need exceptions to eCQM 996 that do not need fibrinolytic or PCI

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Dorothy Harden
    • 9259170839
    • Washington Health
    • Hide
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Updated Version 6 STEMI measure specifications for the 2026 reporting period were recently posted to the eCQI Resource Center: https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information. The measure’s updated specifications now include two new denominator exceptions for encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival and not performing PCI within 90 minutes of ED arrival.

      Reasons for not administering fibrinolytic therapy are captured in the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Drug Intervention Not Indicated/Contraindicated” (OID: 2.16.840.1.113762.1.4.1282.1) value sets. Reasons for not performing a PCI are captured in the Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [https://vsac.nlm.nih.gov/welcome]. Please note that you may need to create a free account to view these codes. These value sets cover the scenarios described in the recommendations regarding consent, or procedural indications.

      In terms of EKG timing, the issue of the measure not excluding cases where the STEMI develops during the ED encounter but the measure still assesses appropriate treatment starting from ED arrival time, has been brought to CMS’s attention. Clinical expert input and measure testing informed specifications in which timing of EKGs or time to cardiac catheterization lab is not included in numerator definitions. This decision was informed by review of testing results indicating that EKG timing in EHR documentation was discrepant or unreliable. Within the parameters of EHR limitations, the measure developer and CMS will consider refinements in a future annual update.

      In terms of the recommendation to exclude cases in which an intra-aortic balloon pump was inserted prior to PCI, we highlight that the measure does exclude mechanical circulatory assist device placement or removal occurring 24 hours or less before the start of the ED encounter or during the ED encounter. The Mechanical Circulatory Assist Device value set includes clinical codes for aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device. A full list of codes captured in this value set can be found in VSAC (OID: 2.16.840.1.113883.3.3157.4052): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion/Latest.
      Show
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Updated Version 6 STEMI measure specifications for the 2026 reporting period were recently posted to the eCQI Resource Center: https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information . The measure’s updated specifications now include two new denominator exceptions for encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival and not performing PCI within 90 minutes of ED arrival. Reasons for not administering fibrinolytic therapy are captured in the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Drug Intervention Not Indicated/Contraindicated” (OID: 2.16.840.1.113762.1.4.1282.1) value sets. Reasons for not performing a PCI are captured in the Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [ https://vsac.nlm.nih.gov/welcome ]. Please note that you may need to create a free account to view these codes. These value sets cover the scenarios described in the recommendations regarding consent, or procedural indications. In terms of EKG timing, the issue of the measure not excluding cases where the STEMI develops during the ED encounter but the measure still assesses appropriate treatment starting from ED arrival time, has been brought to CMS’s attention. Clinical expert input and measure testing informed specifications in which timing of EKGs or time to cardiac catheterization lab is not included in numerator definitions. This decision was informed by review of testing results indicating that EKG timing in EHR documentation was discrepant or unreliable. Within the parameters of EHR limitations, the measure developer and CMS will consider refinements in a future annual update. In terms of the recommendation to exclude cases in which an intra-aortic balloon pump was inserted prior to PCI, we highlight that the measure does exclude mechanical circulatory assist device placement or removal occurring 24 hours or less before the start of the ED encounter or during the ED encounter. The Mechanical Circulatory Assist Device value set includes clinical codes for aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device. A full list of codes captured in this value set can be found in VSAC (OID: 2.16.840.1.113883.3.3157.4052): https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion/Latest .
    • CMS0996v6
    • CMS0996v5
    • CMS0996v4
    • this core measure does not accurately reflect the quality of care for STEMI cases in the ED, 2026 reimbursement should not be affected by the results of this ecqm.

      Cases where the positive EKG occurs on a subsequent EKG or patient refusal to sign a consent for PCI or are taken to the cath lab and it is found that the coronaries are clear or there is no culprit lesion should be excluded from the requirement of having a fibrinolytic or PCI within 90 minutes of arrival time.

      exclude cases that refuse consent for PCI or fibrinolytic, have a patient centered reason for delay such as anatomical abnormalities or require an intra aortic ballon pump prior to PCI, the initial EKG upon arrival to ED does not show STEMI, the cardiac catheterization reveals no CAD burden or lesion that can be stented or ballooned. The cardiac catheterization shows diffuse multivessel disease with no culprit lesion to stent. 

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Dorothy Harden
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