Representing Patient Tobacco Use (Smoking Status)

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard for observation values	SNOMED CT®	Final	Production		Yes	Free	N/A
Standard for observations	LOINC®	Final	Production		No	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The 2015 Edition smoking status criterion (§ 170.315(a)(11)) only applies to status of use for smoked tobacco. It does not require a terminology standard. There are limitations in SNOMED CT® for this interoperability need, which include, but not limited to: not being able to capture severity of dependency, level of use, quit attempts, lifetime exposure, and use of e-Cigarettes. LOINC® includes codes that support recording smoking status in the CDC’s preferred (and sometimes required) responses (e.g. Tobacco smoking status NHIS[76691-5]) and other kinds of observations (e.g. Have you smoked at least 100 cigarettes in your entire life [PhenX] [63581-3] or How old were you when you first started smoking cigarettes every day [PhenX] [63609-2]. See LOINC projects in the Interoperability Proving Ground. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	'Tobacco smoking status NHIS' LOINC® 72166-2 Current Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38 The following smoking status value set of SNOMED CT® codes is only required in the context of using the Common Clinical Data Set (CCDS): Current every day smoker. 449868002 Current some day smoker. 428041000124106 Former smoker. 8517006 Never smoker. 266919005 Smoker, current status unknown. 77176002 Unknown if ever smoked. 266927001 Heavy tobacco smoker. 428071000124103 Light tobacco smoker. 428061000124105 Additional tobacco-related codes: Date quit tobacco smoking: LOINC 74010-0 Date quit smokeless tobacco: LOINC 88030-2 User of smokeless tobacco (finding): SNOMED CT® 713914004 Smokeless tobacco non-user (finding): SNOMED CT® 451381000124107 Former smokeless tobacco user (finding): SNOMED-CT® 456711000124105 Chews tobacco (finding): SNOMED-CT® 81703003 Snuff user (finding): SNOMED-CT® 228494002 User of moist powdered tobacco (finding): SNOMED-CT® 228504007 No known exposure to tobacco smoke (finding): SNOMED-CT® 711563001

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The 2015 Edition smoking status criterion (§ 170.315(a)(11)) only applies to status of use for smoked tobacco. It does not require a terminology standard.
There are limitations in SNOMED CT® for this interoperability need, which include, but not limited to: not being able to capture severity of dependency, level of use, quit attempts, lifetime exposure, and use of e-Cigarettes.
LOINC® includes codes that support recording smoking status in the CDC’s preferred (and sometimes required) responses (e.g. Tobacco smoking status NHIS[76691-5]) and other kinds of observations (e.g. Have you smoked at least 100 cigarettes in your entire life [PhenX] [63581-3] or How old were you when you first started smoking cigarettes every day [PhenX] [63609-2].
See LOINC projects in the Interoperability Proving Ground.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

'Tobacco smoking status NHIS' LOINC® 72166-2
Current Smoking Status urn:oid:2.16.840.1.113883.11.20.9.38
The following smoking status value set of SNOMED CT® codes is only required in the context of using the Common Clinical Data Set (CCDS):
1. Current every day smoker. 449868002
2. Current some day smoker. 428041000124106
3. Former smoker. 8517006
4. Never smoker. 266919005
5. Smoker, current status unknown. 77176002
6. Unknown if ever smoked. 266927001
7. Heavy tobacco smoker. 428071000124103
8. Light tobacco smoker. 428061000124105
Additional tobacco-related codes:
1. Date quit tobacco smoking: LOINC 74010-0
2. Date quit smokeless tobacco: LOINC 88030-2
3. User of smokeless tobacco (finding): SNOMED CT® 713914004
4. Smokeless tobacco non-user (finding): SNOMED CT® 451381000124107
5. Former smokeless tobacco user (finding): SNOMED-CT® 456711000124105
6. Chews tobacco (finding): SNOMED-CT® 81703003
7. Snuff user (finding): SNOMED-CT® 228494002
8. User of moist powdered tobacco (finding): SNOMED-CT® 228504007
9. No known exposure to tobacco smoke (finding): SNOMED-CT® 711563001

Comment

Submitted by mattreid on 2020-03-26

The AMA requests that the…

The AMA requests that the Current Procedural Terminology (CPT) code set be added to the standards listed in Section I: Representing Patient Tobacco Use (Smoking Status). CPT codes 99406 and 99407 identify the patient as a tobacco user and that cessation counseling was provided. In addition, CPT Category II codes identify assessment of tobacco use (1000F), current tobacco user with asthma (1032F), current tobacco user with heart disease (1034F), tobacco use cessation counseling (4000F), tobacco use cessation pharmacologic therapy (4001F), and patient screened as a tobacco user and received cessation intervention (4004F). CPT is a comprehensive and regularly curated uniform language that accurately describes medical, surgical, and diagnostic services and provides for reliable communication among users. It has an extremely robust and mature development process with open and transparent meetings and clinical input from national medical specialties and relevant stakeholders. It is the most widely adopted outpatient procedure code set. Use of the CPT code set is federally required under HIPAA.

Submitted by pwilson@ncpdp.org on 2020-11-07

NCPDP Comment

Substance use fields are available in NCPDP SCRIPT Standard Version 2017071 to allow tobacco use information to be transmitted via SNOMED codes
Add the following:

Type-Implementation Specification Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071 Standards Process Maturity – Final Implementation Maturity- Production Adoption Level – 1 Federally Required – Yes Cost – $ Test Tool Availability – Yes