AQI 18 · Coronary Artery Bypass Graft (CABG), Prolonged Intubation, Inverse Measure

Steward: American Society of Anesthesiologists / Anesthesia Quality Institute | First Performance Year: 2016 2026 Status: Approved by CMS for the 2026 MIPS performance period.

MEASURE DESCRIPTION

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who require postoperative intubation greater than 24 hours.

NQS DOMAIN / MEANINGFUL MEASURES AREA

Effective Clinical Care / Preventable Healthcare Harm

MEASURE TYPE: Outcome HIGH PRIORITY STATUS: Yes INVERSE MEASURE: Yes. A lower rate indicates better quality. RISK ADJUSTED: No NUMBER OF PERFORMANCE RATES: 1 CARE SETTING: Hospital Inpatient TELEHEALTH: No DATA SOURCE: Claims, paper medical record, EHR, hybrid, registry CBE NUMBER: Not applicable | eCQM: Not applicable

2026 BENCHMARK

No historical benchmark. CMS may establish a performance-period benchmark using 2026 submissions. This is not a new measure, so new-measure floors do not apply; other CMS rules, including small-practice exceptions, may affect scoring.

Practical implication: the final scoring treatment remains uncertain until CMS determines whether a performance-period benchmark can be established. Consider the measure’s clinical relevance and applicable scoring exceptions when planning your submission.

CHANGE FOR 2026

A new denominator exclusion was added: transcatheter aortic valve replacement (TAVR) and transcatheter aortic valve implantation (TAVI) cases.

INSTRUCTIONS

Report each time an isolated CABG procedure is performed during the reporting period. It is anticipated that qualified anesthesia providers and eligible clinicians who provide services for isolated CABG will submit this measure. The measure is intended to reflect the quality of services provided for isolated CABG or isolated reoperation CABG patients.

Measure reporting via the QCDR: CPT codes and patient demographics identify patients in the denominator. The measure must capture both the surgical and the related anesthesia code. G-codes report the numerator.

DENOMINATOR

All patients aged 18 years and older undergoing isolated CABG surgery.

Definition: Isolated CABG refers to CABG using arterial and/or venous grafts only.

Denominator Criteria (Eligible Cases): - Patient aged 18 years and older on date of encounter - AND Surgical CPT: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536 AND Anesthesia CPT: 00566, 00567 - OR Surgical CPT: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536 AND CPT 33530 AND Anesthesia CPT: 00562

DENOMINATOR EXCLUSIONS

- Organ donors as designated by ASA Physical Status 6 - Procedure reduced or discontinued prior to initiation of cardiopulmonary bypass, as indicated on the claim by Modifier 52 or Modifier 53 - NEW FOR 2026: Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) cases, CPT codes 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 93355 (12A38)

NUMERATOR

Patients who require intubation greater than 24 hours following exit from the operating room.

Numerator Quality-Data Coding Options:

Performance Met: G8569 Prolonged postoperative intubation (greater than 24 hours) required

OR

Performance Not Met: G8570 Prolonged postoperative intubation (greater than 24 hours) not required

Note on inverse scoring: because this is an inverse measure, "Performance Met" records the undesirable outcome. A high performance rate is bad. Deciles run in the opposite direction from a standard measure.

RATIONALE

Prolonged intubation or prolonged ventilation following CABG surgery is associated with increased mortality and morbidity. A review of the literature suggests several predictors of prolonged ventilation following CABG, including increased incidence of pneumonia and pulmonary atelectasis, history of hypertension, COPD, kidney disease, and endocarditis. Most of these complications were associated with prolonged ICU and hospital length of stay and increased resource use.

Physician anesthesiologists and other qualified anesthesia providers maintain respiratory function throughout the perioperative period and play a critical role in respiratory care. Because they control the patient's breathing function, their decision-making around airway management substantially affects outcomes related to prolonged intubation and ventilation. Research shows that aortic aneurysm procedures, combined and valve procedures, preoperative renal dysfunction, and stroke are strong predictors of prolonged ventilation. Changes to care and procedures that reduce adverse respiratory outcomes require the engagement of anesthesia expertise.

REFERENCES

1. Ji Q, Duan Q, Wang X, et al. Risk factors for ventilator dependency following coronary artery bypass grafting. Int J Med Sci 2012;9(4):306-310. doi:10.7150/ijms.4340 2. Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res 2014;6(4):211-216. doi:10.15171/jcvtr.2014.014

RELEVANT FIELDS (Graphium capture)

- Date of service - Date of birth - ASA CPT code and surgical CPT code - Isolated CABG surgery flag - ASA physical status - Modifier 52 / 53 - TAVR or TAVI case flag - Intubation greater than 24 hours after OR exit

REPORTING CODES

DENOMINATOR CPT CODES

A case must carry one of the codes below to enter this measure's denominator. The other denominator criteria above still apply - a matching code makes a case eligible for consideration, not automatically countable.

Procedure codes (17) - the case must carry one of these and one of the anesthesia codes that follow:

Anesthesia codes (3):

Excluded by CPT (10) - a case carrying one of these is taken back out of the denominator:

Requires a CABG surgical code AND the related anesthesia code. A surgical code alone does not place the case in the denominator.

Source: 2026 AQI NACOR QCDR Measure Book. CPT copyright American Medical Association.