Use of HCPCS codes instead of CPT codes for STEMI eCQM

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: 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 captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. The measure uses the Percutaneous Coronary Intervention value set (OID: 2.16.840.1.113883.3.3157.2000.5), to capture encounters with PCI procedures. Currently the value set includes CPT, ICD-10-PCS, SNOMEDCT, and HCPCS codes. The four HCPCS codes captured in this value set include C9600, C9602, C9604, and C9607. Code 93460 is not captured in the value set as it is used to indicate angiograms and does not refer to any intervention such as PCI. Code 92978 is not included in the value set as this is an add-on procedure code. CMS and the measure developer may consider updates to the PCI value set to capture additional codes in a future annual update. A full list of clinical codes captured in the PCI value set can be found on VSAC [https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion/Latest]. Please note, you may need to create a free account to view these 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 captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. The measure uses the Percutaneous Coronary Intervention value set (OID: 2.16.840.1.113883.3.3157.2000.5), to capture encounters with PCI procedures. Currently the value set includes CPT, ICD-10-PCS, SNOMEDCT, and HCPCS codes. The four HCPCS codes captured in this value set include C9600, C9602, C9604, and C9607. Code 93460 is not captured in the value set as it is used to indicate angiograms and does not refer to any intervention such as PCI. Code 92978 is not included in the value set as this is an add-on procedure code. CMS and the measure developer may consider updates to the PCI value set to capture additional codes in a future annual update. A full list of clinical codes captured in the PCI value set can be found on VSAC [ https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion/Latest ]. Please note, you may need to create a free account to view these codes.
    • CMS1246v1
    • CMS1206v3
    • CMS0996v5
    • CMS0996v4
    • We are having STEMI eCQM fallouts due to requirement by Medicare to use HCPCS codes instead of CPT codes for patients who are transferred after their PCI

      One example is a patient with the following codes, which are NOT in the STEMI value set:

      93460 (catheter placement in coronary artery) - this is the HCPCS code used for an angiography - why is this not in the value set?

      92978 (endoluminal imaging of coronary vessel) - why is this not in the value set?

      We have had 145 patients in 2025 with C960 codes for PCI that were outpatient, two of which were ED patients that would qualify for the STEMI eCQM.

       

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Erin McBeth
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