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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
326 1525 Process No Effective Clinical Care Registry

Measure Description

Percentage of patients aged 18 years and older with nonvalvular atrial fibrillation (AF) or atrial flutter who were prescribed
warfarin OR another FDA-approved anticoagulant drug for the prevention of thromboembolism during the measurement
period

Instructions

This measure is to be submitted a minimum of once per performance period for patients with nonvalvular AF or atrial flutter seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: No 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

Patients with nonvalvular AF or atrial flutter for whom warfarin or another FDA-approved anticoagulant was prescribed

Definition

Prescribed – also satisfied by documentation in current medication list Comfort Care Only – Refers to medical treatment of a dying person where the natural dying process is permitted to occur while assuring maximum comfort. It includes attention to the psychological and spiritual needs of the patient and support for both the dying patient and the patient’s family. Comfort Measures Only is commonly referred to as “comfort care” by the general public. It may be completed in an inpatient, outpatient or home environment. Comfort Measures Only includes hospice, palliative and supportive treatment for patients who are suffering from a terminal illness—e.g., AIDS, cancer—or who have refused life-sustaining treatment. In order to use G9930, a patient must be on comfort care measures only and not be receiving any other types of care. It is not equivalent to a physician order to withhold emergency resuscitative measures such as Do Not Resuscitate (DNR)

CHA2DS2-VASc Stroke Risk Assessment The assessment of patients with nonvalvular AF or atrial flutter,
assessment of thromboembolic risk should include:

 

CHA2DS2-VASc Criteria Score
Congestive HF 1
Hypertension 1
Age >= 75 years 2
Diabetes Mellitus 1
Stroke/Transient Ischemic Attack (TIA)/Thromboembolism (TE) 2
Vascular disease (prior myocardial infarction [MI], peripheral artery disease
[PAD], or aortic plaque)
1
Age 64-74 years 1
Sex category (i.e.; female) 1

Numerator Quality-Data Coding Options

NUMERATOR 

If patient is not eligible for this measure because patient has transient or reversible cause of AF OR patient is receiving comfort care OR CHA2DS2-VASc of 0 or 1

(One of three quality-data codes [G9929 OR G9930 OR G9931] is required on the claim form to submit this
numerator option)

Denominator Exclusion: G9929:

Patient has transient or reversible cause of AF (e.g.,
pneumonia, hyperthyroidism, pregnancy, cardiac
surgery)

OR

Denominator Exclusion: G9930:

Patients who are receiving comfort care only

OR

Denominator Exclusion: G9931:

Documentation of CHA2DS2-VASc risk score of 0 or 1

NUMERATOR 

Warfarin or Another FDA-Approved Oral Anticoagulant that is Prescribed
(One quality-data code [G8967] is required on the claim form to submit this numeratoroption)

Performance Met: G8967:

Warfarin OR another FDA-approved oral anticoagulant is prescribed

 

OR

Warfarin or Another FDA-Approved Anticoagulant that is Not Prescribed for Medical Reasons
(One quality-data code [G8968] is required on the claim form to submit this numeratoroption)

Denominator Exception: G8968:

Documentation of medical reason(s) for not prescribing warfarin OR another FDA-approved anticoagulant (e.g., atrial appendage device in place)

OR

Warfarin or Another FDA-Approved Anticoagulant Not Prescribed for Patient Reasons
(One quality-data code [G8969] is required on the claim form to submit this numeratoroption)

Denominator Exception: G8969:

Documentation of patient reason(s) for not prescribing warfarin OR another FDA-approved oral anticoagulant that is FDA approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed)

OR

Warfarin or Another FDA-Approved Anticoagulant Not Prescribed for System Reasons
(One quality-data code [G9927] is required on the claim form to submit this numeratoroption)

Denominator Exception G9927:

Documentation of system reason(s) for not prescribing warfarin OR another FDA-approved anticoagulation due to patient being currently enrolled in a clinical trial related to AF/atrial flutter treatment

NUMERATOR:

Performance Not Met: G9928:
Warfarin OR Another FDA-Approved Anticoagulant Not Prescribed, Reason not Given
(One quality-data code [G9928] is required on the claim form to submit this numerator option)

Warfarin OR another FDA-approved anticoagulant not prescribed, reason not given

Numerator Note: No data

Denominator

All patients aged 18 years and older with a diagnosis of nonvalvular AF or atrial flutter who do not have a documented CHA2 DS2-VASc risk score of 0 or 1

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on the date of encounter
AND
Diagnosis for nonvalvular atrial fibrillation or atrial flutter (ICD-10-CM):
I48.0, I48.1, I48.2, I48.3, I48.4,
I48.91, I48.92
AND
Patient encounter during the performance period (CPT):
99201, 99202, 99203, 99204, 99205, 99212,
99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309,
99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344,
99345, 99347, 99348, 99349, 99350
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02

 

 

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