Representing Patient Secondhand Tobacco Smoke Exposure

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard for observations	LOINC®	Final	Production		No	Free	N/A
Standard for observation values	SNOMED CT® U.S. Edition	Final	Production		Yes	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)(15)) applies only to smoked tobacco. It does not require the ability to capture other forms of tobacco or nicotine use (e.g., smokeless tobacco, e-cigarettes, secondhand smoke). In HTI-1, the criterion language did not change however SNOMED CT is required as a result of including USCDI v3. HL7® FHIR® US Core 7.0.0 and C-CDA 3.0 terminology bindings are updated to reference a value set that encompasses smoked tobacco, exposure to secondhand smoke, vaping and other methods of ingesting tobacco products. Smoking Status Type is used to categorize whether the smoking status is for smoking or tobacco use. It also includes concepts to reflect number of pack years or calculated pack years for cumulative lifetime tobacco exposure. Units of measure for quantitative result values should be represented using UCUM, see Representing Units of Measure. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	SmokingStatusComprehensive: 2.16.840.1.113762.1.4.1267.3 SmokingStatusType: 2.16.840.1.113762.1.4.1267.6

Limitations, Dependencies, and Preconditions for Consideration

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

The 2015 Edition smoking status criterion (§ 170.315(a)(15)) applies only to smoked tobacco. It does not require the ability to capture other forms of tobacco or nicotine use (e.g., smokeless tobacco, e-cigarettes, secondhand smoke).

In HTI-1, the criterion language did not change however SNOMED CT is required as a result of including USCDI v3.

HL7® FHIR® US Core 7.0.0 and C-CDA 3.0 terminology bindings are updated to reference a value set that encompasses smoked tobacco, exposure to secondhand smoke, vaping and other methods of ingesting tobacco products. Smoking Status Type is used to categorize whether the smoking status is for smoking or tobacco use. It also includes concepts to reflect number of pack years or calculated pack years for cumulative lifetime tobacco exposure.

Units of measure for quantitative result values should be represented using UCUM, see Representing Units of Measure.

For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

SmokingStatusComprehensive: 2.16.840.1.113762.1.4.1267.3
SmokingStatusType: 2.16.840.1.113762.1.4.1267.6

Comment

Submitted by chris.baumgart… on 2022-09-20

WA State Department of Health Tobacco/Smoking/Vaping Comments

In 2018, e-cigarette products with nicotine concentrations of five percent or greater comprised approximately two-thirds of the e-cigarette market, while zero-nicotine products accounted for less than one percent.[1] To more accurately assess nicotine intake and potential nicotine dependence among patients, Washington State Department of Health recommends distinguishing e-cigarette use by nicotine concentration, rather than e-cigarette liquid with nicotine versus e-cigarette liquid without nicotine. Additionally, Washington State Department of Health concurs with the recommendation submitted on September 19, 2018 by Dr. Michael Fiore and Robert Adsit to implement non-overlapping values for smoking status. [1] Romberg AR, Miller Lo EJ, Cuccia AF, Willet JG, Xiao H, Hair EC . . . King BA (2019). Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018, Drug and Alcohol Dependence, 203, 1-7. doi:10.1016/j.drugalcdep.2019.05.029.

Submitted by chris.baumgart… on 2021-09-29

WA State Department of Health Tobacco/Smoking/Vaping Comments

[1] Romberg AR, Miller Lo EJ, Cuccia AF, Willet JG, Xiao H, Hair EC . . . King BA (2019). Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018, Drug and Alcohol Dependence, 203, 1-7. doi:10.1016/j.drugalcdep.2019.05.029.

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

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 – 5

Federally Required – Yes

Cost – $

Test Tool Availability – Yes

Include Test Tool Link: https://tools.ncpdp.org/erx/#/home

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 Second Hand Tobacco Smoke Exposure. CPT Category II code 1032F identifies a patient who is a current smoker or currently exposed to secondhand smoke.

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.