​Thank you for your question about CMS71 (eSTK-3), Anticoagulation Therapy for Atrial Fibrillation/Flutter. Yes, ICD code I48.91, ‘Unspecified atrial fibrillation’ is found in valueset "Atrial Fibrillation/Flutter" (2.16.840.1.113883.3.117.1.7.1.202). This valueset includes concepts that identify a diagnosis of a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter. And if this Atrial Fibrillation/Flutter diagnosis prevalence period start time occurred on or before the end of the Ischemic Stroke relevant period, then it will qualify the Encounter for the Denominator. There is no time limit on the Afib/flutter diagnosis in eSTK-3. Clinically speaking, once patients have Afib/flutter(AF) they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return. Some of ways that patients may be excluded from eSTK-3 are listed below: - Inpatient hospitalizations for patients admitted for elective carotid intervention are not included in this measure. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Patients with a documented reason for not prescribing anticoagulation therapy at discharge (see valueset "Medical Reason" (2.16.840.1.113883.3.117.1.7.1.473) or valueset "Patient Refusal" (2.16.840.1.113883.3.117.1.7.1.93)) authored during the Encounter relevant period. In addition, you may want to check with your informatics expert to see if the mapping for this particular patient and situation was correct. Please let us know if you have additional questions.

In STK-71, our facilities have seen where the ICD code I48.91 is coded when the coder finds the statement "self-reported AFIB in medical history without evidence this hospital stay" in the medical record. This code is therefore identified in STK-71 as requiring anticoagulant treatment. However, anticoagulant treatment is not appropriate upon discharge for this type of patient since there was no diagnostic evidence of arrhythmia during the inpatient stay. Can there be an accommodation for this ICD code so that anticoagulation treatment is not required upon discharge? This code is viewed as being ambiguous without the additional context from the medical history or documentation from previous encounters.