AQI 71 · Ambulatory Glucose Management

Steward: American Society of Anesthesiologists / Anesthesia Quality Institute | First Performance Year: 2021 2026 Status: Approved by CMS for the 2026 MIPS performance period.

MEASURE DESCRIPTION

Percentage of diabetic patients aged 18 years and older who receive an office-based or ambulatory surgery whose blood glucose level is appropriately managed throughout the perioperative period.

This measure consists of four performance rates:

AQI 71a: Percentage of patients with a current diagnosis of diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery whose blood glucose level is tested prior to the start of anesthesia.

AQI 71b: Percentage of patients with diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level greater than 180 mg/dL (10.0 mmol/L) and who received insulin prior to anesthesia end time.

AQI 71c: Percentage of patients with diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who received insulin perioperatively and who received a follow-up blood glucose level check following administration of insulin and prior to discharge.

AQI 71d: Percentage of patients with diabetes mellitus receiving anesthesia services for office-based or ambulatory surgery who experienced a blood glucose level greater than 180 mg/dL (10.0 mmol/L) and who received education on managing their glucose in the postoperative period prior to discharge.

NOTE: The overall measure score is calculated as an average of the performance rates of parts a, b, c, and d. To be scored on this measure, clinicians must have at least one eligible case reported for each of the four sub-metrics. Missing any one of them zeroes the composite.

CHANGES FOR 2026

- Measure Type changed from Process to Composite. - High Priority Status changed from No to Yes. - ICD-10 code list for diabetes mellitus expanded to add E10.A0, E10.A1, and E10.A2 across all four sub-measures.

NQS DOMAIN / MEANINGFUL MEASURES AREA

Effective Clinical Care / Healthcare Associated Infections

MEASURE TYPE: Composite (changed for 2026) HIGH PRIORITY STATUS: Yes (changed for 2026) INVERSE MEASURE: No | RISK ADJUSTED: No NUMBER OF PERFORMANCE RATES: 5 (the composite plus four sub-rates) OVERALL PERFORMANCE RATE FOR SCORING: 1st Performance Rate (the composite average) CARE SETTING: Ambulatory Care (Hospital), Ambulatory Surgical Center TELEHEALTH: No DATA SOURCE: Claims, 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: review the requirements for all four sub-metrics and your eligible case population. Clinical relevance and complete reporting matter; the absence of a historical benchmark does not establish the measure’s final scoring potential.

INSTRUCTIONS

Each sub-measure should be reported, as appropriate, each time a patient undergoes a procedure in an office-based or ambulatory setting during the reporting period. All four sub-metrics are required to be reported during the performance period.

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

SHARED DENOMINATOR ELEMENTS (all four sub-measures)

Denominator Definition: Office-based and ambulatory surgery is a therapeutic or diagnostic procedure performed in a healthcare facility that does not require an overnight stay (less than 24 hours of care).

• All patients aged 18 years and older
• AND Diagnosis of diabetes mellitus (11A41) OR an ICD-10-CM code from the measure's diabetes list. The list spans the E10, E11, and E13 families, roughly 250 codes, and was expanded for 2026 to include E10.A0, E10.A1, and E10.A2. See the AQI NACOR 2026 QCDR Measure Specifications for the enumerated list.
• AND Place of Service Code 11, 19, 22, or 24 (Office, Off Campus Outpatient Hospital, On Campus Outpatient Hospital, Ambulatory Surgical Center)
• AND Patient encounter during the reporting period matching the measure's ambulatory anesthesia CPT list (a narrower ambulatory subset; 143 codes for AQI 71a, 71b and 71d, and 137 for AQI 71c. The full lists appear at the end of this measure.)

SHARED DENOMINATOR EXCLUSION (all four sub-measures)

- Procedure less than 30 minutes duration (11A45)

AQI 71a: Ambulatory Point-of-Care Glucose Testing

DENOMINATOR: Shared elements above.

NUMERATOR: Patients who received a blood glucose test prior to the start of anesthesia.

Performance Met: 11A51 Patient received a blood glucose test prior to start of anesthesia OR Performance Not Met: 11A52 Patient did NOT receive a glucose test prior to start of anesthesia

AQI 71b: Ambulatory Hyperglycemia Control

DENOMINATOR: Shared elements above, AND experienced a blood glucose level greater than 180 mg/dL (10.0 mmol/L) prior to anesthesia end time (11A44).

NUMERATOR: Patients who received insulin prior to anesthesia end time.

Performance Met: 11A53 Patient received insulin prior to anesthesia end time OR Denominator Exception: 11A82 Documentation that insulin was not given because the patient had severe comorbidities and glucose concentrations between 180 mg/dL and 250 mg/dL (10 to 13.9 mmol/L) OR Performance Not Met: 11A54 Patient did NOT receive insulin prior to anesthesia end time

AQI 71c: Follow-Up Glucose Check for Patients Receiving Insulin

DENOMINATOR: Shared elements above, AND patient received insulin perioperatively (11A55).

NUMERATOR: Patients who received a follow-up blood glucose level check following the administration of insulin and prior to discharge.

Performance Met: 11A56 Patient received a follow-up blood glucose level check following the administration of insulin and prior to discharge OR Performance Not Met: 11A57 Patient did NOT receive a follow-up blood glucose level check following the administration of insulin and prior to discharge

AQI 71d: Hyperglycemia Management Patient Education

DENOMINATOR: Shared elements above, AND experienced a blood glucose level greater than 180 mg/dL (10.0 mmol/L) prior to anesthesia end time (11A44).

NUMERATOR: Patients who received education on managing their glucose in the postoperative period prior to discharge.

Numerator Note: To meet this measure, the anesthesiologist or another member of the care team must provide both oral and written education. Provision of written materials alone is not sufficient.

Performance Met: 11A58 Patient received education on managing their glucose in the postoperative period prior to discharge OR Performance Not Met: 11A59 Patient did NOT receive education on managing their glucose in the postoperative period prior to discharge

RATIONALE

Diabetes mellitus is an important risk factor for surgical site infection and other surgical complications. With increasingly complex procedures being performed in ambulatory settings, perioperative glucose management is an important aspect of ambulatory anesthesia care. For diabetic patients, preoperative testing of blood glucose provides an important indicator of intraoperative insulin and care management needs. Despite this, evidence shows glucose testing is not consistently performed in the ambulatory setting. Improved preoperative glucose testing helps anesthesia providers anticipate and manage the needs of diabetic patients throughout the perioperative period.

Perioperative administration of insulin to hyperglycemic patients improves clinical outcomes by decreasing surgical site infections and hyperglycemia in the PACU. Blood glucose values of 180 mg/dL (10 mmol/L) or higher are treated with insulin. The target range for the perioperative period is 140 to 180 mg/dL (7.7 to 10 mmol/L).

CLINICAL RECOMMENDATION STATEMENTS

2010 SAMBA Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery: "Ambulatory surgical facilities taking care of diabetic patients must have glucose monitoring capabilities such as point-of-care monitors. Adequate monitoring of blood glucose levels is critical in maintaining patient safety and should facilitate insulin titration to achieve optimal blood glucose levels as well as allow for early detection of hypoglycemia. It has been suggested that blood glucose levels should be checked on the patient's arrival to the facility before surgery and before discharge home." (LoE category 2A)

SAMBA recommends intraoperative blood glucose levels below 180 mg/dL. The AACE Task Force and the American Diabetes Association recommend target glucose levels between 140 and 180 mg/dL in critically ill patients. The Society of Critical Care Medicine advises treatment triggered at blood glucose levels at or above 150 mg/dL, with a goal of maintaining glucose below that level and absolutely below 180 mg/dL. The Society of Thoracic Surgeons recommends maintaining serum glucose at or below 180 mg/dL for at least 24 hours after cardiac surgery.

RELEVANT FIELDS (Graphium capture)

- Date of procedure, date of birth - Diabetes diagnosis and ICD-10 code - Place of service code - ASA CPT code - Procedure duration - Preoperative blood glucose value and timing - Any blood glucose value greater than 180 mg/dL and timing - Insulin administered, and timing relative to anesthesia end - Follow-up glucose check after insulin, prior to discharge - Postoperative glucose management education, oral and written

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.

AQI 71a, AQI 71b and AQI 71d

143 anesthesia CPT codes:

AQI 71c

137 anesthesia CPT codes:

Four sub-measures. AQI 71a, 71b and 71d share one list; 71c is slightly narrower.

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