NQF 0083: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

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, at least two times during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*: 

• Office Encounter (CPT) Code or Patient Provider Interaction/Face-to-Face Interaction (SNOMED) Code for TWO UNIQUE ENCOUNTERS during the measurement period
Valid Office Encounter Codes: 
CPT: 
CodeDescription
99201Office 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.
99202Office 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.
99203Office 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.
99204Office 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.
99205Office 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.
99212Office 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.
99213Office 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.
99214Office 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.
99215Office 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.
99241Office 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.
99242Office 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.
99243Office 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.
99244Office 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.
99245Office 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.
99304Initial 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.
99305Initial 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.
99306Initial 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.
99307Subsequent 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.
99308Subsequent 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.
99309Subsequent 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.
99310Subsequent 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.
99324Domiciliary 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.
99325Domiciliary 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.
99326Domiciliary 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.
99327Domiciliary 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.
99328Domiciliary 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.
99334Domiciliary 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.
99335Domiciliary 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.
99336Domiciliary 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.
99337Domiciliary 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.
99341Home 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.
99342Home 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.
99343Home 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.
99344Home 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.
99345Home 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.
99347Home 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.
99348Home 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.
99349Home 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.
99350Home 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: 
CodeDescription
4525004Emergency department patient visit (procedure)
11797002Telephone call by physician to patient or for consultation (procedure)
12843005Subsequent hospital visit by physician (procedure)
12843005Subsequent hospital visit by physician (procedure)
18170008Subsequent nursing facility visit (procedure)
18170008Subsequent nursing facility visit (procedure)
19681004Nursing evaluation of patient and report (procedure)
19681004Nursing evaluation of patient and report (procedure)
87790002Follow-up inpatient consultation visit (procedure)
87790002Follow-up inpatient consultation visit (procedure)
90526000Initial evaluation and management of healthy individual (procedure)
90526000Initial evaluation and management of healthy individual (procedure)
185316007Indirect encounter (procedure)
185317003Telephone encounter (procedure)
185318008Third party encounter (procedure)
185320006Encounter by computer link (procedure)
185321005Letter encounter to patient (procedure)
185349003Encounter for "check-up" (procedure)
185349003Encounter for "check-up" (procedure)
185463005Visit out of hours (procedure)
185463005Visit out of hours (procedure)
185465003Weekend visit (procedure)
185465003Weekend visit (procedure)
207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
270424005Letter encounter from patient (procedure)
270427003Patient-initiated encounter (procedure)
270427003Patient-initiated encounter (procedure)
270430005Provider-initiated encounter (procedure)
270430005Provider-initiated encounter (procedure)
308335008Patient encounter procedure (procedure)
308335008Patient encounter procedure (procedure)
308720009Letter encounter (procedure)
386473003Telephone follow-up (procedure)
390906007Follow-up encounter (procedure)
390906007Follow-up encounter (procedure)
401267002Telephone triage encounter (procedure)
401271004E-mail sent to patient (procedure)
406547006Urgent follow-up (procedure)
406547006Urgent follow-up (procedure)
438515009E-mail encounter from carer (procedure)
438516005E-mail encounter to carer (procedure)
439708006Home visit (procedure)
439708006Home visit (procedure)
445450000Encounter by short message service text messaging (procedure)
448337001Telemedicine consultation with patient (procedure)
• 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:  

• LVSD Diagnosis (SNOMED) Code that occurs on or before the first encounter during the measurement period
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)
• Ejection Fraction Result of <40% that occurs on or before the first encounter during the measurement period, with attached LOINC Code
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
  • 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 to Beta Blocker Therapy Ingredient

    Allergy:

  • Acebutolol allergy (disorder)
  • Atenolol allergy (disorder)
  • Beta-adrenoceptor blocking drug allergy (disorder)
  • Betaxolol allergy (disorder)
  • Bisoprolol allergy (disorder)
  • Cardioselective beta-blocker allergy (disorder)
  • Carteolol allergy (disorder)
  • Carvedilol allergy (disorder)
  • Celiprolol allergy (disorder)
  • Esmolol allergy (disorder)
  • History of beta blocker allergy (situation)
  • Labetalol allergy (disorder)
  • Levobunolol allergy (disorder)
  • Metipranolol allergy (disorder)
  • Metoprolol allergy (disorder)
  • Nadolol allergy (disorder)
  • Non-cardioselective beta-blocker allergy (disorder)
  • Oxprenolol allergy (disorder)
  • Penbutolol allergy (disorder)
  • Pindolol allergy (disorder)
  • Practolol allergy (disorder)
  • Propranolol allergy (disorder)
  • Sotalol allergy (disorder)
  • Timolol allergy (disorder)
  • Ingredient: 

    • Acebutolol
    • Acebutolol / Hydrochlorothiazide
    • Acebutolol Hydrochloride
    • Atenolol
    • Atenolol / Chlorthalidone
    • Bendroflumethiazide / Nadolol
    • Betaxolol
    • Betaxolol Hydrochloride
    • Bisoprolol
    • Bisoprolol / Hydrochlorothiazide
    • Bisoprolol Fumarate
    • Carteolol
    • Carteolol Hydrochloride
    • carvedilol
    • carvedilol phosphate
    • Clopamide / Pindolol
    • Coreg
    • Corgard
    • Corzide
    • Dutoprol
    • Hydrochlorothiazide / Labetalol
    • Hydrochlorothiazide / Metoprolol
    • Hydrochlorothiazide / Pindolol
    • Hydrochlorothiazide / Propranolol
    • Hydrochlorothiazide / Timolol
    • Inderal
    • InnoPran
    • Kerlone
    • Labetalol
    • Labetalol hydrochloride
    • Lopressor
    • Lopressor HCT
    • Metoprolol
    • metoprolol succinate
    • Metoprolol Tartrate
    • Nadolol
    • Normodyne
    • Pindolol
    • Propranolol
    • Propranolol Hydrochloride
    • Sectral
    • Tenoretic
    • Tenormin
    • Timolol
    • Timolol Maleate
    • Toprol
    • Trandate
    • Visken
    • Zebeta
    • Ziac
    • Applicable Diagnosis (ICD-9, ICD-10 or SNOMED) Code for Arrhythmia, Hypotension, Asthma, Intolerance to Beta Blocker Therapy, Bradycardia, or Atrioventricular Block (without Cardiac Pacer)

    Valid Diagnosis Codes for Arrhythmia Exception:

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

    Valid Diagnosis Codes for Hypotension Exception:

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

    Valid Diagnosis Codes for Asthma Exception:

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

    Valid Beta Blocker Therapy Intolerance Exclusion Codes:

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

    Valid Diagnosis Codes for Bradycardia Exception:

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

    Valid Diagnosis Codes for Atrioventricular Block Exception:

    ICD-9: 
    CodeDescription
    426Atrioventricular block, complete
    426.12Mobitz (type) II atrioventricular block
    426.13Other second degree atrioventricular block
    ICD-10:   
    CodeDescription
    I44.1Atrioventricular block, second degree
    I44.2Atrioventricular block, complete
    SNOMED: 
    CodeDescription
    27885002Complete atrioventricular block (disorder)
    28189009Mobitz type II atrioventricular block (disorder)
    54016002Mobitz type I incomplete atrioventricular block (disorder)
    93130009Lenegre's disease (disorder)
    195042002Second degree atrioventricular block (disorder)
    233917008Atrioventricular block (disorder)
    233918003Postoperative complete heart block (disorder)
    251114004Intermittent second degree atrioventricular block (disorder)
    283645003Lev's syndrome (disorder)

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

    ICD-9: 
    CodeDescription
    V45.01Cardiac pacemaker in situ
    ICD-10: 
    CodeDescription
    Z95.0Presence of cardiac pacemaker
    SNOMED: 
    CodeDescription
    14106009Cardiac pacemaker, device (physical object)
    56961003Cardiac transvenous pacemaker, device (physical object)
    360127006Intravenous cardiac pacemaker system (physical object)
    360128001Intravenous triggered cardiac pacemaker system (physical object)
    424921004Permanent cardiac pacemaker, device (physical object)
    441509002Cardiac 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:

    medication not ordered button

    medication not ordered

    *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.

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