Timing of PCI Exceptions

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Sora Park
    • 9178902742
    • NYP
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      Thank you for your inquiry regarding CMS996v6, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED).

      To capture this denominator exception, documentation of the reason for not performing a PCI
      must occur during the ED encounter, as indicated by the logic definition below, found in the measure’s HTML file posted on the eCQI Resource Center: (https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html).
       
      ED Encounter With A Documented Reason For No PCI Performed Within 90 Minutes Of ED Arrival

        "ED Encounter With STEMI Diagnosis" EDwSTEMI
        with (["Procedure, Not Performed": "Percutaneous Coronary Intervention"] NoPCI
                where (NoPCI.negationRationale in "Patient Refusal" or NoPCI.negationRationale in "Procedure Not Indicated/Contraindicated")) PCIRefused
          such that PCIRefused.authorDatetime during EDwSTEMI.relevantPeriod

      The denominator exception is defined using the negationRationale attribute of the “Procedure, Not Performed” QDM datatype. The negationRationale needs to be recorded using the codes in 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 author Datetime attribute indicates documentation of the time the decision to not perform a PCI occurred, which must be during the ED relevantPeriod. RelevantPeriod is an attribute of the “Encounter, Performed” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time). Please note that a patient’s ED encounter should end when there are changes in patient disposition to another level of care (i.e., inpatient) or when they are discharged from the ED. The end of the ED encounter is not impacted by transfers to other locations (e.g., cardiac catheterization lab) unless the patient disposition changes to another level of care before transport. Therefore, a reason for not performing a PCI documented during cardiac catheterization is considered as occurring during the ED encounter as if the patient disposition is not changed beforehand. However, if documentation of the reason for not performing a PCI occurs outside of the ED encounter, such as the inpatient setting, the denominator exception would not be triggered.
      Show
      Thank you for your inquiry regarding CMS996v6, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). To capture this denominator exception, documentation of the reason for not performing a PCI must occur during the ED encounter, as indicated by the logic definition below, found in the measure’s HTML file posted on the eCQI Resource Center: ( https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ).   ED Encounter With A Documented Reason For No PCI Performed Within 90 Minutes Of ED Arrival   "ED Encounter With STEMI Diagnosis" EDwSTEMI   with (["Procedure, Not Performed": "Percutaneous Coronary Intervention"] NoPCI           where (NoPCI.negationRationale in "Patient Refusal" or NoPCI.negationRationale in "Procedure Not Indicated/Contraindicated")) PCIRefused     such that PCIRefused.authorDatetime during EDwSTEMI.relevantPeriod The denominator exception is defined using the negationRationale attribute of the “Procedure, Not Performed” QDM datatype. The negationRationale needs to be recorded using the codes in 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 author Datetime attribute indicates documentation of the time the decision to not perform a PCI occurred, which must be during the ED relevantPeriod. RelevantPeriod is an attribute of the “Encounter, Performed” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time). Please note that a patient’s ED encounter should end when there are changes in patient disposition to another level of care (i.e., inpatient) or when they are discharged from the ED. The end of the ED encounter is not impacted by transfers to other locations (e.g., cardiac catheterization lab) unless the patient disposition changes to another level of care before transport. Therefore, a reason for not performing a PCI documented during cardiac catheterization is considered as occurring during the ED encounter as if the patient disposition is not changed beforehand. However, if documentation of the reason for not performing a PCI occurs outside of the ED encounter, such as the inpatient setting, the denominator exception would not be triggered.
    • CMS0996v6
    • CMS0996v5
    • Exclusion and/or inclusion of patients appropriately

      We are requesting clarification regarding the timing requirements for exceptions related to "PCI not performed within 90 minutes" in the eCQM STEMI specification, specifically when the clinical reason for non-performance occurs outside the ED encounter.

      In practice, certain valid exceptions- such as unfavorable coronary anatomy, inability to cross a lesion, or clinical decision to pursue CABG - are often identified after the patient has left the ED, during cardiac catheterization or inpatient care. However, current measure language indicates that the author date/time for the exception needs to occur during the ED encounter, which does not always align with when this determination can be made.

      Can you clarify on the following:

      1. Whether exceptions for PCI not performed may be documented at any point during the hospitalization, rather than strictly during the ED encounter
      2. Whether CMS intends for these exceptions to be tied to the ED encounter timing, even when the clinical decision or discovery logically occurs later

      Thank you for your time and guidance.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Sora Park
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              Created:
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