CMS145v12 – Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF ≤ 40%)

All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease.

A qualifying encounter in this case includes any of the following:

• Office Visit
• Outpatient Consultation
• Nursing Facility Visit
• Care Services in Long-Term Residential Facility
• Home Healthcare Services
• Patient Provider Interaction

Note: The Coronary Artery Disease (CAD) diagnosis should take place during one of the outpatient encounters.

– DENOMINATORAll patients aged 18 years and older with:

• Two qualifying encounters during the measurement period
• Diagnosis of coronary artery disease and
• Prior (within the past 3 years) MI or a current or prior LVEF ≤ 40%.

Note: The Coronary Artery Disease (CAD) diagnosis should take place during one of the outpatient encounters. Furthermore, the patient should have a history of Cardiac Surgery prior to the encounter.

– NUMERATOR

Patients who were prescribed beta-blocker therapy.

– DENOMINATOR EXCEPTIONS

• Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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).
• Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).

For Denominator 1:

• To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

• To document the diagnosis for CAD, use the workflow Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any necessary diagnosis details and once done, click ‘Save’.

• Documentation of the cardiac surgery procedure can be done via Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the relevant procedure. Add the procedure details and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

It can also be done through Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant procedure. From the ‘Status’ drop-down select ‘Performed’ and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• To document ‘Ejection Fraction’ diagnostic study and ‘Moderate or Severe LVSD’, use the workflow Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant intervention.

For Denominator 2:

• To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
• The diagnosis for ‘Myocardial Infarction’ can be recorded via Patient > Provider Note > Diagnoses. Click ‘Add’, search for the diagnosis, and add the diagnosis details. Then click ‘Save’.

• To document cardiac surgery procedure, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’ or ‘Sign & Accept’

For Numerator:

• To order beta blocker therapy, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the relevant prescription. Enter the medication details and click ‘Prescribe’.

• To document an active beta blocker therapy, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the relevant medication. Enter the medication details and click ‘Save’.

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’.

• To document an allergy or intolerance to beta-blocker therapy, head over to Patient > Provider Note > Allergies. Click ‘Add’ and search for the relevant allergy. Once done, click ‘Save’. Then click ‘Accept’ to add the allergy to the current provider note.

• The documentation of patient reasons for not prescribing beta-blocker therapy can be done via Patient > Provider Note > Medications > Current > Discontinue. Here, the reason for discontinuing an active medication is to be selected from the drop-down.

• 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’.