STEMI occurring while inpatient attributing to ED encounter

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Richard Cabatic
    • 973-754-3153
    • St. Joseph's University Medical Center
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      Thank you for your inquiry regarding CMS996v4: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We understand the intent of your inquiry is to determine why a patient with an ED diagnosis that occurred after the ED encounter with a present on admission indicator of “no” is captured in the STEMI measure denominator. The prevalencePeriod attribute is currently used to capture a STEMI diagnosis signifying onset dateTime to abatement dateTime. The measure intends to capture STEMI during the ED encounter only; therefore, it’s important that both the onset and abatement times are populated in the electronic health record (EHR) and mapped to the appropriate Quality Data Model (QDM) data element to avoid misattribution. We can consider using a presentOnAdmissionIndicator attribute for the “Encounter, Performed” datatype in future Annual Updates.
      Show
      Thank you for your inquiry regarding CMS996v4: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We understand the intent of your inquiry is to determine why a patient with an ED diagnosis that occurred after the ED encounter with a present on admission indicator of “no” is captured in the STEMI measure denominator. The prevalencePeriod attribute is currently used to capture a STEMI diagnosis signifying onset dateTime to abatement dateTime. The measure intends to capture STEMI during the ED encounter only; therefore, it’s important that both the onset and abatement times are populated in the electronic health record (EHR) and mapped to the appropriate Quality Data Model (QDM) data element to avoid misattribution. We can consider using a presentOnAdmissionIndicator attribute for the “Encounter, Performed” datatype in future Annual Updates.
    • CMS0996v4
    • This scenario results in facility failure frequently despite the patient presenting to the ED without STEMI.

      Patients presenting to hospital without STEMI are admitted for non-cardiac condition. Patient experiences STEMI the day after or later in admission on the inpatient unit. Analysis of coding shows that cases where this happens have a present on admission (POA) indicator of 'N', yet these patients still fall into this measure and the hospital fails the case.

      Diagnosis Codes are not date/timed as procedures are when an encounter is billed. POA indicator of "N" is currently not an exclusion.

      Is there a value set, data element or algorithm change that can address this chronology issue? 

      Can the Present on Admission Indicator for STEMI diagnoses be added as an exclusion?

       

            Assignee:
            Augustine Weber
            Reporter:
            Richard Cabatic (Inactive)
            Votes:
            1 Vote for this issue
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              Created:
              Updated:
              Resolved:
              Solution Posted On: