VTE-2 "Diagnoses": "Venous Thromboembolism"

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Jessica Johnston
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      Thank you for your inquiry regarding CMS0190v12, Intensive Care Unit Venous Thromboembolism Prophylaxis. Z codes (i.e., Z86.718, Z79.01) are situational status codes that denote a personal history of a condition. They are not diagnostic codes, and therefore are not included in the Venous Thromboembolism value set (2.16.840.1.113883.3.117.1.7.1.279). The measure’s numerator logic looks for a history of other venous thromboembolism diagnoses encoded in SNOMEDCT and ICD10CM codes that start prior to the encounter, using diagnosis prevalence period as an indicator of history of diagnosis. We hope this helps.
      Show
      Thank you for your inquiry regarding CMS0190v12, Intensive Care Unit Venous Thromboembolism Prophylaxis. Z codes (i.e., Z86.718, Z79.01) are situational status codes that denote a personal history of a condition. They are not diagnostic codes, and therefore are not included in the Venous Thromboembolism value set (2.16.840.1.113883.3.117.1.7.1.279). The measure’s numerator logic looks for a history of other venous thromboembolism diagnoses encoded in SNOMEDCT and ICD10CM codes that start prior to the encounter, using diagnosis prevalence period as an indicator of history of diagnosis. We hope this helps.
    • CMS0190v12
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      Patient not meeting Numerator/Pass with "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After First ICU Stay or Procedure" in Union with "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE" when the patient has been administered medication and has history of DVT. This is DUE TO data element "Diagnosis: Venous Thromboembolism" not picking up history of DVT.
      Show
      Patient not meeting Numerator/Pass with "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After First ICU Stay or Procedure" in Union with "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE" when the patient has been administered medication and has history of DVT. This is DUE TO data element "Diagnosis: Venous Thromboembolism" not picking up history of DVT.

      We had a fallout for a CMS eCQM measure and after a deep dive in the chart this patient should not have fallen out as all aspects of the measure were met.  When we reviewed the chart the patient clearly has a history of DVT documented throughout the record and is on lifelong Eliquis (received Eliquis on day of or day after). Coding includes Z86.718 “Personal history of other venous thrombosis and embolism”.  The code Z86.718 is not coded as POA. The patient is on lifelong Eliquis and has coding for long term use of anti-coagulant,  Z79.01.

      Is history of DVT not included in CMS190v12 value set 2.16.840.1.113883.3.117.1.7.1.279? If not why?

            Assignee:
            Augustine Weber
            Reporter:
            Jessica Johnston (Inactive)
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