CMS135v11 – Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS135v11
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) ≤ 40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period.
– INITIAL POPULATION
All patients aged 18 years and older with two qualifying encounters (at least one of which is a Heart Failure outpatient encounter) during the measurement period and a diagnosis of heart failure.
A qualifying encounter can include any of the following:
Office Visit
Outpatient Consultation
Nursing Facility Visit
Care Services in Long Term Residential Facility
Home Healthcare Services
Patient Provider Interaction
A qualifying heart failure outpatient encounter includes any of the following:
Care Services in Long Term Residential Facility
Home Healthcare Services
Nursing Facility Visit
Office Visit
Outpatient Consultation
– DENOMINATOR
Patients aged 18 years and older with the following:
Two qualifying encounters (at least one of which is a heart failure outpatient encounter) during the measurement period
AND a diagnosis of heart failure
AND current or prior LVEF ≤ 40%
– DENOMINATOR EXCEPTIONS
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).
Documentation of patient reasons(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).
– DENOMINATOR EXCLUSIONS
Patients with a history of heart transplant (or heart transplant related diagnosis)
Patients with Left Ventricular Assist Device (or LVAD related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD.
– NUMERATOR
Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period.
– APPLICATION WORKFLOW
For Denominator:
To record an encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
eSuperbill
To document a diagnosis for heart failure, navigate to Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the relevant diagnosis and add the diagnosis details. Then click ‘Save’.
Example of Heart Failure Diagnosis
An LVEF (Left Ventricular Ejection Fraction) diagnostic study can be recorded via Patient > Provider Notes > Orders >Procedures. Click ‘Add’ and search for the relevant procedure. Fill out the required details and once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of Diagnostic Study to Measure Ejection Fraction
This can also be done through Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the relevant diagnostic study. Select the relevant ‘Status’ from the drop-down menu and log in the results as needed. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of Diagnostic Study to Measure Ejection Fraction
For Numerator:
To document ACEI, ARB, or ARNI therapy ordered, navigate to Patient > Provider Note > Prescription or to Patient > Provider Notes > Medications. Click ‘Add’ and search for the relevant medication. Enter the relevant details and click ‘Save’.
Example of ACE Inhibitor Prescription
For Denominator Exceptions:
To record ‘Pregnancy’ or ‘Renal Failure Due to ACEI’, use the workflow Patient > Provider Note > Diagnoses or Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the relevant diagnosis and input the diagnosis details. Once you are done, click ‘Accept’. The diagnosis is added to the provider note.
Renal Failure Diagnosis via ProceduresRenal Failure Diagnosis via Evaluations
To document a patient’s allergies or intolerance to ACEI or ARB therapy, head over to Patient > Provider Notes > Allergies or Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’.
Allergy to ACE Inhibitors
Patient reason(s) for refusing ACEI or ARB therapy can be documented via Patient > Provider Notes > Evaluations or through Patient > Provider Notes > Procedures. Click ‘Add’ and search for the relevant code or reason and once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Patient Reason(s) via ProceduresPatient Reason(s) via Evaluations
For Denominator Exclusions:
To document a history of Heart Transplant or Left Ventricular Assist Device, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the relevant procedure. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of LVAD Procedure
A history of Heart Transplant can also be recorded via Patient > Clinical > History > + Surgical. Here, search for heart transplant and fill out the required details. Once done, click ‘Save’.
Heart Transplant History
The documentation of Moderate or Severe LSVD (Left Ventricular Systolic Dysfunction) can be done via Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once done, click ‘Save’.
