| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Registry | Process | Yes | Communication and Care Coordination |
Measure Description
Percentage of patients evaluated in an outpatient setting who within the previous 12 months have experienced an acute myocardial infarction (MI), coronary artery bypass graft (CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina (CSA) and have not already participated in an early outpatient cardiac rehabilitation/secondary prevention (CR) program for the qualifying event/diagnosis who were referred to a CR program
Instruction
This measure is to be reported a minimum of once per performance period for all patients seen during the performane period who had a qualifying diagnosis within the previous 12 months and who have not already participated in an outpatient CR program. 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 age ≥ 18 years evaluated in the outpatient setting during the reporting period who have a qualifying event/diagnosis [chronic stable angina (CSA), or who within the previous 12 months have had an acute myocardial infarction (AMI) or have undergone coronary artery bypass graft (CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery, or cardiac transplantation] who do not meet any of the denominator exceptions (medical factors, health care system factors, previous cardiac rehabilitation for qualifying cardiac event completed)
Denominator Instructions: Coronary Artery Bypass Graft, Percutaneous Coronary Intervention, Cardiac Valve surgery, Cardiac Transplant or Acute Myocardial Infarction, in order to meet the criteria for inclusion of the measure, must have occurred or been performed within 12 months of date of encounter.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, G0438, G0439
WITHOUT
Telehealth Modifier: GQ, GT
AND
Diagnosis for Chronic Stable Angina (ICD-10-CM): I20.1, I20.8, I20.9
OR
Diagnosis of Acute Myocardial Infarction (ICD-10-CM): I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I22.0, I22.1, I22.2, I22.8, I22.9, I25.2
OR
Coronary Artery Bypass Graft Surgery (CPT): 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33572, 33999, 35500, 35600
OR
Percutaneous Coronary Intervention (CPT): 92920, 92924, 92928, 92933, 92937, 92941, 92943
OR
Cardiac Valve Surgery (CPT): 33361, 33362, 33363, 33364, 33365, 33390, 33391, 33404, 33405, 33406, 33410, 33411, 33412, 33413, 33414, 33415, 33416, 33417, 33420, 33422, 33425, 33426, 33427, 33430, 33463, 33464, 33465, 33468, 33470, 33471, 33475, 33476, 33478, 33496, 33600, 33602
OR
Cardiac Transplantation (CPT): 33935, 33945
AND
Qualifying cardiac event/diagnosis in previous 12 months: 1460F
Numerator
Patients who have had a qualifying event/diagnosis within the previous 12 months, who have been referred to an outpatient cardiac rehabilitation/secondary prevention (CR) program
Numerator Instructions: CR programs may include a traditional CR program based on face-to-face interactions and training sessions or other options that include home-based approaches. If alternative CR approaches are used, they should be designed to meet appropriate safety standards.
Numerator Options:
Performance Met: Referral to an outpatient cardiac rehabilitation/secondary prevention program. Referred to an outpatient cardiac rehabilitation program (4500F)
OR
Denominator Exception: Documentation of medical reason(s) for not referring to an outpatient CR program (4500F with 1P)
OR
Denominator Exception: Documentation of system reason(s) for not referring to an outpatient CR program (4500F with 3P)
OR
Denominator Exception: Previous cardiac rehabilitation for qualifying cardiac event completed (4510F)
OR
Performance Not Met: Patient not referred to outpatient CR/secondary prevention program, reason not otherwise specified (4500F with 8P)