Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (2022)

eCQMs / NQF #: CMS144v10 / 0083e
Measure: 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: 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: All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF < 40%.
Denominator Exceptions:   Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., 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 (e.g., patient declined, other patient reasons).

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

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*: 

This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the Diagnosis widget in a note.

ICD-10:  
Code Description
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified

 

SNOMED:  
Code Description
10091002 High output heart failure (disorder)
101281000119107 Congestive heart failure due to cardiomyopathy (disorder)
10633002 Acute congestive heart failure (disorder)
111283005 Chronic left-sided heart failure (disorder)
120851000119104 Systolic heart failure stage D (disorder)
120861000119102 Systolic heart failure stage C (disorder)
120871000119108 Systolic heart failure stage B (disorder)
120881000119106 Diastolic heart failure stage D (disorder)
120891000119109 Diastolic heart failure stage C (disorder)
120901000119108 Diastolic heart failure stage B (disorder)
153931000119109 Acute combined systolic and diastolic heart failure (disorder)
153941000119100 Chronic combined systolic and diastolic heart failure (disorder)
153951000119103 Acute on chronic combined systolic and diastolic heart failure (disorder)
15629541000119106 Congestive heart failure stage C due to Ischemic cardiomyopathy (disorder)
15629591000119103 Congestive heart failure stage B due to ischemic cardiomyopathy (disorder)
15629641000119107 Systolic heart failure stage B due to ischemic cardiomyopathy (disorder)
15629741000119102 Systolic heart failure stage C due to ischemic cardiomyopathy (disorder)
15781000119107 Hypertensive heart AND chronic kidney disease with congestive heart failure (disorder)
15964701000119109 Acute cor pulmonale co-occurrent and due to saddle embolus of pulmonary artery (disorder)
194767001 Benign hypertensive heart disease with congestive cardiac failure (disorder)
194779001 Hypertensive heart and renal disease with (congestive) heart failure (disorder)
194781004 Hypertensive heart and renal disease with both (congestive) heart failure and renal failure (disorder)
195111005 Decompensated cardiac failure (disorder)
195112003 Compensated cardiac failure (disorder)
195125002 Acute left ventricular failure (disorder)
206586757 Congenital cardiac failure (disorder)
23341000119109 Congestive heart failure with right heart failure (disorder)
233924009 Heart failure as a complication of care (disorder)
25544003 Low output heart failure (disorder)
314206753 Refractory heart failure (disorder)
364006 Acute left-sided heart failure (disorder)
410431009 Cardiorespiratory failure (disorder)
417996759 Systolic heart failure (disorder)
418304008 Diastolic heart failure (disorder)
42343007 Congestive heart failure (disorder)
424404003 Decompensated chronic heart failure (disorder)
426263006 Congestive heart failure due to left ventricular systolic dysfunction (disorder)
426611007 Congestive heart failure due to valvular disease (disorder)
43736758 Rheumatic left ventricular failure (disorder)
44088000 Low cardiac output syndrome (disorder)
441481004 Chronic systolic heart failure (disorder)
441530006 Chronic diastolic heart failure (disorder)
44313006 Right heart failure secondary to left heart failure (disorder)
443253003 Acute on chronic systolic heart failure (disorder)
443254009 Acute systolic heart failure (disorder)
443343001 Acute diastolic heart failure (disorder)
443344007 Acute on chronic diastolic heart failure (disorder)
46113002 Hypertensive heart failure (disorder)
471880001 Heart failure due to end stage congenital heart disease (disorder)
48447003 Chronic heart failure (disorder)
5148006 Hypertensive heart disease with congestive heart failure (disorder)
5375005 Chronic left-sided congestive heart failure (disorder)
56675007 Acute heart failure (disorder)
67431000119105 Congestive heart failure stage D (disorder)
67441000119101 Congestive heart failure stage C (disorder)
698594003 Symptomatic congestive heart failure (disorder)
703272007 Heart failure with reduced ejection fraction (disorder)
703273002 Heart failure with reduced ejection fraction due to coronary artery disease (disorder)
703274008 Heart failure with reduced ejection fraction due to myocarditis (disorder)
703275009 Heart failure with reduced ejection fraction due to cardiomyopathy (disorder)
703276755 Heart failure with reduced ejection fraction due to heart valve disease (disorder)
717840005 Congestive heart failure stage B (disorder)
72481000119103 Congestive heart failure as early postoperative complication (disorder)
74967503 Acute left-sided congestive heart failure (disorder)
82523003 Congestive rheumatic heart failure (disorder)
83105008 Malignant hypertensive heart disease with congestive heart failure (disorder)
84125007 Heart failure (disorder)
85232009 Left heart failure (disorder)
871617000 Low output heart failure due to and following Fontan operation (disorder)
88805009 Chronic congestive heart failure (disorder)
90727007 Pleural effusion due to congestive heart failure (disorder)
92506755 Biventricular congestive heart failure (disorder)

AND at least one of the following:

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

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.
99315 Nursing facility discharge day management; 30 minutes or less
99316 Nursing facility discharge day management; more than 30 minutes
99318 Evaluation and management of a patient involving an annual nursing facility assessment, which requires these 3 key components: A detailed interval history; A comprehensive examination; and Medical decision making that is of low to 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 is stable, recovering, or improving. Typically, 30 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.

 

SNOMED:  
Code Description
18170008 Subsequent nursing facility visit (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)
185460008 Home visit request by patient (procedure)
185462000 Home visit request by relative (procedure)
185463005 Visit out of hours (procedure)
185464004 Out of hours visit – not night visit (procedure)
185465003 Weekend visit (procedure)
185466002 Home visit for urgent condition (procedure)
185467006 Home visit for acute condition (procedure)
185468001 Home visit for chronic condition (procedure)
185470005 Home visit elderly assessment (procedure)
207195004 History and physical examination with evaluation and management of nursing facility patient (procedure)
209099002 History and physical examination with management of domiciliary or rest home patient (procedure)
210098006 Domiciliary or rest home patient evaluation and management (procedure)
225929007 Joint home visit (procedure)
270424005 Letter encounter from patient (procedure)
270427003 Patient-initiated encounter (procedure)
270430005 Provider-initiated encounter (procedure)
281036007 Follow-up consultation (procedure)
30346009 Evaluation and management of established outpatient in office or other outpatient facility (procedure)
308335008 Patient encounter procedure (procedure)
308720009 Letter encounter (procedure)
315205008 Bank holiday home visit (procedure)
3391000175108 Office visit for pediatric care and assessment (procedure)
37894004 Evaluation and management of new outpatient in office or other outpatient facility (procedure)
386473003 Telephone follow-up (procedure)
390906007 Follow-up encounter (procedure)
401267002 Telephone triage encounter (procedure)
401271004 E-mail sent to patient (procedure)
406547006 Urgent follow-up (procedure)
438515009 E-mail encounter from carer (procedure)
438516005 E-mail encounter to carer (procedure)
439708006 Home visit (procedure)
439740005 Postoperative follow-up visit (procedure)
445450000 Encounter by short message service text messaging (procedure)
448337001 Telemedicine consultation with patient (procedure)
698704008 Home visit for rheumatology service (procedure)
704126008 Home visit for anticoagulant drug monitoring (procedure)
77406008 Confirmatory medical consultation (procedure)
87790002 Follow-up inpatient consultation visit (procedure)
90526000 Initial evaluation and management of healthy individual (procedure)

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

CPT:  
Code Description
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 that occurs before or during the measurement period:

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

LOINC:    
Code Description
10230-1 Left ventricular Ejection fraction
18043-0 Left ventricular Ejection fraction by US
18044-8 Left ventricular Ejection fraction by US.2D+Calculated by single-plane ellipse method
18045-5 Left ventricular Ejection fraction by US.2D+Calculated by biplane ellipse method
18046-3 Left ventricular Ejection fraction by US 2D modified
18047-1 Left ventricular Ejection fraction by US 2D modified biplane
18048-9 Left ventricular Ejection fraction by US 2D modified single-plane
18049-7 Left ventricular Ejection fraction by US.M-mode+Calculated by Teichholz method
77889-4 Left ventricular Ejection fraction by US.M-mode+Calculated by cube method
77890-2 Left ventricular Ejection fraction by US.2D+Calculated by cube method
77891-0 Left ventricular Ejection fraction by US.2D+Calculated by Teichholz method
77892-8 Left ventricular Ejection fraction by US.2D+Calculated by modified Simpson method
79990-8 Left ventricular Ejection fraction by US.3D.segmentation
79991-6 Left ventricular Ejection fraction by US.2D+Calculated by biplane method of disks
79992-4 Left ventricular Ejection fraction by US.2D.A2C+Calculated by single plane method of disks
79993-2 Left ventricular Ejection fraction by US.2D.A4C+Calculated by single plane method of disks
8806-2 Left ventricular Ejection fraction by 2D echo
8807-0 Left ventricular Ejection fraction by 2D echo.visual estimate
8808-8 Left ventricular Ejection fraction by Cardiac angiogram
8809-6 Left ventricular Ejection fraction by Cardiac angiogram.visual estimate
8810-4 Left ventricular Ejection fraction by Spiral CT
8811-2 Left ventricular Ejection fraction by MR
8812-0 Left ventricular Ejection fraction by Nuclear blood pool
SNOMED:  
Code Description
981000124106 Moderate left ventricular systolic dysfunction (disorder)
991000124109 Severe left ventricular systolic dysfunction (disorder)

Denominator Exceptions:

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):

• A medication allergy to an ingredient of beta blocker therapy  is captured by entering a medication ingredient with a valid RXNORM code in the Allergy widget 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.

Allergy:

RXNORM:  
Code Description
10600 Timolol
1202 Atenolol
149 Acebutolol
1520 Betaxolol
19484 Bisoprolol
20352 carvedilol
2116 Carteolol
6185 Labetalol
6918 Metoprolol
7226 Nadolol
8332 Pindolol
8787 Propranolol

Medication Intolerance:

RXNORM:  
Code Description
1191185 Penbutolol Sulfate 20 MG Oral Tablet
1297753 Betaxolol Hydrochloride 10 MG Oral Tablet
1297757 Betaxolol Hydrochloride 20 MG Oral Tablet
1495058 Propranolol Hydrochloride 4.28 MG/ML Oral Solution
152916 Atenolol 50 MG / Chlorthalidone 12.5 MG Oral Tablet
1593725 Sotalol Hydrochloride 5 MG/ML Oral Solution
1923422 Sotalol Hydrochloride 120 MG Oral Tablet
1923424 Sotalol Hydrochloride 160 MG Oral Tablet
1923426 Sotalol Hydrochloride 80 MG Oral Tablet
197379 Atenolol 100 MG Oral Tablet
197380 Atenolol 25 MG Oral Tablet
197381 Atenolol 50 MG Oral Tablet
197382 Atenolol 100 MG / Chlorthalidone 25 MG Oral Tablet
197383 Atenolol 50 MG / Chlorthalidone 25 MG Oral Tablet
198000 Bendroflumethiazide 5 MG / Nadolol 40 MG Oral Tablet
198001 Bendroflumethiazide 5 MG / Nadolol 80 MG Oral Tablet
198006 Nadolol 20 MG Oral Tablet
198007 Nadolol 40 MG Oral Tablet
198008 Nadolol 80 MG Oral Tablet
198104 Pindolol 10 MG Oral Tablet
198105 Pindolol 5 MG Oral Tablet
198284 Timolol 10 MG Oral Tablet
198285 Timolol 20 MG Oral Tablet
198286 Timolol 5 MG Oral Tablet
199277 Pindolol 15 MG Oral Tablet
199494 Oxprenolol 20 MG Oral Tablet
199495 Oxprenolol 40 MG Oral Tablet
199717 Clopamide 5 MG / Pindolol 10 MG Oral Tablet
199786 Oxprenolol 80 MG Oral Tablet
199787 Oxprenolol 160 MG Extended Release Oral Tablet
200031 carvedilol 6.25 MG Oral Tablet
200032 carvedilol 12.5 MG Oral Tablet
200033 carvedilol 25 MG Oral Tablet
245854 Hydrochlorothiazide 25 MG / Pindolol 10 MG Oral Tablet
245855 Hydrochlorothiazide 50 MG / Pindolol 10 MG Oral Tablet
387013 nebivolol 5 MG Oral Tablet
686924 carvedilol 3.125 MG Oral Tablet
751612 nebivolol 10 MG Oral Tablet
751618 nebivolol 2.5 MG Oral Tablet
827073 nebivolol 20 MG Oral Tablet
854901 Bisoprolol Fumarate 10 MG Oral Tablet
854905 Bisoprolol Fumarate 5 MG Oral Tablet
854908 Bisoprolol Fumarate 10 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854916 Bisoprolol Fumarate 2.5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854919 Bisoprolol Fumarate 5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
856422 Hydrochlorothiazide 25 MG / Propranolol Hydrochloride 40 MG Oral Tablet
856429 Hydrochlorothiazide 25 MG / Propranolol Hydrochloride 80 MG Oral Tablet
856448 Propranolol Hydrochloride 10 MG Oral Tablet
856457 Propranolol Hydrochloride 20 MG Oral Tablet
856460 24 HR Propranolol Hydrochloride 120 MG Extended Release Oral Capsule
856481 24 HR Propranolol Hydrochloride 160 MG Extended Release Oral Capsule
856519 Propranolol Hydrochloride 40 MG Oral Tablet
856535 24 HR Propranolol Hydrochloride 60 MG Extended Release Oral Capsule
856556 Propranolol Hydrochloride 60 MG Oral Tablet
856569 24 HR Propranolol Hydrochloride 80 MG Extended Release Oral Capsule
856578 Propranolol Hydrochloride 80 MG Oral Tablet
856713 Propranolol Hydrochloride 160 MG Oral Tablet
856724 Propranolol Hydrochloride 4 MG/ML Oral Solution
856733 Propranolol Hydrochloride 8 MG/ML Oral Solution
860510 24 HR carvedilol phosphate 10 MG Extended Release Oral Capsule
860516 24 HR carvedilol phosphate 20 MG Extended Release Oral Capsule
860522 24 HR carvedilol phosphate 40 MG Extended Release Oral Capsule
860532 24 HR carvedilol phosphate 80 MG Extended Release Oral Capsule
866412 24 HR metoprolol succinate 100 MG Extended Release Oral Tablet
866419 24 HR metoprolol succinate 200 MG Extended Release Oral Tablet
866427 24 HR metoprolol succinate 25 MG Extended Release Oral Tablet
866436 24 HR metoprolol succinate 50 MG Extended Release Oral Tablet
866452 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 100 MG Extended Release Oral Tablet
866461 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 25 MG Extended Release Oral Tablet
866472 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 50 MG Extended Release Oral Tablet
866479 Hydrochlorothiazide 25 MG / Metoprolol Tartrate 100 MG Oral Tablet
866482 Hydrochlorothiazide 25 MG / Metoprolol Tartrate 50 MG Oral Tablet
866491 Hydrochlorothiazide 50 MG / Metoprolol Tartrate 100 MG Oral Tablet
866511 Metoprolol Tartrate 100 MG Oral Tablet
866514 Metoprolol Tartrate 50 MG Oral Tablet
866924 Metoprolol Tartrate 25 MG Oral Tablet
896758 Labetalol hydrochloride 100 MG Oral Tablet
896762 Labetalol hydrochloride 200 MG Oral Tablet
896766 Labetalol hydrochloride 300 MG Oral Tablet
896983 Labetalol hydrochloride 400 MG Oral Tablet
896987 Labetalol hydrochloride 50 MG Oral Tablet
904561 Sotalol Hydrochloride 100 MG Oral Tablet
904589 Sotalol Hydrochloride 240 MG Oral Tablet
998685 Acebutolol Hydrochloride 400 MG Oral Capsule
998689 Acebutolol Hydrochloride 200 MG Oral Capsule
998693 Acebutolol Hydrochloride 100 MG Oral Capsule
998694 Acebutolol Hydrochloride 200 MG / Hydrochlorothiazide 12.5 MG Oral Tablet
998695 Acebutolol Hydrochloride 400 MG Oral Tablet

This is captured by adding a diagnosis with a valid ICD10 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-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-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-10:  
Code Description
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.990 Exercise induced bronchospasm
J45.991 Cough variant asthma
J45.998 Other asthma
SNOMED:  
Code Description
11641008 Millers’ asthma (disorder)
12428000 Intrinsic asthma without status asthmaticus (disorder)
13151001 Flax-dressers’ disease (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)
233683003 Hay fever with asthma (disorder)
233688007 Sulfite-induced asthma (disorder)
266361008 Non-allergic asthma (disorder)
281239006 Exacerbation of asthma (disorder)
304527002 Acute asthma (disorder)
31387002 Exercise-induced 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)
427603009 Intermittent asthma (disorder)
427679007 Mild intermittent asthma (disorder)
442025000 Acute exacerbation of chronic asthmatic bronchitis (disorder)
55570000 Asthma without status asthmaticus (disorder)
56968009 Wood asthma (disorder)
59786004 Weavers’ cough (disorder)
63088003 Extrinsic asthma without status asthmaticus (disorder)
707445000 Exacerbation of mild persistent asthma (disorder)
707446004 Exacerbation of moderate persistent asthma (disorder)
707447008 Exacerbation of severe persistent asthma (disorder)
708038006 Acute exacerbation of asthma (disorder)
708090002 Acute severe exacerbation of asthma (disorder)
708093000 Acute exacerbation of immunoglobulin E-mediated allergic asthma (disorder)
708094006 Acute exacerbation of intrinsic asthma (disorder)
708095007 Acute severe exacerbation of immunoglobin E-mediated allergic asthma (disorder)
708096008 Acute severe exacerbation of intrinsic asthma (disorder)
782520007 Exacerbation of allergic asthma due to infection (disorder)
85761009 Byssinosis (disorder)
92807009 Chemical-induced asthma (disorder)
93432008 Drug-induced asthma (disorder)

Valid Beta Blocker Therapy Allergy Exclusion Codes:

SNOMED:  
Code Description
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)
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-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 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-10:  
Code Description
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.30 Unspecified atrioventricular block
I44.39 Other atrioventricular block
SNOMED:  
Code Description
102451000119107 Complete atrioventricular block as complication of atrioventricular nodal ablation (disorder)
195042002 Second degree atrioventricular block (disorder)
204383001 Congenital complete atrioventricular heart block (disorder)
233917008 Atrioventricular block (disorder)
233918003 Postoperative complete heart block (disorder)
251114004 Intermittent second degree atrioventricular block (disorder)
27885002 Complete atrioventricular block (disorder)
28189009 Mobitz type II atrioventricular block (disorder)
283645003 Lev’s syndrome (disorder)
284941000119107 High degree second degree atrioventricular block (disorder)
54016002 Mobitz type I incomplete atrioventricular block (disorder)
733125004 Acquired complete atrioventricular block (disorder)

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

ICD-10:  
Code Description
Z95.0 Presence of cardiac pacemaker
Z95.810 Presence of automatic (implantable) cardiac defibrillator
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)

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.

Medical Reason

SNOMED:  
Code Description
183932001 Procedure contraindicated (situation)
183964008 Treatment not indicated (situation)
183966005 Drug treatment not indicated (situation)
266721009 Absent response to treatment (situation)
269191009 Late effect of medical and surgical care complication (disorder)
31438003 Drug resistance (disorder)
35688006 Complication of medical care (disorder)
397745006 Medical contraindication (finding)
407563006 Treatment not tolerated (situation)
410534003 Not indicated (qualifier value)
410536001 Contraindicated (qualifier value)
416098002 Allergy to drug (finding)
428119001 Procedure not indicated (situation)
59037007 Intolerance to drug (finding)
62014003 Adverse reaction caused by drug (disorder)
79899007 Drug interaction (finding)

Patient Reason

SNOMED Description
105480006 Refusal of treatment by patient (situation)
134397009 Angiotensin converting enzyme inhibitor declined (situation)
401084003 Angioensin II receptor antagonist declined (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 Medication 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)
713247000 Procedure discontinued 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)
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 discontinued by patient (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)

Required Data Elements for the Numerator*: 

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.

RXNORM:  
Code Description
200031 carvedilol 6.25 MG Oral Tablet
200032 carvedilol 12.5 MG Oral Tablet
200033 carvedilol 25 MG Oral Tablet
686924 carvedilol 3.125 MG Oral Tablet
854901 Bisoprolol Fumarate 10 MG Oral Tablet
854905 Bisoprolol Fumarate 5 MG Oral Tablet
854908 Bisoprolol Fumarate 10 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854916 Bisoprolol Fumarate 2.5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
854919 Bisoprolol Fumarate 5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet
860510 24 HR carvedilol phosphate 10 MG Extended Release Oral Capsule
860516 24 HR carvedilol phosphate 20 MG Extended Release Oral Capsule
860522 24 HR carvedilol phosphate 40 MG Extended Release Oral Capsule
860532 24 HR carvedilol phosphate 80 MG Extended Release Oral Capsule
866412 24 HR metoprolol succinate 100 MG Extended Release Oral Tablet
866419 24 HR metoprolol succinate 200 MG Extended Release Oral Tablet
866427 24 HR metoprolol succinate 25 MG Extended Release Oral Tablet
866436 24 HR metoprolol succinate 50 MG Extended Release Oral Tablet
866452 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 100 MG Extended Release Oral Tablet
866461 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 25 MG Extended Release Oral Tablet
866472 24 HR Hydrochlorothiazide 12.5 MG / metoprolol succinate 50 MG Extended Release Oral Tablet

*ADDITIONAL INFORMATION:

  • The Ejection Fraction result LOINC code can be linked to a numeric template 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 ChartMaker Clinical. If a patient encounter was not entered into Clinical, that encounter is not included in the denominator for the statistical calculations in the MIPS Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.