Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

CMS / NQF #: 144 / 2908
Measure: Record the 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 beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
Numerator: The number of patients who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
Denominator: The number of patients aged 18 years and older with a diagnosis of heart failure and a current or prior LVEF < 40%.
Exception: Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons).
Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the healthcare system).
NQS Domain: Effective Clinical Care

 

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient, age 18 years or older and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*: 

• Heart Failure Diagnosis Code (with attached SNOMED) that occurs during or prior to the first encounter during the measurement period
ICD-9: 
CodeDescription
402.01Malignant hypertensive heart disease with heart failure
402.11Benign hypertensive heart disease with heart failure
402.91Unspecified hypertensive heart disease with heart failure
404.01Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.03Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease
404.11Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.13Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease
404.91Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.93Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease
428Congestive heart failure, unspecified
428.1Left heart failure
428.2Systolic heart failure, unspecified
428.21Acute systolic heart failure
428.22Chronic systolic heart failure
428.23Acute on chronic systolic heart failure
428.3Diastolic heart failure, unspecified
428.31Acute diastolic heart failure
428.32Chronic diastolic heart failure
428.33Acute on chronic diastolic heart failure
428.4Combined systolic and diastolic heart failure, unspecified
428.41Acute combined systolic and diastolic heart failure
428.42Chronic combined systolic and diastolic heart failure
428.43Acute on chronic combined systolic and diastolic heart failure
428.9Heart failure, unspecified
ICD-10: 
CodeDescription
I11.0Hypertensive heart disease with heart failure
I13.0Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I50.1Left ventricular failure
I50.20Unspecified systolic (congestive) heart failure
I50.21Acute systolic (congestive) heart failure
I50.22Chronic systolic (congestive) heart failure
I50.23Acute on chronic systolic (congestive) heart failure
I50.30Unspecified diastolic (congestive) heart failure
I50.31Acute diastolic (congestive) heart failure
I50.32Chronic diastolic (congestive) heart failure
I50.33Acute on chronic diastolic (congestive) heart failure
I50.40Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9Heart failure, unspecified
SNOMED: 
CodeDescription
364006Acute left-sided heart failure (disorder)
5053004Cardiac insufficiency due to prosthesis (disorder)
5148006Hypertensive heart disease with congestive heart failure (disorder)
5375005Chronic left-sided congestive heart failure (disorder)
10091002High output heart failure (disorder)
10335000Chronic right-sided heart failure (disorder)
10633002Acute congestive heart failure (disorder)
25544003Low output heart failure (disorder)
42343007Congestive heart failure (disorder)
43736008Rheumatic left ventricular failure (disorder)
44313006Right heart failure secondary to left heart failure (disorder)
46113002Hypertensive heart failure (disorder)
48447003Chronic heart failure (disorder)
56675007Acute heart failure (disorder)
60856006Cardiac insufficiency following cardiac surgery (disorder)
66989003Chronic right-sided congestive heart failure (disorder)
74960003Acute left-sided congestive heart failure (disorder)
77737007Benign hypertensive heart disease with congestive heart failure (disorder)
80479009Acute right-sided congestive heart failure (disorder)
82523003Congestive rheumatic heart failure (disorder)
83105008Malignant hypertensive heart disease with congestive heart failure (disorder)
84114007Heart failure (disorder)
85232009Left heart failure (disorder)
88805009Chronic congestive heart failure (disorder)
90727007Pleural effusion due to congestive heart failure (disorder)
92506005Biventricular congestive heart failure (disorder)
111283005Chronic left-sided heart failure (disorder)
128404006Right heart failure (disorder)
194767001Benign hypertensive heart disease with congestive cardiac failure (disorder)
194779001Hypertensive heart and renal disease with (congestive) heart failure (disorder)
194781004Hypertensive heart and renal disease with both (congestive) heart failure and renal failure (disorder)
195111005Decompensated cardiac failure (disorder)
195112003Compensated cardiac failure (disorder)
195114002Acute left ventricular failure (disorder)
206586007Congenital cardiac failure (disorder)
233924009Heart failure as a complication of care (disorder)
277639002Sepsis-associated right ventricular failure (disorder)
314206003Refractory heart failure (disorder)
359617009Acute right-sided heart failure (disorder)
359620001Acute right heart failure (disorder)
367363000Right ventricular failure (disorder)
410431009Cardiorespiratory failure (disorder)
417996009Systolic heart failure (disorder)
418304008Diastolic heart failure (disorder)
424404003Decompensated chronic heart failure (disorder)
426012001Right heart failure due to pulmonary hypertension (disorder)
426263006Congestive heart failure due to left ventricular systolic dysfunction (disorder)
426611007Congestive heart failure due to valvular disease (disorder)
441481004Chronic systolic heart failure (disorder)
441530006Chronic diastolic heart failure (disorder)

AND at least one of the following:

• Office Visit, Home Healthcare Service, Care Service in Long-Term Residential Facility, Nursing Facility Visit, Outpatient Consultation, or Face to Face interaction for TWO UNIQUE ENCOUNTERS during the measurement period

This is captured by adding a procedure with a valid CPT and/or SNOMED code using the procedure widget in a note.

Valid Office Encounter Codes:
CPT:  
Code Description
99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99241 Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99242 Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99243 Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99244 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99245 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.
99304 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.
99305 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.
99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient's facility floor or unit.
99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient's facility floor or unit.
99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.
99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.
99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.
99324 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver.
99325 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver.
99326 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver.
99327 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver.
99328 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver.
99334 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.
99335 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver.
99336 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver.
99337 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver.
99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342 Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
Valid Patient Provider Interaction and Face-to- Face Interaction Codes:
SNOMED:  
Code Description
4525004 Emergency department patient visit (procedure)
11797002 Telephone call by physician to patient or for consultation (procedure)
12843005 Subsequent hospital visit by physician (procedure)
12843005 Subsequent hospital visit by physician (procedure)
18170008 Subsequent nursing facility visit (procedure)
18170008 Subsequent nursing facility visit (procedure)
19681004 Nursing evaluation of patient and report (procedure)
19681004 Nursing evaluation of patient and report (procedure)
87790002 Follow-up inpatient consultation visit (procedure)
87790002 Follow-up inpatient consultation visit (procedure)
90526000 Initial evaluation and management of healthy individual (procedure)
90526000 Initial evaluation and management of healthy individual (procedure)
185316007 Indirect encounter (procedure)
185317003 Telephone encounter (procedure)
185318008 Third party encounter (procedure)
185320006 Encounter by computer link (procedure)
185321005 Letter encounter to patient (procedure)
185349003 Encounter for "check-up" (procedure)
185349003 Encounter for "check-up" (procedure)
185463005 Visit out of hours (procedure)
185463005 Visit out of hours (procedure)
185465003 Weekend visit (procedure)
185465003 Weekend visit (procedure)
207195004 History and physical examination with evaluation and management of nursing facility patient (procedure)
207195004 History and physical examination with evaluation and management of nursing facility patient (procedure)
270424005 Letter encounter from patient (procedure)
270427003 Patient-initiated encounter (procedure)
270427003 Patient-initiated encounter (procedure)
270430005 Provider-initiated encounter (procedure)
270430005 Provider-initiated encounter (procedure)
308335008 Patient encounter procedure (procedure)
308335008 Patient encounter procedure (procedure)
308720009 Letter encounter (procedure)
386473003 Telephone follow-up (procedure)
390906007 Follow-up encounter (procedure)
390906007 Follow-up encounter (procedure)
401267002 Telephone triage encounter (procedure)
401271004 E-mail sent to patient (procedure)
406547006 Urgent follow-up (procedure)
406547006 Urgent follow-up (procedure)
438515009 E-mail encounter from carer (procedure)
438516005 E-mail encounter to carer (procedure)
439708006 Home visit (procedure)
439708006 Home visit (procedure)
445450000 Encounter by short message service text messaging (procedure)
448337001 Telemedicine consultation with patient (procedure)
• An Inpatient Hospital discharge service during the measurement period

This is captured by adding a procedure with a valid CPT code using the procedure widget in a note.

99238 Hospital discharge day management; 30 minutes or less
99239 Hospital discharge day management; more than 30 minutes

and at least one of the following:  

•An active diagnosis of moderate of severe LVSD starting before or during the same visit referenced in the heart failure section of the denominator above

This can be captured in the following ways:

  • Adding a diagnosis of moderate of severe LVSD with a valid SNOMED code using the diagnosis widget in a note.

OR

  • Adding a diagnosis of left ventricular systolic dysfunction with a valid SNOMED code and attaching a valid SNOMED code for moderate or severe severity.
SNOMED: 
CodeDescription
6736007Moderate (severity modifier) (qualifier value)
24484000Severe (severity modifier) (qualifier value)
134401001Left ventricular systolic dysfunction (disorder)
981000124106Moderate left ventricular systolic dysfunction (disorder)
991000124109Severe left ventricular systolic dysfunction (disorder)
• An ejection fraction result < 40% occurring before or during the same visit referenced in the heart failure section of the denominator above

This is captured by adding a numeric result with a valid LOINC code using a numeric control in a note. 

LOINC:   
CodeDescription
10230-1Left ventricular Ejection fraction
18043-0Left ventricular Ejection fraction by US
18044-8Left ventricular Ejection fraction by US 2D single-plane ellipse
18045-5Left ventricular Ejection fraction by US 2D biplane ellipse
18046-3Left ventricular Ejection fraction by US 2D modified
18047-1Left ventricular Ejection fraction by US 2D modified biplane
18048-9Left ventricular Ejection fraction by US 2D modified single-plane
18049-7Left ventricular Ejection fraction by US.M-mode.Teichholz
8806-2Left ventricular Ejection fraction by 2D echo
8807-0Left ventricular Ejection fraction by 2D echo.visual estimate
8808-8Left ventricular Ejection fraction by Cardiac angiogram
8809-6Left ventricular Ejection fraction by Cardiac angiogram.visual estimate
8810-4Left ventricular Ejection fraction by Spiral CT
8811-2Left ventricular Ejection fraction by MRI
8812-0Left ventricular Ejection fraction by Nuclear blood pool

Required Data Elements for the Numerator*: 

• Beta Blocker order or Active Medication that occurs on or before the first encounter during the measurement period

This is captured by prescribing or renewing a medication with a valid RXNORM code using the medication button in a note or the facesheet in a chart.

  • 24 HR carvedilol phosphate 10 MG Extended Release Oral Capsule
  • 24 HR carvedilol phosphate 20 MG Extended Release Oral Capsule
  • 24 HR carvedilol phosphate 40 MG Extended Release Oral Capsule
  • 24 HR carvedilol phosphate 80 MG Extended Release Oral Capsule
  • 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 100 MG Extended Release Oral Tablet
  • 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 25 MG Extended Release Oral Tablet
  • 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 50 MG Extended Release Oral Tablet
  • 24 HR metoprolol succinate 100 MG Extended Release Oral Tablet
  • 24 HR metoprolol succinate 200 MG Extended Release Oral Tablet
  • 24 HR metoprolol succinate 25 MG Extended Release Oral Tablet
  • 24 HR metoprolol succinate 50 MG Extended Release Oral Tablet
  • Bisoprolol Fumarate 10 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
  • Bisoprolol Fumarate 10 MG Oral Tablet
  • Bisoprolol Fumarate 2.5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
  • Bisoprolol Fumarate 5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
  • Bisoprolol Fumarate 5 MG Oral Tablet
  • carvedilol 12.5 MG Oral Tablet
  • carvedilol 25 MG Oral Tablet
  • carvedilol 3.125 MG Oral Tablet
  • carvedilol 6.25 MG Oral Tablet

EXCEPTION DETAILS: 

This measure makes an exception for patients who were not prescribed Beta Blocker Therapy due to Medical, Patient or System reasons.  In order to meet the requirements for this exception, the appropriate information must be documented in the chart (at least one of the following):

• Most Recent Heart Rate Result < 50 bpm

Vitals_Pulse

• Applicable Allergy or Intolerance to Beta Blocker Therapy Ingredient

• A medication allergy to an ingredient of beta blocker therapy  is captured by adding an allergy with a valid RXNORM code using the allergy button in a note.

OR
• A medication intolerance to beta blocker therapy  is captured by discontinuing a beta blocker therapy medication with a valid RXNORM code and selecting a reason of intolerance using the medication button in a note or the facesheet in a chart.

*RXNORM Codes for both cases are listed below:*

Allergy:

1007360Hydrochlorothiazide / Pindolol
10600Timolol
1202Atenolol
1372709Dutoprol
1372756Corzide
142130Acebutolol Hydrochloride
142132Carteolol Hydrochloride
142144Betaxolol Hydrochloride
142146Bisoprolol Fumarate
149Acebutolol
151195Atenolol / Chlorthalidone
151549Corgard
151890Inderal
1520Betaxolol
152413Tenormin
152440Trandate
19484Bisoprolol
196460Kerlone
202693Labetalol hydrochloride
202978Visken
203191Metoprolol Tartrate
203344Lopressor
20352carvedilol
2116Carteolol
214288Bendroflumethiazide / Nadolol
214317Bisoprolol / Hydrochlorothiazide
214621Hydrochlorothiazide / Metoprolol
214623Hydrochlorothiazide / Propranolol
214625Hydrochlorothiazide / Timolol
216221Coreg
218072Lopressor HCT
221002Zebeta
221124metoprolol succinate
37789Tenoretic
392512Clopamide / Pindolol
392564Acebutolol / Hydrochlorothiazide
42933Timolol Maleate
6185Labetalol
668310carvedilol phosphate
6918Metoprolol
7226Nadolol
75038Ziac
82084Propranolol Hydrochloride
8332Pindolol
856468InnoPran
865575Toprol
8787Propranolol
9631Sectral

Medication Intolerance:

1191185Penbutolol Sulfate 20 MG Oral Tablet
1297753Betaxolol Hydrochloride 10 MG Oral Tablet
1297757Betaxolol Hydrochloride 20 MG Oral Tablet
1495058Propranolol Hydrochloride 4.28 MG/ML Oral Solution
152916Atenolol 50 MG / Chlorthalidone 12.5 MG Oral Tablet
1593725Sotalol Hydrochloride 5 MG/ML Oral Solution
197379Atenolol 100 MG Oral Tablet
197380Atenolol 25 MG Oral Tablet
197381Atenolol 50 MG Oral Tablet
197382Atenolol 100 MG / Chlorthalidone 25 MG Oral Tablet
197383Atenolol 50 MG / Chlorthalidone 25 MG Oral Tablet
198000Bendroflumethiazide 5 MG / Nadolol 40 MG Oral Tablet
198001Bendroflumethiazide 5 MG / Nadolol 80 MG Oral Tablet
198005Nadolol 160 MG Oral Tablet
198006Nadolol 20 MG Oral Tablet
198007Nadolol 40 MG Oral Tablet
198008Nadolol 80 MG Oral Tablet
198104Pindolol 10 MG Oral Tablet
198105Pindolol 5 MG Oral Tablet
198284Timolol 10 MG Oral Tablet
198285Timolol 20 MG Oral Tablet
198286Timolol 5 MG Oral Tablet
199277Pindolol 15 MG Oral Tablet
199494Oxprenolol 20 MG Oral Tablet
199495Oxprenolol 40 MG Oral Tablet
199717Clopamide 5 MG / Pindolol 10 MG Oral Tablet
199786Oxprenolol 80 MG Oral Tablet
199787Oxprenolol 160 MG Extended Release Oral Tablet
200031carvedilol 6.25 MG Oral Tablet
200032carvedilol 12.5 MG Oral Tablet
200033carvedilol 25 MG Oral Tablet
245854Hydrochlorothiazide 25 MG / Pindolol 10 MG Oral Tablet
245855Hydrochlorothiazide 50 MG / Pindolol 10 MG Oral Tablet
310811Hydrochlorothiazide 25 MG / Timolol 10 MG Oral Tablet
387013nebivolol 5 MG Oral Tablet
686924carvedilol 3.125 MG Oral Tablet
751612nebivolol 10 MG Oral Tablet
751618nebivolol 2.5 MG Oral Tablet
827073nebivolol 20 MG Oral Tablet
854901Bisoprolol Fumarate 10 MG Oral Tablet
854905Bisoprolol Fumarate 5 MG Oral Tablet
854908Bisoprolol Fumarate 10 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854916Bisoprolol Fumarate 2.5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854919Bisoprolol Fumarate 5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
856422Hydrochlorothiazide 25 MG / Propranolol Hydrochloride 40 MG Oral Tablet
856429Hydrochlorothiazide 25 MG / Propranolol Hydrochloride 80 MG Oral Tablet
856448Propranolol Hydrochloride 10 MG Oral Tablet
856457Propranolol Hydrochloride 20 MG Oral Tablet
85646024 HR Propranolol Hydrochloride 120 MG Extended Release Oral Capsule
85648124 HR Propranolol Hydrochloride 160 MG Extended Release Oral Capsule
856519Propranolol Hydrochloride 40 MG Oral Tablet
85653524 HR Propranolol Hydrochloride 60 MG Extended Release Oral Capsule
856556Propranolol Hydrochloride 60 MG Oral Tablet
85656924 HR Propranolol Hydrochloride 80 MG Extended Release Oral Capsule
856578Propranolol Hydrochloride 80 MG Oral Tablet
856713Propranolol Hydrochloride 160 MG Oral Tablet
856724Propranolol Hydrochloride 4 MG/ML Oral Solution
856733Propranolol Hydrochloride 8 MG/ML Oral Solution
86051024 HR carvedilol phosphate 10 MG Extended Release Oral Capsule
86051624 HR carvedilol phosphate 20 MG Extended Release Oral Capsule
86052224 HR carvedilol phosphate 40 MG Extended Release Oral Capsule
86053224 HR carvedilol phosphate 80 MG Extended Release Oral Capsule
86641224 HR metoprolol succinate 100 MG Extended Release Oral Tablet
86641924 HR metoprolol succinate 200 MG Extended Release Oral Tablet
86642724 HR metoprolol succinate 25 MG Extended Release Oral Tablet
86643624 HR metoprolol succinate 50 MG Extended Release Oral Tablet
86645224 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 100 MG Extended Release Oral Tablet
86646124 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 25 MG Extended Release Oral Tablet
86647224 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 50 MG Extended Release Oral Tablet
866479Hydrochlorothiazide 25 MG / Metoprolol Tartrate 100 MG Oral Tablet
866482Hydrochlorothiazide 25 MG / Metoprolol Tartrate 50 MG Oral Tablet
866491Hydrochlorothiazide 50 MG / Metoprolol Tartrate 100 MG Oral Tablet
866511Metoprolol Tartrate 100 MG Oral Tablet
866514Metoprolol Tartrate 50 MG Oral Tablet
866924Metoprolol Tartrate 25 MG Oral Tablet
896758Labetalol hydrochloride 100 MG Oral Tablet
896762Labetalol hydrochloride 200 MG Oral Tablet
896766Labetalol hydrochloride 300 MG Oral Tablet
896983Labetalol hydrochloride 400 MG Oral Tablet
896987Labetalol hydrochloride 50 MG Oral Tablet
904561Sotalol Hydrochloride 100 MG Oral Tablet
904567Sotalol Hydrochloride 120 MG Oral Tablet
904579Sotalol Hydrochloride 160 MG Oral Tablet
904589Sotalol Hydrochloride 240 MG Oral Tablet
904601Sotalol Hydrochloride 80 MG Oral Tablet
978577Carteolol Hydrochloride 2.5 MG Oral Tablet
978581Carteolol Hydrochloride 5 MG Oral Tablet
998685Acebutolol Hydrochloride 400 MG Oral Capsule
998689Acebutolol Hydrochloride 200 MG Oral Capsule
998693Acebutolol Hydrochloride 100 MG Oral Capsule
998694Acebutolol Hydrochloride 200 MG / Hydrochlorothiazide 12.5 MG Oral Tablet
998695Acebutolol Hydrochloride 400 MG Oral Tablet
• Applicable Diagnosis (ICD-9, ICD-10 or SNOMED) Code for Arrhythmia, Hypotension, Asthma, Allergy to Beta Blocker Therapy, Intolerance to Beta Blocker Therapy, Bradycardia, or Atrioventricular Block (without Cardiac Pacer)

This is captured by adding a diagnosis with a valid ICD10/ICD9 and/or SNOMED code using the diagnosis widget in a note. (Applies to the following: An active diagnosis of allergy to beta blocker therapy, intolerance to beta blocker therapy, arrhythmia, hypotension, asthma, or bradycardia.)

Valid Diagnosis Codes for Arrhythmia Exception:

ICD-9:  
Code Description
427.89 Other specified cardiac dysrhythmias
427.9 Cardiac dysrhythmia, unspecified
ICD-10:   
Code Description
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia, unspecified
SNOMED:  
Code Description
184004 Withdrawal arrhythmia (disorder)
10164001 Parasystole (disorder)
10626002 Multifocal premature ventricular complexes (disorder)
11157007 Ventricular bigeminy (disorder)
11849007 Atrioventricular junctional rhythm (disorder)
13640000 Fusion beats (disorder)
17338001 Ventricular premature beats (disorder)
17366009 Atrial arrhythmia (disorder)
17869006 Anomalous atrioventricular excitation (disorder)
26950008 Chronic ectopic atrial tachycardia (disorder)
27337007 Unifocal premature ventricular complexes (disorder)
29320008 Ectopic rhythm (disorder)
33413000 Ectopic beats (disorder)
36083008 Sick sinus syndrome (disorder)
38274001 Interpolated ventricular premature complexes (disorder)
39260000 Nonparoxysmal atrioventricular nodal tachycardia (disorder)
39357005 Paroxysmal atrial tachycardia with block (disorder)
40593004 Fibrillation (disorder)
44808001 Conduction disorder of the heart (disorder)
47830009 Junctional escape beats (disorder)
49982000 Multifocal atrial tachycardia (disorder)
55475008 Lown-Ganong-Levine syndrome (disorder)
59272004 Ventricular parasystole (disorder)
60423000 Sinus node dysfunction (disorder)
61277005 Accelerated idioventricular rhythm (disorder)
63232000 Multifocal premature beats (disorder)
63593006 Supraventricular premature beats (disorder)
69730002 Idiojunctional tachycardia (disorder)
71908006 Ventricular fibrillation (disorder)
72654001 Supraventricular arrhythmia (disorder)
74390002 Wolff-Parkinson-White pattern (disorder)
74615001 Tachycardia-bradycardia (disorder)
75532003 Ventricular escape beat (disorder)
81681009 Junctional premature beats (disorder)
81898007 Ventricular escape rhythm (disorder)
88412007 Atrio-ventricular node arrhythmia (disorder)
195060002 Ventricular pre-excitation (disorder)
195069001 Paroxysmal atrial tachycardia (disorder)
195071001 Paroxysmal junctional tachycardia (disorder)
195072008 Paroxysmal nodal tachycardia (disorder)
195083004 Ventricular fibrillation and flutter (disorder)
233891009 Sinoatrial node tachycardia (disorder)
233892002 Ectopic atrial tachycardia (disorder)
233893007 Re-entrant atrial tachycardia (disorder)
233894001 Incessant atrial tachycardia (disorder)
233895000 Ectopic atrioventricular node tachycardia (disorder)
233904005 Permanent junctional reciprocating tachycardia (disorder)
233915000 Paroxysmal familial ventricular fibrillation (disorder)
233922008 Concealed accessory pathway (disorder)
233923003 Unidirectional retrograde accessory pathway (disorder)
234172002 Electromechanical dissociation (disorder)
251161003 Slow ventricular response (disorder)
251162005 Atrio-ventricular-junctional (nodal) bradycardia (disorder)
251163000 Atrio-ventricular junctional (nodal) arrest (disorder)
251164006 Junctional premature complex (disorder)
251165007 Atrioventricular junctional (nodal) tachycardia (disorder)
251166008 Atrioventricular nodal re-entry tachycardia (disorder)
251167004 Aberrant premature complexes (disorder)
251168009 Supraventricular bigeminy (disorder)
251170000 Blocked premature atrial contraction (disorder)
251172008 Run of atrial premature complexes (disorder)
251173003 Atrial bigeminy (disorder)
251174009 Atrial trigeminy (disorder)
251175005 Ventricular premature complex (disorder)
251176006 Multiple premature ventricular complexes (disorder)
251177002 Run of ventricular premature complexes (disorder)
251178007 Ventricular interpolated complexes (disorder)
251179004 Multiple ventricular interpolated complexes (disorder)
251180001 Ventricular trigeminy (disorder)
251181002 Ventricular quadrigeminy (disorder)
251182009 Paired ventricular premature complexes (disorder)
251186007 Ventricular escape complex (disorder)
251187003 Atrial escape complex (disorder)
251188008 Atrial parasystole (disorder)
276796006 Atrial tachycardia (disorder)
284470004 Premature atrial contraction (disorder)
287057009 Atrial premature complex (disorder)
309809007 Electromechanical dissociation with successful resuscitation (disorder)
406461004 Ectopic atrial beats (disorder)
418341009 Atrioventricular conduction disorder (disorder)
418818005 Brugada syndrome (disorder)
419752005 Sinoatrial nodal reentrant tachycardia (disorder)
421869004 Bradyarrhythmia (disorder)
422348008 Andersen Tawil syndrome (disorder)
429243003 Sustained ventricular fibrillation (disorder)

Valid Diagnosis Codes for Hypotension Exception:

ICD-9:  
Code Description
458 Orthostatic hypotension
458.1 Chronic hypotension
458.21 Hypotension of hemodialysis
458.29 Other iatrogenic hypotension
458.8 Other specified hypotension
458.9 Hypotension, unspecified
ICD-10:  
Code Description
I95.0 Idiopathic hypotension
I95.1 Orthostatic hypotension
I95.2 Hypotension due to drugs
I95.3 Hypotension of hemodialysis
I95.81 Postprocedural hypotension
I95.89 Other hypotension
I95.9 Hypotension, unspecified
SNOMED:   
Code Description
45007003 Low blood pressure (disorder)
61933008 Hyperadrenergic postural hypotension (disorder)
70247006 Hypoadrenergic postural hypotension (disorder)
75181005 Chronic orthostatic hypotension (disorder)
77545000 Chronic hypotension (disorder)
88887003 Maternal hypotension syndrome (disorder)
195506001 Idiopathic hypotension (disorder)
200113008 Maternal hypotension syndrome with antenatal problem (disorder)
200114002 Maternal hypotension syndrome with postnatal problem (disorder)
230664009 Sympathotonic orthostatic hypotension (disorder)
234171009 Drug-induced hypotension (disorder)
271870002 Low blood pressure reading (disorder)
286963007 Chronic hypotension - idiopathic (disorder)
371073003 Postural orthostatic tachycardia syndrome (disorder)
408667000 Hemodialysis-associated hypotension (disorder)
408668005 Iatrogenic hypotension (disorder)
429561008 Exertional hypotension (disorder)

Valid Diagnosis Codes for Asthma Exception:

ICD-9:   
Code Description
493 Extrinsic asthma, unspecified
493.01 Extrinsic asthma with status asthmaticus
493.02 Extrinsic asthma with (acute) exacerbation
493.1 Intrinsic asthma, unspecified
493.11 Intrinsic asthma with status asthmaticus
493.12 Intrinsic asthma with (acute) exacerbation
493.2 Chronic obstructive asthma, unspecified
493.21 Chronic obstructive asthma with status asthmaticus
493.22 Chronic obstructive asthma with (acute) exacerbation
493.81 Exercise induced bronchospasm
493.82 Cough variant asthma
493.9 Asthma, unspecified type, unspecified
493.91 Asthma, unspecified type, with status asthmaticus
493.92 Asthma, unspecified type, with (acute) exacerbation
SNOMED:  
Code Description
11641008 Millers' asthma (disorder)
12428000 Intrinsic asthma without status asthmaticus (disorder)
13151001 Flax-dressers' disease (disorder)
30352005 Allergic-infective asthma (disorder)
31387002 Exercise-induced asthma (disorder)
55570000 Asthma without status asthmaticus (disorder)
56968009 Wood asthma (disorder)
57546000 Asthma with status asthmaticus (disorder)
59327009 Intrinsic asthma with status asthmaticus (disorder)
59786004 Weavers' cough (disorder)
63088003 Extrinsic asthma without status asthmaticus (disorder)
85761009 Byssinosis (disorder)
195949008 Chronic asthmatic bronchitis (disorder)
195967001 Asthma (disorder)
195977004 Mixed asthma (disorder)
225057002 Brittle asthma (disorder)
233672007 Byssinosis grade 3 (disorder)
233678006 Childhood asthma (disorder)
233679003 Late onset asthma (disorder)
233681001 Extrinsic asthma with asthma attack (disorder)
233683003 Hay fever with asthma (disorder)
233685005 Intrinsic asthma with asthma attack (disorder)
233688007 Sulfite-induced asthma (disorder)
266361008 Non-allergic asthma (disorder)
266364000 Asthma attack (disorder)
281239006 Exacerbation of asthma (disorder)
304527002 Acute asthma (disorder)
370218001 Mild asthma (disorder)
370219009 Moderate asthma (disorder)
370220003 Occasional asthma (disorder)
370221004 Severe asthma (disorder)
389145006 Allergic asthma (disorder)
405944004 Asthmatic bronchitis (disorder)
407674008 Aspirin-induced asthma (disorder)
409663006 Cough variant asthma (disorder)
423889005 Non-immunoglobulin E mediated allergic asthma (disorder)
424199006 Substance induced asthma (disorder)
424643009 Immunoglobulin E-mediated allergic asthma (disorder)
425969006 Exacerbation of intermittent asthma (disorder)
426656000 Severe persistent asthma (disorder)
426979002 Mild persistent asthma (disorder)
427295004 Moderate persistent asthma (disorder)
427354000 Exacerbation of persistent asthma (disorder)
427603009 Intermittent asthma (disorder)
427679007 Mild intermittent asthma (disorder)
442025000 Acute exacerbation of chronic asthmatic bronchitis (disorder)

 

Valid Beta Blocker Therapy Allergy Exclusion Codes:

SNOMED:  

293962009 Beta-adrenoceptor blocking drug allergy (disorder)
293963004 Cardioselective beta-blocker allergy (disorder)
293964005 Acebutolol allergy (disorder)
293965006 Atenolol allergy (disorder)
293966007 Betaxolol allergy (disorder)
293967003 Bisoprolol allergy (disorder)
293968008 Celiprolol allergy (disorder)
293969000 Esmolol allergy (disorder)
293970004 Metoprolol allergy (disorder)
293971000 Non-cardioselective beta-blocker allergy (disorder)
293972007 Nadolol allergy (disorder)
293973002 Pindolol allergy (disorder)
293974008 Carvedilol allergy (disorder)
293975009 Metipranolol allergy (disorder)
293976005 Carteolol allergy (disorder)
293977001 Labetalol allergy (disorder)
293978006 Levobunolol allergy (disorder)
293979003 Oxprenolol allergy (disorder)
293980000 Penbutolol allergy (disorder)
293981001 Practolol allergy (disorder)
293982008 Propranolol allergy (disorder)
293983003 Sotalol allergy (disorder)
293984009 Timolol allergy (disorder)

Valid Beta Blocker Therapy Intolerance Exclusion Codes:

SNOMED:   
Code Description
292419005 Beta-adrenoceptor blocking drug adverse reaction (disorder)
292420004 Cardioselective beta-blocker adverse reaction (disorder)
292421000 Acebutolol adverse reaction (disorder)
292424008 Betaxolol adverse reaction (disorder)
292425009 Bisoprolol adverse reaction (disorder)
292426005 Celiprolol adverse reaction (disorder)
292427001 Esmolol adverse reaction (disorder)
292428006 Metoprolol adverse reaction (disorder)
292429003 Non-cardioselective beta-blocker adverse reaction (disorder)
292430008 Nadolol adverse reaction (disorder)
292431007 Pindolol adverse reaction (disorder)
292432000 Carvedilol adverse reaction (disorder)
292433005 Metipranolol adverse reaction (disorder)
292434004 Carteolol adverse reaction (disorder)
292435003 Labetalol adverse reaction (disorder)
292436002 Levobunolol adverse reaction (disorder)
292437006 Oxprenolol adverse reaction (disorder)
292438001 Penbutolol adverse reaction (disorder)
292439009 Practolol adverse reaction (disorder)
292440006 Propranolol adverse reaction (disorder)
292441005 Sotalol adverse reaction (disorder)
292442003 Timolol adverse reaction (disorder)
418370000 Atenolol adverse reaction (disorder)

Valid Diagnosis Codes for Bradycardia Exception:

ICD-9:  
Code Description
427.81 Sinoatrial node dysfunction
427.89 Other specified cardiac dysrhythmias
ICD-10:   
Code Description
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
R00.1 Bradycardia, unspecified
SNOMED:  
Code Description
29894000 Vagal autonomic bradycardia (disorder)
44602002 Persistent sinus bradycardia (disorder)
49044005 Severe sinus bradycardia (disorder)
49710005 Sinus bradycardia (disorder)
251162005 Atrio-ventricular-junctional (nodal) bradycardia (disorder)
397841007 Drug-induced bradycardia (disorder)

Valid Diagnosis Codes for Atrioventricular Block Exception:

This can be captured in the following ways:

  • Adding a diagnosis of cardiac pacer in situ with a valid ICD10/ICD9 and/or SNOMED code using the diagnosis widget in a note.

OR

  • Adding a procedure for implanting a cardiac pacer with a valid SNOMED code using the procedure widget in a note.
ICD-9:  
Code Description
426 Atrioventricular block, complete
426.12 Mobitz (type) II atrioventricular block
426.13 Other second degree atrioventricular block
ICD-10:    
Code Description
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
SNOMED:  
Code Description
27885002 Complete atrioventricular block (disorder)
28189009 Mobitz type II atrioventricular block (disorder)
54016002 Mobitz type I incomplete atrioventricular block (disorder)
93130009 Lenegre's disease (disorder)
195042002 Second degree atrioventricular block (disorder)
233917008 Atrioventricular block (disorder)
233918003 Postoperative complete heart block (disorder)
251114004 Intermittent second degree atrioventricular block (disorder)
283645003 Lev's syndrome (disorder)

Valid Diagnosis Codes for Cardiac Pacer that will negate the Atrioventricular Block Exception:

ICD-9:  
Code Description
V45.01 Cardiac pacemaker in situ
ICD-10:  
Code Description
Z95.0 Presence of cardiac pacemaker
SNOMED:  
Code Description
14106009 Cardiac pacemaker, device (physical object)
56961003 Cardiac transvenous pacemaker, device (physical object)
360127006 Intravenous cardiac pacemaker system (physical object)
360128001 Intravenous triggered cardiac pacemaker system (physical object)
424921004 Permanent cardiac pacemaker, device (physical object)
441509002 Cardiac pacemaker in situ (finding)
• Medical, Patient or System Reason for Not Prescribing Beta Blocker Therapy that occurs during the first encounter of the measurement period

Entered via the Medication button in the note for the first encounter of the measurement period for the patient. 

  • This is captured by adding a medication not ordered with a valid RXNORM code and attaching a valid SNOMED code for the reason not done using the medication button in a note.

medication not ordered button

medication not ordered

 

Medical Reason

SNOMED Description
183932001 Procedure contraindicated (situation)
183964008 Treatment not indicated (situation)
183966005 Drug treatment not indicated (situation)
216952002 Failure in dosage (event)
266721009 Absent response to treatment (situation)
269191009 Late effect of medical and surgical care complication (disorder)
274512008 Drug therapy discontinued (situation)
31438003 Drug resistance (disorder)
35688006 Complication of medical care (disorder)
371133007 Treatment modification (procedure)
397745006 Medical contraindication (finding)
407563006 Treatment not tolerated (situation)
410534003 Not indicated (qualifier value)
410536001 Contraindicated (qualifier value)
416098002 Drug allergy (disorder)
416406003 Procedure discontinued (situation)
428119001 Procedure not indicated (situation)
445528004 Treatment changed (situation)
59037007 Drug intolerance (disorder)
62014003 Adverse reaction to drug (disorder)
79899007 Drug interaction (finding)

Patient Reason

SNOMED Description
105480006 Refusal of treatment by patient (situation)
160932005 Financial problem (finding)
160934006 Financial circumstances change (finding)
182890002 Patient requests alternative treatment (finding)
182895007 Drug declined by patient (situation)
182897004 Drug declined by patient - side effects (situation)
182900006 Drug declined by patient - patient beliefs (situation)
182902003 Drug declined by patient - cannot pay script (situation)
183944003 Procedure refused (situation)
183945002 Procedure refused for religious reason (situation)
184081006 Patient has moved away (finding)
185479006 Patient dissatisfied with result (finding)
185481008 Dissatisfied with doctor (finding)
224187001 Variable income (finding)
225928004 Patient self-discharge against medical advice (procedure)
258147002 Stopped by patient (situation)
266710000 Drugs not taken/completed (situation)
266966009 Family illness (situation)
275694009 Patient defaulted from follow-up (finding)
275936005 Patient noncompliance - general (situation)
281399006 Did not attend (finding)
310343007 Further opinion sought (finding)
373787003 Treatment delay - patient choice (finding)
385648002 Rejected by recipient (qualifier value)
406149000 Medication refused (situation)
408367005 Patient forgets to take medication (finding)
413310006 Patient non-compliant - refused access to services (situation)
413311005 Patient non-compliant - refused intervention / support (situation)
413312003 Patient non-compliant - refused service (situation)
416432009 Procedure not wanted (situation)
423656007 Income insufficient to buy necessities (finding)
424739004 Income sufficient to buy only necessities (finding)
443390004 Refused (qualifier value)

System Reason

SNOMED Description
107724000 Patient transfer (procedure)
182856006 Drug not available - out of stock (finding)
182857002 Drug not available-off market (finding)
185335007 Appointment canceled by hospital (finding)
224194003 Not entitled to benefits (finding)
224198000 Delay in receiving benefits (finding)
224199008 Loss of benefits (finding)
242990004 Drug not available for administration (event)
266756008 Medical care unavailable (situation)
270459005 Patient on waiting list (finding)
309017000 Referred to doctor (finding)
309846006 Treatment not available (situation)
419808006 Finding related to health insurance issues (finding)
424553001 Uninsured medical expenses (finding)

*ADDITIONAL INFORMATION:

•  The appropriate LOINC code for the LVEF result can be linked to the matching condition created from an electronic lab interface, to a numeric template field or to a procedure code.  

•  Whenever documenting a result using a procedure code, be sure to enter it in the Result field.

•  The patient must be at least 18 years of age prior to the start of the measurement period

•  A "Medication Not Ordered" may be undone using the "Undo Medication Not Ordered" option in the Medication button.  It must be done in the same note in which it was originally indicated.

•  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

Check the types of e-mail notifications you want sent to this address: