Thank you for your question regarding CMS71 STK-3: Anticoagulation Therapy for Atrial Fibrillation/Flutter. The measure logic checks whether the Atrial Fibrillation/Flutter (AF) diagnosis occurred on or before the Ischemic Stroke relevant period. ​There is no time limit on the AF diagnosis in eSTK-3. Clinically speaking, once patients have AF they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return. Patients can be excluded from the measure if a physician documents a reason for not giving anticoagulants.

Coding guidelines allow for a diagnosis to be captured on an inpatient encounter when a provider suspects a medical condition, such as atrial fibrillation. This condition is then ruled out on further outpatient testing and the condition resolved in the problem list. The eSTK-3 measure ignores the resolution of atrial fibrillation and considers it a failure if anticoagulant is not started or a declination is not documented. From a medical management standpoint, the provider would not consider the anticoagulant or declination as the patient does not have atrial fibrillation as it was ruled out in the outpatient setting.