Update 2/11/2015: The comprehensive solution proposed to address VTE confirmed related issues has been updated and additional details and materials have been added. You can review these under CQM-882 ( https://jira.oncprojectracking.org/browse/CQM-882 ). We welcome the community's feedback, questions and discussion. Update 1/29/2015: We are considering a preliminary solution for this issue as part of an integrated approach to resolve a number of issues related to VTE confirmed. This solution would eliminate the VTE confirmed value set and use administratively assigned ICD-9-CM/ICD-10-CM codes to capture the specific VTE locations which are the target of the VTE treatment measures. Please see the solution posted for CQM-882 ( https://jira.oncprojectracking.org/browse/CQM-882 ) for additional details. We welcome and encourage feedback from the community regarding the proposed approach. --------- Thank you for your question. The data element in the paper-based measure specifications, “VTE Confirmed” is very specific as to what locations are allowed for a confirmed VTE. These locations are: • DVT located in the proximal leg veins, including superficial femoral vein • DVT located in the inferior vena cava (IVC) • DVT located in the iliac, femoral or popliteal veins • Pulmonary Emboli (PE) The steward reviewed this value set as part of the 2014 annual update and determined that it satisfied their requirements of where the VTE must be located for a patient to be counted in the denominator in these 4 VTE measures.   Steward update - May 20, 2014 — Clarification of the measures targeted populations — We would like to point out that these measures are designed to focus on pulmonary emboli (PE) or deep vein thrombosis (DVT) in the proximal veins of the lower extremities (inferior vena cava (IVC), iliac, femoral or popliteal veins). Other sites of venous thrombosis such as distal leg veins, or upper extremities are not included in the measure population since VTEs in these locations are not uniformly diagnosed and treated. In addition, DVT of upper extremities can be caused by emboli formed due to intravenous lines, and are therefore not included in the measure population. These are the reasons why the locations the measures focus on have been constrained. — Clarification of the intended purpose of the value sets “VTE” and VTE confirmed — The intent of the measures is to identify those patients who receive appropriate care for a VTE diagnosis fitting the above description. The VTE active diagnosis value set is used to identify the initial patient population of VTE patients; this value set is derived from a table of ICD-9-CM codes used in the original chart-abstracted measure that targets PE and DVT in the proximal veins of the lower extremities but also includes less specific codes that could meet the measure population requirements. The VTE confirmed value set further constrains the population, for two reasons. 1. To determine which of the VTE diagnoses are in fact diagnoses of VTE in the specified locations 2. To ensure that the VTE finding is supported by an appropriate diagnostic study. This means that not all patients that are pulled into the measures’ initial patient population with a diagnosis of VTE (per the VTE active diagnosis value set) will end up being part of the denominator population (which restricts it to patients with VTE confirmed in the defined locations).  In short, the “VTE Confirmed” value set and logic is our current solution to include those patients for whom a diagnosis of an applicable VTE was made as a result of diagnostic testing. — Further Considerations — We understand that this is causing workflow and feasibility issues, and have extensively discussed the possibility of directly using the VTE value set as an active diagnosis. This comes with its own set of issues, for example:  1. If using ICD-9-CM/ICD-10-CM, coding guidelines state that suspicions should be coded, which means that depending on where the ICD 9 CM/ICD-10-CM codes are being pulled from, they may or may not relate to a confirmed VTE;  2. There are no ICD-9-CM codes to discriminate between distal and proximal lower extremity VTEs, which means if we include the less specific codes we could be targeting distal VTEs for a particular treatment course that may or may not be appropriate;  3. Requiring a detailed diagnosis (including the VTE location) to be entered on the problem list would eliminate the need for two value sets but would the link between the diagnostic test and the confirmation of the VTE would be lost. In addition, this may not address the workflow issues being raised. We believe a resolution to this issue is not straightforward, and will require a concerted effort with vendors and hospitals. We look forward to the continued discussion of potential solutions that are less workflow-challenging, but also hope there is a better understanding of the intended scope of these measures.