| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, Registry | Process | No | Effective Clinical Care | Internal Medicine, Cardiology, General Practice/Family Medicine |
Measure Description
Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation (AF) or atrial flutter whose assessment of the specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor, as determined by CHADS2 risk stratification, who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism
Instruction
This measure is to be reported a minimum of once per performance period for patients with nonvalvular AF or atrial flutter seen during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Denominator
All patients aged 18 years and older with a diagnosis of nonvalvular AF or atrial flutter whose assessment ofthe specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor,as determined by CHADS2 risk stratification
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on 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
AND
One or more high risk factors for thromboembolism OR more than one moderate risk factor for thromboembolism: G8972
AND NOT
DENOMINATOR EXCLUSION:
Patient has mitral stenosis or prosthetic heart valves OR patient has transient or reversible cause of AF (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery): G9746
Numerator
Patients who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism
Definition:
Prescribed – May include prescription given to the patient for warfarin OR another oral anticoagulant that is FDA approved for the prevention of thromboembolism at one or more visits in the measurement period OR patient already taking warfarin OR another oral anticoagulant that is FDA approved for the prevention of thromboembolism as documented in current medicationlist.
The assessment of patients with nonvalvular AF or atrial flutter for thromboembolic risk factors should include the following criteria:
Table 1 – Risk Factors for Atrial Fibrillation and Atrial Flutter
| Risk Factors | Weighting |
| Prior stroke, TIA or systemic embolism | High risk |
| Age ≥ 75 years | Moderate risk |
| Hypertension | Moderate risk |
| Diabetes Mellitus | Moderate risk |
| Heart failure or impaired left ventricular systolic function | Moderate risk |
Numerator Options:
Performance Met: Warfarin OR another oral anticoagulant that is FDA approved prescribed (G8967)
OR
Denominator Exception: Documentation of medical reason(s) for not prescribing warfarin OR another oral anticoagulant that is FDA approved for the prevention of thromboembolism (e.g., allergy, risk of bleeding, other medical reasons (G8968)
OR
Denominator Exception: Documentation of patient reason(s) for not prescribing warfarin OR another oral anticoagulant that is FDA approved for the prevention of thromboembolism (e.g., economic, social, and/or religious impediments, noncompliance, patient refusal, other patient reasons) (G8969)
OR
Performance Not Met: Warfarin OR another oral anticoagulant that is FDA approved not prescribed, reason not given (G8971)