VBR Smoking Cessation FAQ

A list of the most common questions regarding ASPIRE Value Based Reimbursement Smoking Cessation measures.

Measure Definitions

How does ASPIRE calculate performance for the ‘smoking status within 30 days prior to surgery’ measure?

  • First, assess each case for smoking status (see ‘Smoking Status Definitions’ section) 
  • Then calculate:

Total number of cases with a smoking status documented (current, former, non-smoker)
Total number of cases in the MPOG registry for the hospital

How does ASPIRE calculate performance to determine the proportion of current smokers that have smoking treatment documented?

  • First, assess each case for smoking treatment documented (see ‘Smoking Treatment Definitions’ section)
  • Then calculate for each month:

Total number of cases with smoking treatment documented
Total number of cases with smoking status = current smoker

  • The month with the highest performance score during the measurement time period will be used to determine if success is ≥ 10% for the measure.

What is the measurement time period for 2023 VBR?

  • December 1, 2021 – November 30, 2022

Smoking Status Definitions

What MPOG concepts are used to determine smoking status?

  • 70128 = History – Social History – Tobacco
  • 70160 = History – Social History – Tobacco (Current Smoker)
  • 70161 = History – Social History – Tobacco (Former Smoker)
  • 70162 = History – Social History – Tobacco (Non Smoker)
  • 71100 = History – Social History – Tobacco Details Pack Years
  • 71110 = History – Social History – Tobacco Details Current vs Past
  • 71040 = General – Past Medical History ICD-9 Code
  • 71041 = General – Past Medical History ICD-10 Code
  • 70125 = History – Social History – General
  • 70126 = History – Social History – Alcohol
  • 70127 = History – Social History – Illicit Drug Use
  • 70338 = General – PONV Risk Factors

How does ASPIRE assign the status of ‘current smoker?’

ASPIRE determines ‘current smoker’ if any of the following are true:

    • Documentation  of smoking cigarettes within 30 days prior to the procedure
    • Documentation of tobacco use with no other details
    • Documentation of pack year history, packs per day, cigarettes per day without indication of former smoker
    • Documentation of “history of smoking” or “history of tobacco use”
    • Numbers that do not look like a year are documented in a smoking field without additional information (i.e. 18,20). (This is typically the age the patient started smoking)

How does ASPIRE assign the status of ‘non-smoker?’

ASPIRE determines ‘non-smoker’ if any of the following are true:

    • Documented non-smoker or never smoker
    • Documentation of marijuana use but not smoking tobacco
    • Documentation of smokeless tobacco (chewing tobacco) use without documentation of smoking

How does ASPIRE determine smoking status if more than one of the above are true?

ASPIRE will use the latest smoking status that was documented prior to anesthesia start. If more than one (current smoker, former smoker, non-smoker) are documented at the same time, the following concepts are considered in this order of hierarchy:    

    1. 70160 History-Social History-Tobacco (current smoker)    
    2. 70161 History-Social History-Tobacco (former smoker)
    3. 70162 History-social history-Tobacco (non-smoker)   

For all other concepts, the following hierarchy is applied:

    1. Current Smoker
    2. Former Smoker
    3. Non-Smoker
    4. Unknown
    5. Invalid
    6. Unmapped

If there are no smoking notes prior to anesthesia start, MPOG assumes that smoking status was not documented or reviewed by anesthesia and considers smoking status as unknown. Please refer to the MPOG Smoking Tobacco Classification phenotype for more details.

How does ASPIRE assign the status of ‘former smoker?’

ASPIRE determines ‘former smoker’ if any of the following are true:

    • Documentation of a quit date >30 days prior to the procedure
    • Documentation indicates former smoker without a quit date
    • Documentation of numbers that look like a year with no other details (i.e. 2018, 2000) – assumed to be the ‘quit smoking’ date
    • Documentation of a date (i.e. May 2020, 11/2/1999, 10/2020, 20 years ago) – assumed to be the ‘quit smoking’ date
    • ICD-9 or ICD-10 codes that include “in remission”

How does ASPIRE determine smoking status if more than one of the above are true?

ASPIRE will use the latest smoking status that was documented prior to anesthesia start. If more than one (current smoker, former smoker, non-smoker) are documented at the same time, we will apply the below hierarchy in this order:

    1. Current Smoker
    2. Former Smoker
    3. Non-Smoker

If there are no smoking notes, it will result as ‘Missing.” If there are smoking notes but the entries are not discernable to smoking status,it will result as ‘Invalid.”

How does ASPIRE determine smoking status for other tobacco products (vape/e-cigarettes, cigars, smokeless tobacco, etc.)?

  • Smokeless tobacco/chew use without documentation to indicate current or former smoker is considered non-smoker
  • Documentation of vape/e-cigarettes, cigars, pipe tobacco use is considered ‘current smoker’

Smoking Treatment Definitions

What MPOG concepts are assessed for smoking treatment?

  • 70164 Tobacco Cessation Intervention (preoperative observation concept type)

How does ASPIRE define ‘smoking treatment?’

Documentation of smoking cessation intervention including:

    • Counseling
    • Treatment
    • Referral for tobacco cessation counseling
    • Patient refusal or documentation suggesting ‘no interest in quitting’ or ‘patient declined’

What time frame is considered for smoking cessation intervention documentation?

  • 30 days prior to anesthesia start through hospital discharge date

What services for treatment are available for Michigan sites?

  • Patients can receive text message support from the Healthy Behaviors of Michigan (HBOM) hotline by visiting their website: https://www.hbomich.org/signup/ 
  • Patients and providers can contact the Michigan Tobacco Quitline: 1-800-QUIT-NOW (1-800-784-8669) or https://michigan.quitlogix.org/en-US/
  • Most hospitals also offer an internal tobacco cessation service

For more information and materials, please visit the Healthy Behaviors of Michigan website: https://www.hbomich.org/

For any inquiries please email