Eliquis ordered with diagnosis other than atrial fibrillation

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Kacy Clanton
    • 773-896-2646
    • St. Bernard Hospital
    • Hide
      Thank you for your question for CMS108v13/VTE-1. Per the measure specifications, Oral Xa Factor Inhibitors only qualify an encounter for the numerator if the patient has a past or present diagnosis of Atrial Fibrillation or VTE, or a past or present hip or knee replacement. If an oral factor Xa inhibitor was given without atrial fibrillation/VTE or hip or knee surgery, the patient will not meet the numerator.

      For all other encounters in the denominator, the numerator is met if the patient receives one of the following:

      · "Medication, Administered": "Low Dose Unfractionated Heparin for VTE Prophylaxis" (2.16.840.1.113762.1.4.1045.39)
      · "Medication, Administered": "Low Molecular Weight Heparin for VTE Prophylaxis" (2.16.840.1.113883.3.117.1.7.1.219)
      · "Medication, Administered": "Injectable Factor Xa Inhibitor for VTE Prophylaxis" (2.16.840.1.113883.3.117.1.7.1.211)
      · "Medication, Administered": "Warfarin" (2.16.840.1.113883.3.117.1.7.1.232)
      · "Medication, Administered": "Rivaroxaban and Betrixaban for VTE Prophylaxis" (2.16.840.1.113762.1.4.1110.50)
      · “Procedure Performed": "Application of Intermittent Pneumatic Compression Devices" (2.16.840.1.113762.1.4.1110.65)
      · "Procedure, Performed": "Application of Venous Foot Pumps" (2.16.840.1.113762.1.4.1110.64)
      · "Procedure, Performed": "Application of Graduated Compression Stockings" (2.16.840.1.113762.1.4.1110.66)

      All value sets are available at the Value Set Authority Center (https://vsac.nlm.nih.gov/)​.
      Show
      Thank you for your question for CMS108v13/VTE-1. Per the measure specifications, Oral Xa Factor Inhibitors only qualify an encounter for the numerator if the patient has a past or present diagnosis of Atrial Fibrillation or VTE, or a past or present hip or knee replacement. If an oral factor Xa inhibitor was given without atrial fibrillation/VTE or hip or knee surgery, the patient will not meet the numerator. For all other encounters in the denominator, the numerator is met if the patient receives one of the following: · "Medication, Administered": "Low Dose Unfractionated Heparin for VTE Prophylaxis" (2.16.840.1.113762.1.4.1045.39) · "Medication, Administered": "Low Molecular Weight Heparin for VTE Prophylaxis" (2.16.840.1.113883.3.117.1.7.1.219) · "Medication, Administered": "Injectable Factor Xa Inhibitor for VTE Prophylaxis" (2.16.840.1.113883.3.117.1.7.1.211) · "Medication, Administered": "Warfarin" (2.16.840.1.113883.3.117.1.7.1.232) · "Medication, Administered": "Rivaroxaban and Betrixaban for VTE Prophylaxis" (2.16.840.1.113762.1.4.1110.50) · “Procedure Performed": "Application of Intermittent Pneumatic Compression Devices" (2.16.840.1.113762.1.4.1110.65) · "Procedure, Performed": "Application of Venous Foot Pumps" (2.16.840.1.113762.1.4.1110.64) · "Procedure, Performed": "Application of Graduated Compression Stockings" (2.16.840.1.113762.1.4.1110.66) All value sets are available at the Value Set Authority Center ( https://vsac.nlm.nih.gov/ )​.
    • CMS0108v13
    • Causing fallouts

      Several providers have ordered Eliquis to meet the VTE prophylaxis requirement. Their patients did not have a history of atrial fibrillation, VTE, or hip/knee surgery. In these cases the patient had a history of PE that they were already on Eliquis for. Another patient was already started on Eliquis due to their hemodialysis. In these cases and the like where a patient is already taking Eliquis for a diagnosis not listed, would the case be considered a fail if a history of A-fib is not documented? If so, is there another intervention, (ex. a medication) that the provider must order in addition to Eliquis?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Kacy Clanton
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