Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram

Last updated: May 3, 2018

CMS Measure ID: CMS109v4
Version: 4
NQF Number: None
Measure Description:

This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol.

Initial Patient Population:

Patients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE)

Denominator Statement:

Patients with VTE confirmed through a diagnostic test and receiving IV UFH therapy

Denominator Exclusions:
  • Patients with comfort measures documented
  • Patients discharged to an acute care facility
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
Numerator Statement:

Patients who have their IV UFH therapy dosages and platelet counts monitored according to defined parameters such as a nomogram or protocol.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:


Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: VTE4
Next Version:
Previous Version:
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate


CMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure.

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

Treatment adjustment by protocol and/or use of a clinical pathway must be specific to unfractionated heparin therapy. Heparin protocols and clinical pathways may include use of a nomogram.

The construct of Unfractionated Heparin (route: 'Intravenous route') intends to capture continually infused heparin rather than heparin flushes or pushes.


Release Notes


  • Added guidance statement from CMS regarding the capture of the VTE confirmed concept and its impact on the use of the measure.
  • Copyright updated.
  • eMeasure version number incremented.
  • Updated Initial Population header statement to align with logic.
  • Updated rationale and references in measure header.
  • Updated the Numerator header statement to better align with measure logic.


  • Added intravenous administration route attribute to instances of 'Medication, Order: Unfractionated Heparin' in the Numerator logic to ensure consistency in references to Unfractionated Heparin.
  • Added logic to Numerator to allow for UFH therapy during the ED visit.
  • Changed data type of 'Result' or 'Finding' to 'Performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the 'Intersection of' operator to specify the selection of the data sets common to all individual statements underneath the 'Intersection of'.
  • Introduced variables $EncounterInpatient, $DiagnosisVTE, and $InterventionComfortMeasures to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed extraneous AND from the Initial Population.
  • Removed occurrencing and added timing constraint to 'Encounter, Performed: Emergency Department Visit' when this QDM element is used on the right-hand side of a temporal operation, to enforce a constraint that wasn't necessarily achieved through occurrencing alone.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced timing relationship 'during' with 'starts during' where both a start datetime and an end datetime associated with a particular QDM element are not critical to fulfill the measure intent.
  • Replaced timing relationship 'ends before start of' with 'ends before or concurrent with start of' in logic criteria relating 'Encounter, Performed: Emergency Department Visit' and $EncounterInpatient, allowing for the Emergency Department Visit discharge to occur in the same minute as the inpatient admission.
  • Replaced timing relationship 'starts after start' with 'starts after or concurrent with' in Numerator logic relating heparin monitoring protocols with heparin order. This change allows for documentation of monitoring protocols within the heparin order.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Discharge to Acute Care Facility (OID 2.16.840.1.113883. Deleted 1 SNOMED code (306699001) and added 2 SNOMED codes (306703003, 434781000124105). Updated value set name from Discharge to Another Hospital to Discharge to Acute Care Facility.
  • Value set Obstetrics VTE (OID 2.16.840.1.113883. Added 8 ICD10CM codes (O03.35, O07.35, O22.8X1, O22.8X2, O22.8X3, O22.8X9, O87.0, O87.3) and 1 SNOMED code (609497003).
  • Value set Unfractionated Heparin (OID 2.16.840.1.113883. Added 2 RXNORM codes (1361226, 1362831).
  • Value set Venous Thromboembolism (OID 2.16.840.1.113883. Deleted 5 ICD10CM codes (I80.231, I80.232, I80.233, I80.239, I82.210) and 12 SNOMED codes. Added 4 SNOMED codes (1001000119102, 132251000119101, 132251000119106, 132251000119107).
  • Value set VTE Confirmed (OID 2.16.840.1.113883. Deleted 37 SNOMED codes; added 5 SNOMED codes (1001000119102, 132251000119101, 132251000119106, 132301000119107, 57834008).

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