eCQM STEMI OP40 Clarification on Exclusion Logic

XMLWordPrintable

    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Sora Park
    • Hide
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure calculates the percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to an acute care facility within 45 minutes of ED arrival. We understand the intent of your question is to seek guidance on preventing patients who experience a cardiopulmonary emergency (e.g., ventricular fibrillation (Vfib), ventricular tachycardia (Vtach) or cardiac arrest) outside of the ED encounter. From the example you provided, we interpret that the patient had an initial ED Encounter and was then discharged from the ED to a subsequent inpatient encounter where they experienced Vfib/Vtach.

      Based on this information, it seems that both encounters are being combined, rather than documented in the EHR as two separate encounters. Therefore, we recommend working with your EHR vendor to document the ED encounter and the inpatient encounter separately, and map the ED encounter to the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” QDM datatype, and the inpatient encounter to the “Encounter, Performed”: “Encounter Inpatient” QDM datatype. Documentation of both encounters separately will help ensure that diagnoses occurring during the inpatient encounter are not erroneously pulled into the ED encounter, resulting in denominator exclusions.

      Additionally, we emphasize that several denominator exclusions utilize the “Diagnosis” QDM datatype. The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. Therefore, we recommend working with your EHR vendor to ensure accurate documentation of diagnosis onset and abatement times to ensure that encounters are not improperly excluded from the measure.
      Show
      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure calculates the percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to an acute care facility within 45 minutes of ED arrival. We understand the intent of your question is to seek guidance on preventing patients who experience a cardiopulmonary emergency (e.g., ventricular fibrillation (Vfib), ventricular tachycardia (Vtach) or cardiac arrest) outside of the ED encounter. From the example you provided, we interpret that the patient had an initial ED Encounter and was then discharged from the ED to a subsequent inpatient encounter where they experienced Vfib/Vtach. Based on this information, it seems that both encounters are being combined, rather than documented in the EHR as two separate encounters. Therefore, we recommend working with your EHR vendor to document the ED encounter and the inpatient encounter separately, and map the ED encounter to the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” QDM datatype, and the inpatient encounter to the “Encounter, Performed”: “Encounter Inpatient” QDM datatype. Documentation of both encounters separately will help ensure that diagnoses occurring during the inpatient encounter are not erroneously pulled into the ED encounter, resulting in denominator exclusions. Additionally, we emphasize that several denominator exclusions utilize the “Diagnosis” QDM datatype. The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. Therefore, we recommend working with your EHR vendor to ensure accurate documentation of diagnosis onset and abatement times to ensure that encounters are not improperly excluded from the measure.
    • CMS0996v5
    • Diagnosis of Vtach, Vfib, or cardiac arrest originating from non-emergency encounters is qualifying for exclusion

      Example: A patient is admitted through the ED with STEMI is taken to the cath lab, where they later experience Vfib/Vtach arrest.
      Currently, this patient is excluded under Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start, even though the Vfib/Vtach did not occur during or within 24 hours of the ED encounter.
      What would you recommend to prevent these patients from being incorrectly excluded? 
      Thank you for your guidance!

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Sora Park
            Votes:
            0 Vote for this issue
            Watchers:
            8 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: