Criteria List for C1 Manual Entry Test

CMS108v4 Venous Thromboembolism Prophylaxis

Data Criteria Value Set(s) Required Attributes Attribute Details/Value Set
Procedure, Performed
  • General Surgery: 2.16.840.1.113883.3.117.1.7.1.255
  • Gynecological Surgery: 2.16.840.1.113883.3.117.1.7.1.257
  • Hip Fracture Surgery: 2.16.840.1.113883.3.117.1.7.1.258
  • Hip Replacement Surgery: 2.16.840.1.113883.3.117.1.7.1.259
  • Intracranial Neurosurgery: 2.16.840.1.113883.3.117.1.7.1.260
  • Knee Replacement Surgery: 2.16.840.1.113883.3.117.1.7.1.261
  • Urological Surgery: 2.16.840.1.113883.3.117.1.7.1.272
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Diagnosis, Active
  • Mental Disorders: 2.16.840.1.113883.3.117.1.7.1.262
  • Hemorrhagic Stroke: 2.16.840.1.113883.3.117.1.7.1.212
  • Ischemic Stroke: 2.16.840.1.113883.3.117.1.7.1.247
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
  • ICU Admission or Transfer: 2.16.840.1.113883.3.117.1.7.1.305
 Length of stay stay ≤ 120 d
Device, Applied
  • Intermittent pneumatic compression devices (IPC): 2.16.840.1.113883.3.117.1.7.1.214
  • Venous foot pumps (VFP): 2.16.840.1.113883.3.117.1.7.1.230
  • Graduated compression stockings (GCS): 2.16.840.1.113883.3.117.1.7.1.256
 Negation Code Patient Refusal: 2.16.840.1.113883.3.117.1.7.1.93
Medication, Order
  • Unfractionated Heparin for VTE prophylaxis ingredient specific: 2.16.840.1.113762.1.4.1021.13
  • Low Molecular Weight Heparin for VTE prophylaxis ingredient specific: 2.16.840.1.113762.1.4.1021.12
  • Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific: 2.16.840.1.113762.1.4.1021.11
  • Warfarin-only ingredient specific: 2.16.840.1.113762.1.4.1021.10
 Negation Code Patient Refusal: 2.16.840.1.113883.3.117.1.7.1.93
Risk Category Assessment
  • VTE Risk Assessment: 2.16.840.1.113883.3.117.1.7.1.357
 Result Low Risk: 2.16.840.1.113883.3.117.1.7.1.400
Laboratory Test, Performed
  • INR: 2.16.840.1.113883.3.117.1.7.1.213
 Result
Intervention, Performed
  • Comfort Measures: 1.3.6.1.4.1.33895.1.3.0.45

CMS171v5 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision

Data Criteria Value Set(s) Required Attributes Attribute Details/Value Set
Procedure, Performed
  • CABG Surgeries: 2.16.840.1.113883.3.666.5.694
  • Cardiac Surgery Other Than CABG: 2.16.840.1.113883.3.666.5.701
  • Hip arthroplasty: 2.16.840.1.113883.3.666.5.703
  • Knee Arthroplasty Surgery: 2.16.840.1.113883.3.666.5.1816
  • Colon Surgery: 2.16.840.1.113883.3.666.5.705
  • Abdominal Hysterectomy: 2.16.840.1.113883.3.666.5.710
  • Vaginal Hysterectomy: 2.16.840.1.113883.3.666.5.712
  • Vascular Surgery: 2.16.840.1.113883.3.666.5.713
 Incision datetime
Diagnosis, Active
  • Any infection: 2.16.840.1.113883.3.666.5.696
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
 Length of stay stay ≤ 120 d
Medication, Administered
  • IV Quinolones: 2.16.840.1.113883.3.666.5.835
  • IV Vancomycin: 2.16.840.1.113883.3.666.5.766
  • IV Antimicrobial medication: 2.16.840.1.113883.3.666.5.765
 Route Substance or Medication Administration Route IV: 2.16.840.1.113883.3.666.5.1108
Patient Characteristic Ethnicity
  • Ethnicity: 2.16.840.1.114222.4.11.837

CMS172v5 Prophylactic Antibiotic Selection for Surgical Patients

Data Criteria Value Set(s) Required Attributes Attribute Details/Value Set
Procedure, Performed
  • SCIP Major Surgical Procedure: 2.16.840.1.113883.3.117.1.7.1.2
  • CABG Surgeries: 2.16.840.1.113883.3.666.5.694
  • Hip arthroplasty: 2.16.840.1.113883.3.666.5.703
  • Cardiac Surgery Other Than CABG: 2.16.840.1.113883.3.666.5.701
  • Knee Arthroplasty Surgery: 2.16.840.1.113883.3.666.5.1816
  • Colon Surgery: 2.16.840.1.113883.3.666.5.705
  • Abdominal Hysterectomy: 2.16.840.1.113883.3.666.5.710
  • Vaginal Hysterectomy: 2.16.840.1.113883.3.666.5.712
  • Vascular Surgery: 2.16.840.1.113883.3.666.5.713
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Diagnosis, Active
  • Any infection: 2.16.840.1.113883.3.666.5.696
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
 Discharge datetime
Medication, Order
  • IV Vancomycin: 2.16.840.1.113883.3.666.5.766
 Reason Request of physician: 2.16.840.1.113883.3.666.5.2254
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
  • Acute care hospital Inpatient Encounter: 2.16.840.1.113883.3.666.5.2289
Intervention, Performed
  • Chronic Wound Care: 2.16.840.1.113883.3.666.5.719
Patient Characteristic Ethnicity
  • Ethnicity: 2.16.840.1.114222.4.11.837

CMS188v5 Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients

Data Criteria Value Set(s) Required Attributes Attribute Details/Value Set
Diagnosis, Active
  • Pneumonia: 2.16.840.1.113883.3.666.5.752
  • Respiratory failure acute or chronic: 2.16.840.1.113883.3.666.5.2319
  • Septicemia: 2.16.840.1.113883.3.666.5.672
 Ordinality Principal: 2.16.840.1.113883.3.117.1.7.1.14
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
 Length of stay stay ≤ 1 d
Transfer from Ambulatory surgical center: 2.16.840.1.113883.3.666.5.687
Medication, Administered
  • IV Antipseudomonal quinolones: 2.16.840.1.113883.3.666.5.896
  • IV Macrolides ICU: 2.16.840.1.113883.3.666.5.758
  • IV Beta lactams: 2.16.840.1.113883.3.666.5.770
  • IV Antipneumococcal/antipseudomonal beta lactams: 2.16.840.1.113883.3.666.5.759
  • IV Aminoglycosides: 2.16.840.1.113883.3.666.5.727
  • IV Doxycycline: 2.16.840.1.113883.3.666.5.2204
  • IV Quinolones Antipneumococcal: 2.16.840.1.113883.3.666.5.465
  • IV Tigecycline: 2.16.840.1.113883.3.666.5.2203
 Route Substance or Medication Administration Route IV: 2.16.840.1.113883.3.666.5.1108
Procedure, Performed
  • Procedures as Reasons for Admission to ICU Due to Pneumonia: 2.16.840.1.113762.1.4.1111.26
  • Hemodialysis or Peritoneal Dialysis: 2.16.840.1.113883.3.666.5.2282
  • Wound Care: 2.16.840.1.113883.3.666.5.2192
  • Tracheostomy care: 2.16.840.1.113762.1.4.1045.77
  • Ventilator care: 2.16.840.1.113883.3.666.5.782
  • Immunocompromised Therapies: 2.16.840.1.113883.3.666.5.2348
Intervention, Performed
  • Comfort Measures: 1.3.6.1.4.1.33895.1.3.0.45
Encounter, Performed
  • Encounter Inpatient: 2.16.840.1.113883.3.666.5.307
  • Emergency Department Visit: 2.16.840.1.113883.3.117.1.7.1.292
  • ICU Admission or Transfer: 2.16.840.1.113883.3.117.1.7.1.305
  • Nursing Home or Extended Care Facility: 2.16.840.1.113883.3.666.5.2202
  • Acute care hospital Inpatient Encounter: 2.16.840.1.113883.3.666.5.2289