QID 404 · Anesthesiology Smoking Abstinence

Steward: CMS | Collection Type: MIPS CQM 2026 Status: Active. Included in the CMS-recommended Anesthesiology Measure Set. Available in the Anesthesia MVP.

MEASURE DESCRIPTION

The percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure.

MEASURE TYPE: Intermediate Outcome HIGH PRIORITY STATUS: Yes INVERSE MEASURE: No | RISK ADJUSTED: No NUMBER OF PERFORMANCE RATES: 1 REPORTING OPTIONS: MVP and Traditional MIPS

2026 BENCHMARK

National average performance rate: 79.89%. Historical benchmark. Not topped out. Not capped.

Reading this benchmark: this is the widest and most useful benchmark available to anesthesia in 2026. The scoring range spans 87 percentage points and every decile is meaningfully separated. It is the only anesthesia measure where genuine improvement translates reliably into more points, rather than needing near-perfection to move a decile. It is also an outcome measure, which satisfies the Traditional MIPS requirement for at least one outcome or high priority measure on its own. If your group can capture smoking status and abstinence reliably, QID 404 should be a core measure.

INSTRUCTIONS

Submit each time an elective surgery, diagnostic, or pain procedure is performed under anesthesia during the performance period. There is no diagnosis associated with this measure.

DENOMINATOR

All patients aged 18 years and older who are evaluated in preparation for an elective surgical, diagnostic, or pain procedure requiring anesthesia services, identified as a current smoker prior to the day of the surgery or procedure, with instruction from an anesthesiologist or proxy to abstain from smoking on the day of surgery or procedure.

DENOMINATOR NOTE: Preoperative smoking cessation instruction can be performed by an anesthesiologist or proxy, including but not limited to a surgeon, nursing staff, or other preoperative care team member, as part of the preoperative evaluation.

Denominator Criteria (Eligible Cases): - Patients aged 18 years or older on date of service - AND Patient procedure during the performance period matching the measure's CPT list (309 codes spanning the ASA anesthesia range plus pain management and injection codes; the full list appears at the end of this measure) - AND Current smoker, including cigarette, cigar, pipe, e-cigarette, or marijuana (G9642) - AND Elective surgery (G9643) - AND Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery (G9497)

NUMERATOR

Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure.

Definition: Abstinence is defined by either patient self-report or an exhaled carbon monoxide level below 10 ppm.

Performance Met: G9644 Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure OR Performance Not Met: G9645 Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure

RATIONALE

Each year, approximately 10 million cigarette smokers require surgery and anesthesia in the U.S. Smoking is a significant independent risk factor for perioperative heart, lung, and wound-related complications. There is good evidence that perioperative abstinence from smoking reduces the risk of those complications, and that the perioperative period represents a teachable moment for smoking cessation that improves long-term abstinence rates.

While a longer duration of abstinence is associated with greater benefit, even abstinence on the morning of surgery is associated with reduced nicotine and carbon monoxide levels and a reduced risk of myocardial ischemia and surgical site infection. Evidence shows that perioperative tobacco cessation interventions can increase abstinence rates in surgical patients who smoke and decrease the rate of perioperative complications. Recent reviews identified a range of effective interventions, from brief counseling to behavioral therapy and pharmacotherapy, that anesthesiologists and surgeons can incorporate into practice.

Unfortunately, evidence also suggests that few physicians take advantage of the opportunity to intervene, and that many surgical patients still smoke on the morning of surgery. If more surgical patients get help quitting around the time of surgery, this will reduce smoking-related perioperative complications such as wound infection and lead to long-term improvements in health, since the average smoker gains six to eight life years by quitting. This measure therefore not only directly affects acute surgical risk but also serves as a marker for the provision of effective preoperative tobacco use interventions.

RELEVANT FIELDS (Graphium capture)

- Date of service, date of birth - ASA CPT code - Smoker status - Elective case flag - Cessation instruction given, and date given (must be prior to day of surgery) - Smoked on day of procedure

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.

The eligible CPT codes are grouped below for readability. A case needs one code from either list, not a code from both lists, to satisfy the CPT criterion. All other denominator criteria still apply.

Procedure codes (49):

Anesthesia codes (260):

Source: CMS 2026 MIPS measure specification. CPT copyright American Medical Association.