CMS 996v5 STEMI Numerator PCI

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED).

      In alignment with clinical best practice, the measure intends to capture the time from ED arrival to balloon inflation. It is ideal to capture the time of balloon inflation or reperfusion, and map to the relevantPeriod.startTime attribute of the “Procedure, Performed” QDM data element. The value set for Percutaneous Coronary Intervention (2.16.840.1.113883.3.3157.2000.5) includes CPT codes for balloon dilation. With regard to timestamps in the electronic health record (EHR), we recommend working with your EHR vendor on determining the best way to capture this information since we are aware that it is captured in other ways clinically.

      We will consider refinements in a future Annual Update.
      Show
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). In alignment with clinical best practice, the measure intends to capture the time from ED arrival to balloon inflation. It is ideal to capture the time of balloon inflation or reperfusion, and map to the relevantPeriod.startTime attribute of the “Procedure, Performed” QDM data element. The value set for Percutaneous Coronary Intervention (2.16.840.1.113883.3.3157.2000.5) includes CPT codes for balloon dilation. With regard to timestamps in the electronic health record (EHR), we recommend working with your EHR vendor on determining the best way to capture this information since we are aware that it is captured in other ways clinically. We will consider refinements in a future Annual Update.
    • CMS0996v5

      CMS 996v5: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

      Regarding the numerator logic for "PCI within 90 Minutes of Arrival"

      Numerator

      • ( "Fibrinolytic Therapy Within 30 Minutes of Arrival"
            union "PCI within 90 Minutes of Arrival"
            union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"
        )

      Definitions

      PCI within 90 Minutes of Arrival

      • "ED Encounter with STEMI Diagnosis" EDwSTEMI
          with ["Procedure, Performed": "Percutaneous Coronary Intervention"] PCI
            such that Global."NormalizeInterval" ( PCI.relevantDatetime, PCI.relevantPeriod ) starts 90 minutes or less after Global."EmergencyDepartmentArrivalTime" ( EDwSTEMI )

      "Procedure, Performed" QDM Datatype guidance says "Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set."

      However, when looking at some older ONC JIRAs:

      It seems as though the general guidance for PCI timing is as follows: "The device deployment time is when the blood vessel is opened using the balloon. That is what is measured in door-to-balloon. The start of PCI time is immaterial. As, an operator could take a long time to get the catheters and wires in place before the vessel is opened. That additional time also counts against that institution’s door to balloon time. That is the reason it is called door-to-balloon time and not door-to-PCI time. "

      Questions:

      1. If the PCI procedure starts at 10/29/2024 at 15:21 and is completed/done at 10/29/2024 16:22 and there is no documentation of the actual blood vessel opening time, what time should be used to determine if it is 90 minutes or less after the ED Arrival Time?
      2. If that is the start date and time, doesn't that contradict the "Procedure, Performed" QDM Datatype?
      3. It does not appear that it is in the natural clinical workflow to document the actual time the blood vessel was opened discretely, so what would be the guidance to get as close to this value as possible?

            Assignee:
            Augustine Weber
            Reporter:
            Becky Crellin
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