Thank you for your question that applies to CMS104 and CMS72 - Discharged on Antithrombotic Therapy (STK-2) and Antithrombotic Therapy by End of Hospital Day 2 (STK-5). Patients with a Principal Diagnosis Code for hemorrhagic stroke are excluded from the STK eCQMs. Patients assigned a Principal Diagnosis Code for ischemic stroke are included in the measure population. A secondary diagnosis of hemorrhagic stroke assigned for hemorrhagic conversion/ hemorrhagic transformation usually represents a complication related to thrombolysis for ischemic stroke. Each measure has a denominator exception for a documented reason for not administering / prescribing antithrombotic therapy. The CMS72 (STK-5) denominator exception states, “Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival”. The CMS104 (STK—2) denominator exception states, "Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge".

Although we report on ischemic stroke patients, many of these patients also have subdural or intracranial hemorrhages coded as secondary diagnoses and are being mis-identified in reporting as "numerator not met" for the STK measures when there is an easily identifiable reason not to administer.