CMS144v12 – Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
CMS144v12
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 beta-blocker therapy during the measurement period.
– INITIAL POPULATION
All patients aged 18 years and older with two qualifying encounters (one of which is a heart failure outpatient encounter) during the measurement period along with a diagnosis of heart failure.
The other qualifying encounter in this case can include any of the following:
Care Services in Long Term Residential Facility
Home Healthcare Services
Nursing Facility Visit
Office Visit
Outpatient Consultation
Patient Provider Interaction
– DENOMINATOR
All patients aged 18 years and older with:
Two qualifying encounters, one of which is a heart failure outpatient encounter, during the measurement period
Diagnosis of heart failure
Current or prior LVEF ≤ 40% (Indicating Moderate to Severe LSVD).
Note: The findings of moderate to severe LSVD are to be taken during a heart failure outpatient encounter.
– NUMERATOR
Patients who were prescribed or already taking beta-blocker therapy during the measurement period.
Note: The beta-blocker therapy should be prescribed or active medication should be documented during a heart failure outpatient encounter.
– DENOMINATOR EXCLUSIONS
Patients with a history of heart transplant (or heart transplant related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD.
Patients with Left Ventricular Assist Device Implanted (or LVAD related diagnosis) prior to the end of the encounter with Moderate or Severe LVSD.
– DENOMINATOR EXCEPTIONS
Documentation of medical reason(s) for not prescribing beta-blocker therapy. Examples of these medical reasons can include the following:
Arrhythmia
Asthma
Bradycardia
Hypotension
Patients with atrioventricular block without cardiac pacer
Observation of consecutive heart rates < 50
Allergy
Intolerance
Other medical reasons.
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
– APPLICATION WORKFLOW
For Denominator:
To record the encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.
eSuperbill for Encounter
To document the heart failure diagnosis, navigate to Patient > Provider Note > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once all relevant details are added, click ‘Save’.
Example of Heart Failure Diagnosis
An LVEF (Left Ventricular Ejection Fraction) diagnostic study can be recorded via Patient > Provider Note > Evaluations. Click ‘Add’ and search for the relevant procedure. From the ‘Status’ drop-down select ‘Performed’ and in the result field, input a numeric result. Once done, click ‘Save & Accept’ or ‘Sign & Accept.
Example of LVEF Diagnostic Study
Documentation of the LVSD diagnosis can be done through Patient > Provider Note > Evaluations. Here, search for ‘Severe Left Ventricular Systolic Dysfunction (disorder)’ or ‘Moderate Left Ventricular Systolic Dysfunction (disorder)’. From the ‘Status’ drop-down select ‘Active’ and once done, click ‘Save & Accept’ or ‘Sign & Accept’.
Example of LVSD Diagnosis
For Numerator:
To order beta blocker therapy for LVSD, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the relevant prescription. Enter the medication details and click ‘Prescribe’.
Example of Beta Blocker Therapy
To document active beta blocker therapy for LVSD, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the relevant medication. Enter the medication details and click ‘Save’.
To document a heart failure patient encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.
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
The documentation of Moderate or Severe LSVD (Left Ventricular Systolic Dysfunction) can be done via Patient > Provider Note > Evaluations.
Documentation of Moderate or Severe LVSD
For Denominator Exceptions:
To document:
Arrhythmia
Asthma
Hypotension
Atrioventricular Block
Bradycardia
Cardiac Pacer in Situ
use the workflow Patient > Provider Note > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Once all details have been filled, click ‘Save’.
Example of Arrhythmia Diagnosis
To document an allergy or intolerance to beta-blocker therapy, head over to Patient > Provider Notes > Allergies. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’.
Example of Beta Blocker Allergy
The documentation of patient reasons for not prescribing beta-blocker therapy can be done via Patient > Provider Notes > Medications > Current > Discontinue. Here, the reason for discontinuing an active medication is to be selected from the drop-down.
Documenting Reasons for Discontinuing Medication
The heart rate can be documented through Patient > Provider Note > Vitals. Click ‘Add’ and in the ‘Pulse’ field, enter the pulse rate while specifying the position in which it was taken. Once done, click ‘Accept’.
