CMS145v10 – 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 a diagnosis of coronary artery disease seen within a 12-month period and who also have prior (within the past 3 years) MI or a current or prior LVEF <40%

– DENOMINATOR EXCEPTIONS

• Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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).

– NUMERATOR

Patients who were prescribed beta-blocker therapy

For Denominator 1:

Patients satisfying all of the following conditions are included in denominator 1:

• Patients aged 18 years or older at the start of the measurement period with two or more qualifying encounters during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

• Patients with a qualifying CAD encounter and moderate or severe LVSD. LVSD findings should exist before end of qualifying CAD encounter. A record of a coronary artery disease encounter or a history of cardiac surgery is considered to be a qualifying CAD encounter.
  • The diagnosis for ‘Coronary Artery Disease No MI’ should overlap a face to face encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’.

• • The cardiac surgery procedure should start before the end of a face to face encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To document cardiac surgery procedure performed, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’. The procedure is added to the provider note. 

Note: 

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.  

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button. 

• • Ejection Fraction diagnostic study should be performed or a diagnosis for either ‘Moderate or Severe LVSD’ or ‘Left Ventricular Systolic Dysfunction’ should exist. To document ‘Ejection Fraction’ diagnostic study performed, use the workflow Patient > Clinical > Orders & Results > Radiology. Click ‘+ Order’ and add the radiology order details. Then hover over ‘Sign’ and click ‘Queue’. 

 Mark the radiology order as completed by clicking the ‘Mark As Completed’ button.

Note:

For LOINC Codes Based Labs: Please ensure that the test code is mapped to a LOINC Code from the Settings. To map a LOINC with the radiology test code, navigate to Settings > EHR > Radiology. Select the radiology test and navigate to the ‘Code’ tab. Then, click on a code. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

For CPT Codes Based Labs: When a CPT code is added to a test order, please ensure that the CPT code is present in the ‘Procedures’.  

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

To document the LVSD diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’. 

For Denominator 2:

Patients satisfying all of the following conditions are included in denominator 2:

• Patients aged 18 years or older at the start of the measurement period with two or more qualifying encounters during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
• Patients with a qualifying CAD encounter and prior MI. A record of a coronary artery disease encounter or a history of cardiac surgery is considered to be a qualifying CAD encounter.
  • The diagnosis for ‘Myocardial Infarction’ can be recorded via the workflow Patient > Provider Note > Diagnoses. Click ‘Add’, search for the diagnosis, and add the diagnosis details. Then click ‘Save’. Myocardial infarction prevalence period should end 3 years or less before one day after the start of CAD encounter. Additionally, moderate or severe LVSD findings should not exist for the patient before the qualifying CAD encounter.
  • The cardiac surgery procedure should start before the end of a face to face encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To document cardiac surgery procedure performed, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’. The procedure is added to the provider note.
  • The diagnosis for ‘Coronary Artery Disease No MI’ should overlap a face to face encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To document the LVSD diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’.

For Numerator 1:

Include patients fulfilling any of the following criteria:

• Patients having ‘Beta Blocker Therapy for LVSD’ ordered with a qualifying CAD encounter and moderate or severe LVSD. Beta blocker should be ordered during qualifying CAD encounter and moderate or severe LVSD. To document a beta blocker therapy for LVSD ordered, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

• Patients currently taking beta blocker therapy for LVSD with a qualifying CAD encounter and moderate or severe LVSD. Beta blocker therapy should begin after the qualifying CAD encounter and moderate or severe LVSD. To document an active beta blocker therapy for LVSD, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’.

For Numerator 2:

Include patients fulfilling any of the following criteria:

• Patients having ‘Beta Blocker Therapy’ ordered with a qualifying CAD encounter and prior MI. Beta blocker should be ordered during qualifying CAD encounter and prior MI. To document a beta blocker therapy ordered, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.
• Patients currently taking beta blocker therapy with a qualifying CAD encounter and prior MI. Beta blocker therapy should begin after the qualifying CAD encounter and prior MI. To document an active beta blocker therapy, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’.

For Denominator Exceptions 1:

Denominator exceptions 1 for this measure include:

• Patients having diagnosis of ‘Arrhythmia’ or ‘Hypotension’ or ‘Asthma’ or ‘Bradycardia’ overlapping qualifying CAD encounter and moderate or severe LVSD. Diagnoses of arrhythmia, hypotension, asthma, bradycardia can be recorded via Patient > Provider Note > Diagnoses.
• Patients diagnosed with allergy or intolerance to beta blocker therapy. The diagnosis should be documented after qualifying CAD encounter and moderate or severe LVSD. Diagnosis for allergy or intolerance to beta blocker therapy can be recorded via Patient > Provider Note > Diagnoses.
• Patients having diagnosis of atrioventricular block overlapping qualifying CAD encounter and moderate or severe LVSD. Diagnosis for atrioventricular block can be recorded via Patient > Provider Note > Diagnoses.
  • Patient should not have a diagnosis of ‘Cardiac Pacer in Situ’.
  • Patient should not have a ‘Cardiac Pacer’ device applied.

• Patients with allergy or intolerance to beta blocker therapy after qualifying CAD encounter and moderate or severe LVSD.
  • To document allergy or intolerance to beta blocker therapy, use the workflow Patient > Clinical > Allergies. Click ‘+Allergen’ and search for an allergen. Add the allergen details and click ‘Save’.

• Patients with medication not ordered during the qualifying CAD encounter and moderate or severe LVSD. To record medication not ordered, use the workflow Patient > Provider Note > Medications. Click ‘Medications’ and mark the ‘Patient Refused to Provide Current Medication Details’ checkbox.

• Patients with consecutive heart rates less than 50. The heart rate readings should be recorded during a qualifying CAD encounter and moderate or severe LVSD. To record heart rate, use the workflow Patient > Provider Note > Vitals. Click ‘Add’ and enter the pulse reading. The reading must be less than 50 bpm.

For Denominator Exceptions 2:

Denominator exceptions 2 for this measure include:

• Patients having diagnosis of ‘Arrhythmia’ or ‘Hypotension’ or ‘Asthma’ or ‘Bradycardia’ overlapping qualifying CAD encounter and prior MI. Diagnoses of arrhythmia, hypotension, asthma, bradycardia can be recorded via Patient > Provider Note > Diagnoses.
• Patients diagnosed with allergy or intolerance to beta blocker therapy. The diagnosis should be documented after qualifying CAD encounter and prior MI. Diagnosis for allergy or intolerance to beta blocker therapy can be recorded via Patient > Provider Note > Diagnoses.
• Patients having diagnosis of atrioventricular block overlapping qualifying CAD encounter and prior MI. Diagnosis for atrioventricular block can be recorded via Patient > Provider Note > Diagnoses.
  • Patient should not have a diagnosis of ‘Cardiac Pacer in Situ’.
  • Patient should not have a ‘Cardiac Pacer’ device applied.
• Patients with allergy or intolerance to beta blocker therapy after qualifying CAD encounter and prior MI.
  • To document allergy or intolerance to beta blocker therapy, use the workflow Patient > Clinical > Allergies. Click ‘+Allergen’ and search for an allergen. Add the allergen details and click ‘Save’.
• Patients with medication not ordered during the qualifying CAD encounter and prior MI. To record medication not ordered, use the workflow Patient > Provider Note > Medications. Click ‘Medications’ and mark the ‘Patient Refused to Provide Current Medication Details’ checkbox.
• Patients with consecutive heart rates less than 50. The heart rate readings should be recorded during a qualifying CAD encounter and prior MI. To record heart rate, use the workflow Patient > Provider Note > Vitals. Click ‘Add’ and enter the pulse reading. The reading must be less than 50 bpm.