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Intensive Care Unit Venous Thromboembolism Prophylaxis

Compare Versions of: "Intensive Care Unit Venous Thromboembolism Prophylaxis"

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Table Options
Measure Information 2022 Reporting Period 2023 Reporting Period 2024 Reporting Period 2025 Reporting Period
Title Intensive Care Unit Venous Thromboembolism Prophylaxis Intensive Care Unit Venous Thromboembolism Prophylaxis Intensive Care Unit Venous Thromboembolism Prophylaxis Intensive Care Unit Venous Thromboembolism Prophylaxis
CMS eCQM ID CMS190v10 CMS190v11 CMS190v12 CMS190v13
Short Name

VTE-2

VTE-2

VTE-2

VTE-2

CBE ID* Not Applicable Not Applicable Not Applicable Not Applicable
Measure Steward The Joint Commission The Joint Commission The Joint Commission The Joint Commission
Description

This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process Process Process Process
Stratification *See CMS190v10.html *See CMS190v11.html

None

None

Risk Adjustment *See CMS190v10.html *See CMS190v11.html

None

None

Rationale *See CMS190v10.html *See CMS190v11.html

Venous Thromboembolism (VTE) is a known complication of hospitalization, frequently extending the length of stay and increasing hospital mortality (Maynard, 2016). Approximately 20% of VTE are associated with a surgical procedure (Henke et al., 2020).

Almost all hospitalized patients have at least one risk factor for VTE, and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep-vein thrombosis (DVT) is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008).

Commonly, criteria for admission to the Intensive Care Unit (ICU) itself puts patients at an increased risk for developing VTE and subsequent increased risk of morbidity from pulmonary embolism (PE). Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis. Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008). It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts et al., 2004).

American Society of Hematology (ASH) 2018 VTE prophylaxis guidelines strongly recommend pharmacological prophylaxis using unfractionated heparin (UFH), low molecular weight heparin (LMWH) or fondaparinux for acutely and critically ill hospitalized medical patients, unless contraindicated. The use of mechanical prophylaxis is an acceptable alternative for patients with increased risk of bleeding and preferred over no prophylaxis. ASH 2019 guidelines for surgical patients similarly recommend pharmacological or mechanical prophylaxis over no VTE prophylaxis.

Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.

Venous Thromboembolism (VTE) is a known complication of hospitalization, frequently extending the length of stay and increasing hospital mortality (Maynard, 2016). Approximately 20% of VTE are associated with a surgical procedure (Henke et al., 2020).

Almost all hospitalized patients have at least one risk factor for VTE, and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep-vein thrombosis (DVT) is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008).

Commonly, criteria for admission to the Intensive Care Unit (ICU) itself puts patients at an increased risk for developing VTE and subsequent increased risk of morbidity from pulmonary embolism (PE). Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis. Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008). It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts et al., 2004).

American Society of Hematology (ASH) 2018 VTE prophylaxis guidelines strongly recommend pharmacological prophylaxis using unfractionated heparin (UFH), low molecular weight heparin (LMWH) or fondaparinux for acutely and critically ill hospitalized medical patients, unless contraindicated. The use of mechanical prophylaxis is an acceptable alternative for patients with increased risk of bleeding and preferred over no prophylaxis. ASH 2019 guidelines for surgical patients similarly recommend pharmacological or mechanical prophylaxis over no VTE prophylaxis.

Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.

Clinical Recommendation Statement *See CMS190v10.html *See CMS190v11.html

Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary embolism. Screening all patients is the only evidence based practice in reducing incidence of disease. All intensive care unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.

Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary embolism. Screening all patients is the only evidence-based practice in reducing incidence of disease. All intensive care unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.

Improvement Notation

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Definition *See CMS190v10.html *See CMS190v11.html

None

None

Guidance

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project (2022). An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project (CDC, 2022). An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Initial Population

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics that ends during the measurement period

Denominator

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Denominator Exclusions

* Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

* Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission

* Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

* Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

* Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission

- Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

- Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after ICU admission or transfer

- Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

- Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after ICU admission or transfer

Numerator

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date for surgeries that end the day of or the day after ICU admission (or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission (or transfer)

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Denominator Exceptions

Inpatient hospitalizations for patients with ICU LOS less than one day

Inpatient hospitalizations for patients with ICU LOS less than one day

Inpatient hospitalizations for patients with ICU LOS less than one day

Inpatient hospitalizations for patients with ICU LOS less than one day

Next Version No Version Available
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Header

  • Updated the eCQM version number.

    Measure Section:

    eCQM Version Number

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    Annual Update

  • Changed all references from NQF to CBE to identify the consensus-based entity role.

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  • Updated copyright.

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  • Updated grammar, wording, and/or formatting to improve readability and consistency.

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  • Updated references and measure header to reflect current evidence and new or updated literature.

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Logic

  • Removed the time function, 'TJC.TruncateTime,' from the TJCOverall Library and updated the calendar day function 'TJC.CalendarDayOfOrDayAfter' to align with the measure intent.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Updated the timing precision function 'VTE.FromDayOfStartOfHospitalizationToDayAfterFirstICU' in the VTE Library to reflect removal of the time function 'TJC.TruncateTime' and align with the measure intent.

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    Denominator Exclusions

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  • Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.

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    Definitions

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    Standards/Technical Update

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

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  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Definitions

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    Annual Update

  • Updated the version number of the TJCOverall Library to v8.0.000 and the library name from 'TJCOverall' to 'TJCOverallQDM.'

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    Definitions

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  • Updated the version number of the VTE Library to v8.0.000 and the library name from 'VTE' to 'VTEQDM.'

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    Definitions

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    Annual Update

  • Updated the version number of the VTE Library to v8.0.000 and the library name from 'VTE' to 'VTEQDM.'

    Measure Section:

    Functions

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    Annual Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Functions

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    Annual Update

  • Updated the version number of the TJCOverall Library to v8.0.000 and the library name from 'TJCOverall' to 'TJCOverallQDM.'

    Measure Section:

    Functions

    Source of Change:

    Annual Update

  • Removed the time function, 'TJC.TruncateTime,' from the TJCOverall Library and updated the calendar day function 'TJC.CalendarDayOfOrDayAfter' to align with the measure intent.

    Measure Section:

    Functions

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    Measure Lead

  • Updated the timing precision function 'VTE.FromDayOfStartOfHospitalizationToDayAfterFirstICU' in the VTE Library to reflect removal of the time function 'TJC.TruncateTime' and align with the measure intent.

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    Functions

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Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Removed ICD-9 extensional value sets from select grouping value sets, leaving codes from active terminologies (ICD-10 and SNOMED), to reduce implementer burden.

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    Standards/Technical Update

  • Value set Atrial Fibrillation or Flutter (2.16.840.1.113883.3.117.1.7.1.202): Added 6 SNOMED CT codes (1010405004, 280797561000119107, 313377641000119105, 467643831000119105, 489609371000119104, 762247006) based on terminology update. Deleted 2 ICD-9-CM codes (427.31, 427.32) based on applicability of value set and/or OID.

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  • Value set Direct Thrombin Inhibitor (2.16.840.1.113883.3.117.1.7.1.205): Deleted 1 RxNorm code (1804738) based on terminology update.

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  • Value set General Surgery (2.16.840.1.113883.3.117.1.7.1.255): Deleted 1 SNOMED CT code (199001009) based on terminology update.

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  • Value set Graduated compression stockings (2.16.840.1.113883.3.117.1.7.1.256): Added 10 SNOMED CT codes (1142009002, 1142010007, 1142011006, 1142012004, 1142014003, 1142015002, 1142016001, 1142017005, 1142018000, 1142019008) based on terminology update.

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  • Value set Gynecological Surgery (2.16.840.1.113883.3.117.1.7.1.257): Added 1 SNOMED CT code (43426004) based on terminology update. Deleted 1 SNOMED CT code (66169000) based on terminology update.

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  • Value set Hip Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.259): Added 15 SNOMED CT codes based on terminology update. Added 10 ICD-10-PCS codes (0SP908Z, 0SP90EZ, 0SPB08Z, 0SPB0EZ, 0SP907Z, 0SP90KZ, 0SPB07Z, 0SPB0KZ, 0SW908Z, 0SWB08Z) based on terminology update.

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    Terminology

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  • Value set Knee Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.261): Added 18 SNOMED CT codes based on terminology update.

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    Annual Update

  • Value set Low Dose Unfractionated Heparin for VTE Prophylaxis (2.16.840.1.113762.1.4.1045.39): Deleted 2 RxNorm codes (1361568, 1361577) based on terminology update.

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    Terminology

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    Annual Update

  • Value set Low Risk (2.16.840.1.113883.3.117.1.7.1.400): Added 1 SNOMED CT code (723505004) based on terminology update.

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    Terminology

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    Annual Update

  • Value set Obstetrical or Pregnancy Related Conditions (2.16.840.1.113883.3.117.1.7.1.263): Added 112 SNOMED CT codes based on terminology update. Deleted 212 SNOMED CT codes based on terminology update. Added 6 ICD-10-CM codes (O26.641, O26.642, O26.643, O26.649, O90.41, O90.49) based on terminology update. Deleted 1 ICD-10-CM code (O90.4) based on terminology update.

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  • Value set Obstetrics VTE (2.16.840.1.113883.3.117.1.7.1.264): Deleted 2 SNOMED CT codes (200301007, 200232006) based on terminology update.

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  • Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.

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  • Value set Urological Surgery (2.16.840.1.113883.3.117.1.7.1.272): Added 193 ICD-10-PCS codes based on terminology update.

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    Terminology

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    Annual Update

  • Value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279): Deleted 3 SNOMED CT codes (195408002, 58309001, 7387004) based on review by technical experts, SMEs, and/or public feedback.

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    Terminology

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Last Updated: Aug 22, 2024