AQI 65 · Avoidance of Cerebral Hyperthermia for Procedures Involving Cardiopulmonary Bypass

Steward: American Society of Anesthesiologists / Anesthesia Quality Institute | First Performance Year: 2019 2026 Status: Approved by CMS for the 2026 MIPS performance period.

MEASURE DESCRIPTION

Percentage of patients aged 18 years and older undergoing a procedure using cardiopulmonary bypass who did not have a documented intraoperative pulmonary artery, oropharyngeal, or nasopharyngeal temperature greater than or equal to 37.0 degrees Celsius during the period of cardiopulmonary bypass.

NQS DOMAIN / MEANINGFUL MEASURES AREA

Patient Safety / Preventable Healthcare Harm

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

2026 BENCHMARK

National average performance rate: 93.52%. Historical benchmark. Not topped out. Not capped.

Reading this benchmark: the distribution collapses above Decile 4. Anything short of a perfect 100% caps out at Decile 4 (roughly 4 points), and 100% jumps straight to 10. This is a binary-feeling measure in practice. For a cardiac group with reliable temperature documentation it is a strong 10-point measure. For a group with any documentation gaps it is worth 4 points at best, because 11A13 (no documented temperatures) counts as Performance Not Met, not as an exclusion.

CHANGE FOR 2026

A new denominator exclusion was added: TAVR and TAVI cases.

INSTRUCTIONS

Report each time a patient undergoes a cardiac operation using cardiopulmonary bypass during the reporting period. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.

Measure reporting via the QCDR: CPT codes and patient demographics identify patients in the denominator. Registry codes report the numerator.

DENOMINATOR

All patients aged 18 years or older who undergo a procedure using cardiopulmonary bypass.

Denominator Criteria (Eligible Cases): - Patient aged 18 years and older - AND Patient encounter during the reporting period (CPT): 00562, 00563, 00567, 00580

DENOMINATOR EXCLUSIONS

- 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 did not have an intraoperative pulmonary artery, oropharyngeal, or nasopharyngeal temperature greater than or equal to 37.0 degrees Celsius during cardiopulmonary bypass.

Numerator Quality-Data Coding Options:

Performance Met: 11A11 All intraoperative pulmonary artery, oropharyngeal, or nasopharyngeal temperatures less than 37.0 degrees Celsius during cardiopulmonary bypass

OR

Performance Not Met: 11A12 At least one intraoperative pulmonary artery, oropharyngeal, or nasopharyngeal temperature greater than or equal to 37.0 degrees Celsius

OR

Performance Not Met: 11A13 No documented pulmonary artery, oropharyngeal, or nasopharyngeal temperatures during cardiopulmonary bypass

RATIONALE

Appropriate temperature management during cardiopulmonary bypass is important to avoid cerebral hyperthermia and associated cerebral injury. Studies have associated cerebral hyperthermia with complications including cognitive dysfunction, mediastinitis, and acute kidney injury. Through careful monitoring, good communication with perfusionists, and appropriate rewarming strategies, anesthesiologists can prevent cerebral hyperthermia.

CLINICAL RECOMMENDATION STATEMENTS

2015 STS/SCA/ASECT Guidelines on Temperature Management During Cardiopulmonary Bypass: - "Surgical teams should limit arterial outlet blood temperature to less than 37 degrees Celsius to avoid cerebral hyperthermia." (Class I, Level C) - "Pulmonary artery or nasopharyngeal temperature recording is reasonable for core temperature measurement." (Class IIa, Level C)

REFERENCE

Engelman R, Baker RA, Likosky DS, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass, Temperature Management during Cardiopulmonary Bypass. J Extra Corpor Technol 2015;47(3):145-154.

RELEVANT FIELDS (Graphium capture)

- Date of service - Date of birth - ASA CPT code - CPB performed flag - Intraoperative PA, oropharyngeal, or nasopharyngeal temperatures during CPB (all values) - Modifier 52 / 53 - TAVR or TAVI case flag

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.

4 anesthesia CPT codes:

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

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