eCQM: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet (CMS 164v5)

eCQM:

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet

CMS ID:

CMS 164v5

NQF Number:

0068

NQS Domain:

Effective Clinical Care

Measure Type:

Process

MIPS High Priority Measure:

No

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)

Description:

Percentage of patients 18 years of age and older who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antiplatelet during the measurement period.

  • Numerator: Patients who had an active medication of aspirin or another antiplatelet during the measurement year.
  • Denominator: Patients 18 years of age and older with an eligible visit (defined as a signed chart note with one of the following encounter types: Office Visit, Nurse Visit, Home Visit, or Nursing Home Visit) during the measurement period who had an AMI, CABG, or PCI during the 12 months prior to the measurement year or who had a diagnosis of IVD overlapping the measurement year.
    • Denominator Exclusions: Patients who had documentation of use of anticoagulant medications overlapping the measurement year.

    • Denominator Exceptions: None

Performance Benchmark for MIPS: 88.70%
For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click
here.

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. Ensure that patients age 18 and older who had an AMI, CABG, or PCI during the eligible timeframe, or a diagnosis of IVD, have the appropriate diagnosis or procedure, with a start date, recorded in the medical record.

    1. Examples of AMI and IVD diagnosis codes that will be included for this measure can be found in Table 1.

    2. The suggested workflow for recording the appropriate CABG or PCI can be found in Table 2.

  2. Confirm that the patient has an active (i.e. no stop date) aspirin or antiplatelet medication, with a valid start date, recorded in his or her chart OR complete an order for a qualifying medication, ensuring that a valid start date is assigned and no stop date is included.

    1. Examples of appropriate medications can be found in Table 1.

Table 1: Example Measure Criteria that can be Recorded for CMS 164v5

Data Element

Associated Code

Acute Myocardial Infarction (AMI)
(Diagnosis)

  • I21.01 (ICD-10)
  • I25.2 (ICD-10)
  • I23.0 (ICD-10)
  • I23.2 (ICD-10)

Ischemic Vascular Disease (IVD)
(Diagnosis)

  • I20.0 (ICD-10)
  • I20.9 (ICD-10)
  • I63.09 (ICD-10)
  • T82.856A (ICD-10)

Prasugrel
(Medication)


  • 5 MG Oral Tablet (RXNORM 855818)
  • 10 MG Oral Tablet (RXNORM 855812)

Aspirin
(Medication)

  • 81 MG Oral Tablet (RXNORM 243670)
  • 228 MG Chewing Gum (RXNORM 853499)

Clopidogrel
(Medication)

  • 300 MG Oral Tablet (RXNORM 749196)
  • 75 MG Oral Tablet (RXNORM 309362)
Table 2: Practice Fusion Suggested Workflow for Recording CABG or PCI

Procedure

Practice Fusion Suggested Workflow

Coronary Artery Bypass Graft (CABG)

  • In the Screenings/Interventions/Assessments section of the encounter, search for the appropriate CABG and select the item. Examples include:

    • Coronary artery bypass with autogenous graft, three grafts (procedure) (SNOMED CT 10326007)

    • Aortocoronary bypass grafting (procedure) (SNOMED CT 309814006)

  • Record and save the following information in the modal window that opens:

    • Status: Performed

    • Start Date: Date the procedure was performed

Percutaneous Coronary Interventions (PCI)

  • In the Screenings/Interventions/Assessments section of the encounter, search for the appropriate PCI and select the item. Examples include:

    • Percutaneous transluminal coronary angioplasty (procedure) (SNOMED CT 11101003)

    • Transmyocardial revascularization by laser technique (procedure) (SNOMED CT 15256002)

  • Record and save the following information in the modal window that opens:

    • Status: Performed

    • Start Date: Date the procedure was performed

Additional Measure Information
  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:

    • Added an exclusion for patients who used anticoagulant medications during the measurement year to align with the NQF-endorsed measure.

    • Updated the measure description to more accurately reflect the measure intent.

    • Updated the initial population to more accurately reflect the measure intent.

    • Updated measure title to harmonize with the endorsed measure title.

    • Updated the name of the value set from anti-thrombotics to antiplatelets to align with the content of the value set.

    • Removed guidance as it no longer applied.

  • To be recognized for the denominator exclusion, the patient must have a prescribed anticoagulant medication recorded in his or her chart overlapping the measurement year.

  • To access a complete list of the qualifying data for this measure, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

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