Clarification needed on STEMI eCQM on the ED encounter end time and eligibility for denominator exclusion for STEMI patient when mechanical circulatory device inserted prior or during the Cath Lab.

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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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). The measure calculates the percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to a PCI-capable acute care facility within 45 minutes of ED arrival. A patient’s ED encounter should end when they are discharged from the ED, as indicated by an ED discharge disposition. In the scenario depicted in the inquiry, the ED encounter would end when the patient is transferred to the CCU at 14:00pm. If a mechanical circulatory assist device placement occurred during the ED encounter or 24 hours or less before the start of the ED encounter (such as insertion of an intra-aortic balloon pump) the encounter would be excluded from the measure denominator. The full list of corresponding clinical codes for this measure exclusion (i.e., value set: "Insertion or Replacement of Mechanical Circulatory Assist Device" (OID: 2.16.840.1.113883.3.3157.4052)) can be found here: https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm&rel=eCQM%20Update%202024-05-02&q=CMS996v5. Please note that you may need to create a free account to view the codes. In general, we highlight that PCI device deployment time should be used for calculating the numerator criterion: PCI performed within 90 minutes of ED arrival. Therefore, if this patient did not receive placement of a mechanical circulatory assist device during the encounter and was in fact captured in the measure denominator, they would not be captured in the measure numerator since balloon inflation occurred at 13:26pm, which was 118 minutes (>90 minutes) after ED arrival time (11:28am).
      Show
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure calculates the percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to a PCI-capable acute care facility within 45 minutes of ED arrival. A patient’s ED encounter should end when they are discharged from the ED, as indicated by an ED discharge disposition. In the scenario depicted in the inquiry, the ED encounter would end when the patient is transferred to the CCU at 14:00pm. If a mechanical circulatory assist device placement occurred during the ED encounter or 24 hours or less before the start of the ED encounter (such as insertion of an intra-aortic balloon pump) the encounter would be excluded from the measure denominator. The full list of corresponding clinical codes for this measure exclusion (i.e., value set: "Insertion or Replacement of Mechanical Circulatory Assist Device" (OID: 2.16.840.1.113883.3.3157.4052)) can be found here: https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm&rel=eCQM%20Update%202024-05-02&q=CMS996v5 . Please note that you may need to create a free account to view the codes. In general, we highlight that PCI device deployment time should be used for calculating the numerator criterion: PCI performed within 90 minutes of ED arrival. Therefore, if this patient did not receive placement of a mechanical circulatory assist device during the encounter and was in fact captured in the measure denominator, they would not be captured in the measure numerator since balloon inflation occurred at 13:26pm, which was 118 minutes (>90 minutes) after ED arrival time (11:28am).
    • CMS0996v5
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      we would appreciate guidance on ED encounter end time. In a clinical scenario below for a patient in ED with STEMI diagnosis.
      ED arrival time: 11:28am
      STEMI Alert Activation: 12:10pm
      ED departure to Cath Lab: 12:20pm
      Cath Lab Arrival: 12:26pm
      IABP inserted in Cath lab, prior to PCI: 13:05
      D2B: 13:26
      patient transferred to CCU : 14:00pm
      D2B
      Show
      we would appreciate guidance on ED encounter end time. In a clinical scenario below for a patient in ED with STEMI diagnosis. ED arrival time: 11:28am STEMI Alert Activation: 12:10pm ED departure to Cath Lab: 12:20pm Cath Lab Arrival: 12:26pm IABP inserted in Cath lab, prior to PCI: 13:05 D2B: 13:26 patient transferred to CCU : 14:00pm D2B

      Questions for clarification:

      1. When does ED encounter officially end- at the time the patient physically leaves the ED (12:20) or at the time of Cath lab arrival (12:26) or when the patient is transferred to CCU (14:00pm)
      2. The patient had an IBP placed in the Cath lab prior to PCI. does this meet criteria for denominator exclusion.

            Assignee:
            Augustine Weber
            Reporter:
            Saleena (Inactive)
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