.9 |
2 - 2.9 |
3 - 3.9 |
4 - 4.9 |
5 - 5.9 |
6 - 6.9 |
7 - 7.9 |
8 - 8.9 |
-- |
10 |
