CMS 996 (STEMI-ED) Procedure, Performed does not accept coded diagnosis for Mechanical Circulatory Assist Device

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Becky Grigsby
    • 3129471849
    • Rush University Medical Center
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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 excludes ED encounters in which mechanical circulatory assist device placement or removal occurred 24 hours or less before the start of the ED encounter or during the ED encounter. Mechanical circulatory assist devices include aortic balloon pumps, biventricular assist devices, intra-aortic balloons, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pumps, left ventricular devices, percutaneous ventricular assist devices, or ventricular assist devices.

      Version 6 of the measure, recently published to the eCQI Resource Center for the 2026 reporting period [https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6], has made updates to the value set used to indicate this exclusion (OID: 2.16.840.1.113883.3.3157.4052).

      First, the value set was renamed from “Insertion or Replacement of Mechanical Circulatory Assist Device” to “Mechanical Circulatory Assist Device.” Second, the value set was updated to include ICD-10-PCS codes to indicate this exclusion criterion in addition to CPT and SNOMEDCT codes. Therefore, coding of ICD-10-PCS codes included in this value set should trigger the mechanical circulatory assist device placement or removal exclusion criterion. A full list of the updated codes in the Mechanical Circulatory Assist Device value set used in Version 6 of the measure can be viewed on VSAC here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion/Latest. Please note that you may need to create a free account to view the codes.
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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 excludes ED encounters in which mechanical circulatory assist device placement or removal occurred 24 hours or less before the start of the ED encounter or during the ED encounter. Mechanical circulatory assist devices include aortic balloon pumps, biventricular assist devices, intra-aortic balloons, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pumps, left ventricular devices, percutaneous ventricular assist devices, or ventricular assist devices. Version 6 of the measure, recently published to the eCQI Resource Center for the 2026 reporting period [ https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6 ], has made updates to the value set used to indicate this exclusion (OID: 2.16.840.1.113883.3.3157.4052). First, the value set was renamed from “Insertion or Replacement of Mechanical Circulatory Assist Device” to “Mechanical Circulatory Assist Device.” Second, the value set was updated to include ICD-10-PCS codes to indicate this exclusion criterion in addition to CPT and SNOMEDCT codes. Therefore, coding of ICD-10-PCS codes included in this value set should trigger the mechanical circulatory assist device placement or removal exclusion criterion. A full list of the updated codes in the Mechanical Circulatory Assist Device value set used in Version 6 of the measure can be viewed on VSAC here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion/Latest . Please note that you may need to create a free account to view the codes.
    • CMS0996v5
    • Patients are failing the measure and not falling into the denominator exclusion

      For this measure, all other Data Elements for Procedure, Performed allow for Coding to enter the ICD 10 code for the specific procedure, but for  Insertion or Replacement of Mechanical Circulatory Assist Device (2.16.840.1.113883.3.3157.4052), this does not allow for a coded diagnosis.  Why is an ICD10 code not allowed for these procedures that fall into this valueset?  We are failing this measure as the coders are entering these diagnosis for a Balloon pump or VAD during the period of the cardiac cath procedure, but this is not a workflow option and these are not captured.

       

      CPT codes are not entered on Inpatient Charts, and if there is a need for a Mechanical Circulatory Assist Device, they will not be discharged from the ED, so no CPT codes would be entered.

       

      Thank you for your explanation in advance, and can we add ICD10 codes?

      Becky 

            Assignee:
            Augustine Weber
            Reporter:
            Rebecca Grigsby
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