Denominator Exclusions or Exemptions

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Karen Smith
    • 864-237-1219
    • SRHS
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      Thank you for your inquiry regarding CMS996v5 and CMS996v6, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED).

      Starting in CMS996v6, reasons for not performing a PCI are captured using 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. The value sets only cover scenarios where the patient refuses the procedure or the procedure is not medically appropriate. This does not cover scenarios where a PCI is performed and there is a documented reason for delay in reperfusion. The codes included in 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.
      Show
      Thank you for your inquiry regarding CMS996v5 and CMS996v6, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Starting in CMS996v6, reasons for not performing a PCI are captured using 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. The value sets only cover scenarios where the patient refuses the procedure or the procedure is not medically appropriate. This does not cover scenarios where a PCI is performed and there is a documented reason for delay in reperfusion. The codes included in 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.
    • CMS0996v6
    • CMS0996v5
    • This issue impacts the determination of patients meeting criteria and qualifying for the appropriate numerator/denominator population and final percentage for performance.

      In reviewing patients that our EHR has identified as potential STEMI patients for inclusion in this measure, further clarification is needed for those patients who had a documented reason for a delay in reperfusion during the PCI due to significant tortuous anatomy. Does this scenario meet the guidance for a denominator exception? Thank you.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Karen
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              Created:
              Updated:
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