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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
023 0239 Process Yes Patient Safety Claims, Registry

Measure Description

Percentage of surgical patients aged 18 years and older undergoing procedures for which venous thromboembolism (VTE) prophylaxis is indicated in all patients, who had an order for Low Molecular Weight Heparin (LMWH), LowDose Unfractionated Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after surgery end time

Instructions

This measure is to be submitted each time a procedure is performed during the performance period for all patients who undergo surgical procedures for which VTE prophylaxis is indicated. There is no diagnosis associated with this measure. It is anticipated that eligible clinicians who perform the listed surgical procedures as specified in the denominator coding will submit this measure.

NOTE: No additional notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Surgical patients who had an order for LMWH, LDUH, adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after surgery end time

Definition

Mechanical Prophylaxis – Does not include TED hose.

Numerator Instructions:  There must be documentation of order (written order, verbal order, or standing order/protocol) for VTE prophylaxis OR documentation that VTE prophylaxis was given.

Numerator Quality-Data Coding Options

Performance Met: CPT II 4044F:

Appropriate VTE Prophylaxis Ordered

Documentation that an order was given for venous thromboembolism (VTE) prophylaxis to be given within 24 hours prior to incision time or 24 hours after surgery end time

Note:  A single CPT Category II code is provided for VTE prophylaxis ordered or VTE prophylaxis given. If VTE prophylaxis is given, submit 4044F

Denominator Exception: G9196:

Order for First or Second Generation Cephalosporin not Ordered for Medical Reasons

Documentation of medical reason(s) for not ordering a first OR second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to
surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except
colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))

Performance Not Met: G9198:

Order for First or Second Generation Cephalosporin not Ordered, Reason Not Given:

Order for first OR second generation cephalosporin
for antimicrobial prophylaxis was not documented,
reason not given

Append a submission modifier (8P) to CPT Category II code 5015F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Denominator

All surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic

DENOMINATOR NOTE: * CPT Category I procedure codes billed by surgeons performing surgery on the same patient, submitted with modifier 62 (indicating two surgeons, i.e., dual procedures) will be included in the denominator population, therefore both surgeons will be fully accountable for the clinical action described in the measure.

 

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Patient procedure during the performance period (CPT): Listed below are surgical procedures with indications for first or second generation cephalosporin prophylactic antibiotic

Table 1: Surgical procedures with indications for first or second generation cephalosporin
prophylactic antibiotic

SURGICAL PROCEDURE CPT CODE
Integumentary 15733, 15734, 15736, 15738, 15830, 15832, 15833, 15834, 15835,
15836, 15837, 19260, 19271, 19272, 19300, 19301, 19302, 19303,
19304, 19305, 19306, 19307, 19316, 19318, 19324, 19325, 19328,
19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366,
19367, 19368, 19369, 19370, 19371, 19380
Spine 22325, 22510, 22511, 22513, 22514, 22586, 22612, 22630, 22800,
22802, 22804, 63030, 63042
Hip Reconstruction 27125, 27130, 27132, 27134, 27137, 27138
Trauma (Fractures) 27235, 27236, 27244, 27245, 27269, 27758, 27759, 27766, 27769,
27792, 27814
Knee Reconstruction 27440, 27441, 27442, 27443, 27445, 27446, 27447
Vascular 27880, 27881, 27882, 27884, 27886, 27888, 33877, 33880, 33881,
33883, 33886, 33889, 33891, 34701, 34702, 34703, 34704, 34705,
34706, 34707, 34708, 34710, 34812, 34820, 34830, 34831, 34832,
34833, 34834, 34841, 34842, 34843, 34844, 34845, 34846, 34847,
34848, 35011, 35013, 35081, 35082, 35091, 35092, 35102,
35103, 35131, 35141, 35142, 35151, 35152, 35206, 35266, 35301,
35363, 35371, 35372, 35512, 35521, 35522, 35523, 35525, 35533,
35537, 35538, 35539, 35540, 35556, 35558, 35565, 35566, 35570,
35571, 35572, 35583, 35585, 35587, 35601, 35606, 35612, 35616,
35621, 35623, 35626, 35631, 35632, 35633, 35634, 35636, 35637,
35638, 35642, 35645, 35646, 35647, 35650, 35654, 35656, 35661,
35663, 35665, 35666, 35671, 36830, 36902, 36905,37224, 37225,
37226, 37227, 37228, 37229, 37230, 37231, 37246, 37248, 37617
Spleen and Lymph Nodes 38100, 38101, 38115, 38120, 38571, 38572, 38700, 38720, 38724,
38740, 38745, 38747, 38760, 38765, 38770, 38780
Esophagus 43020, 43030, 43045, 43100, 43101, 43107, 43108, 43112, 43113,
43116, 43117, 43118, 43121, 43122, 43123, 43124, 43130, 43135,
43279, 43280, 43281, 43282, 43300, 43305, 43310, 43312, 43313,
43314, 43320, 43325, 43327, 43328, 43330, 43331, 43332, 43333,
43334, 43335, 43336, 43337, 43340, 43341, 43351, 43352, 43360,
43361, 43400, 43401, 43405, 43410, 43415, 43420, 43425, 43496
Stomach 43500, 43501, 43502, 43510, 43520, 43605, 43610, 43611, 43620,
43621, 43622, 43631, 43632, 43633, 43634, 43640, 43641, 43644,
43645, 43651, 43652, 43653, 43800, 43810, 43820, 43825, 43830,
43832, 43840, 43843, 43845, 43846, 43847, 43848, 43850, 43855,
43860, 43865, 43870, 43880
Small Intestine 44005, 44010, 44020, 44021, 44050, 44055, 44100, 44120, 44125,
44126, 44127, 44130, 44132, 44133, 44135, 44136
Colon 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151,
44155, 44156, 44157, 44158, 44160, 44180, 44186, 44187, 44188,
44202, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212,
44227, 44300, 44310, 44312, 44314, 44316, 44320, 44322, 44340,
44345, 44346, 44602, 44603, 44604, 44605, 44615, 44620, 44625,
44626, 44640, 44650, 44660, 44661, 44680, 44700

 

SURGICAL PROCEDURE CPT CODE
Rectum 45000, 45020, 45110, 45111, 45112, 45113, 45114, 45116, 45119,
45120, 45121, 45123, 45126, 45130, 45135, 45136, 45150, 45160,
45171, 45172, 45395, 45397, 45400, 45402, 45540, 45541, 45550,
45560, 45562, 45563, 45800, 45805, 45820, 45825
Biliary 47400, 47420, 47425, 47460, 47480, 47562, 47563, 47564, 47570,
47600, 47605, 47610, 47612, 47620, 47700, 47701, 47711, 47712,
47715, 47720, 47721, 47740, 47741, 47760, 47765, 47780, 47785,
47800, 47801, 47802, 47900
Pancreas 48000, 48001, 48020, 48100, 48102, 48105, 48120, 48140, 48145,
48146, 48148, 48150, 48152, 48153, 48154, 48155, 48500, 48510,
48520, 48540, 48545, 48547, 48548, 48554, 48556
Abdomen, Peritoneum & Omentum 27080, 27158, 27202, 27280, 27282, 49000, 49002, 49010, 49020,
49040, 49060, 49203, 49204, 49205, 49215, 49220, 49250, 49320,
49321, 49322, 49323, 49405, 49406, 49407, 49505, 49507, 49568
Renal Transplant 50320, 50340, 50360, 50365, 50370, 50380
Neurological Surgery 22551, 22554, 22558, 22600, 22612, 22630, 22633, 61154, 61312,
61313, 61315, 61510, 61512, 61518, 61548, 61697, 61700, 61750,
61751, 61867, 62223, 62230, 63015, 63020, 63030, 63042, 63045,
63046, 63047, 63056, 63075, 63081, 63267, 63276
Cardiothoracic Surgery 33120, 33130, 33140, 33141, 33202, 33250, 33251, 33256, 33261,
33305, 33315, 33321, 33322, 33335, 33365, 33366, 33390, 33391,
33404, 33405, 33406, 33410, 33411, 33413, 33416, 33422,
33425, 33426, 33427, 33430, 33460, 33463, 33464, 33465, 33475,
33496, 33510, 33511, 33512, 33513, 33514, 33516, 33530, 33533,
33534, 33535, 33536, 33542, 33545, 33548, 35211, 35241, 35271
General Thoracic Surgery 0236T, 21627, 21632, 21740, 21750, 21825, 31760, 31766, 31770,
31775, 31786, 31805, 32096, 32097, 32098, 32100, 32110, 32120,
32124, 32140, 32141, 32150, 32215, 32220, 32225, 32310, 32320,
32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32491,
32505, 32506, 32507, 32800, 32810, 32815, 32900, 32905, 32906,
32940, 33020, 33025, 33030, 33031, 33050, 33300, 33310, 33320,
33361, 33362, 33363, 33364, 34051, 35021, 35216, 35246, 35276,
35311, 35526, 37616, 38381, 38746, 39000, 39010, 39200, 39220,
39545, 39561, 64746
Foot & Ankle 27702, 27703, 27704, 28192, 28193, 28291, 28415, 28420, 28445,
28465, 28485, 28505, 28525, 28531, 28555, 28585, 28615, 28645,
28675, 28705, 28715, 28725, 28730, 28735, 28737
Laryngectomy 31400, 31420
Mediastinum and Diaphragm 39501, 39540, 39541, 39545, 39560, 39561
Bariatric 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846,
43847, 43848, 43886, 43887, 43888
Meckel’s Diverticulum and Appendix 44800, 44820, 44850, 44900, 44950, 44955, 44960, 44970
Liver 47100, 47120, 47122, 47125, 47130, 47140, 47141, 47142, 47350,
47370, 47371, 47380, 47381
Gynecologic Surgery 57267, 58150, 58152, 58180, 58200, 58210, 58240, 58260, 58262,
58263, 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292,
58293, 58294, 58951, 58953, 58954, 58956
General Surgery 23470, 23472, 23473, 23474, 23616, 24363, 24370, 24371, 60505

 

 

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