Intensive Care Unit Venous Thromboembolism Prophylaxis

Last updated: September 15, 2017

CMS Measure ID: CMS190v5
Version: 5
NQF Number: 0372
Measure 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)

Initial Patient Population:

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

Denominator Statement:

Patients directly admitted or transferred to ICU during the hospitalization

Denominator Exclusions:
  • Patients who have a hospital length of stay (LOS) less than 2 days
  • Patients with comfort measures documented anytime between arrival and the day after ICU admission or transfer
  • 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
  • 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
Numerator Statement:

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)

Patients who have documentation of a reason why no VTE prophylaxis was given:

  • between arrival and ICU admission (for patients directly admitted as inpatients to the ICU)
  • 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)
Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients with ICU LOS less than one day

Measure Steward: The Joint Commission
Domain: Patient Safety
Short Name: VTE2
Next Version: Intensive Care Unit Venous Thromboembolism Prophylaxis
Previous Version: Intensive Care Unit Venous Thromboembolism Prophylaxis
Improvement Notation:

Improvement noted as an increase in rate

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.

Addendum Notes: Value Set content updated, Jan 2017 and Sept 2017

Specifications

Release Notes

Header

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Removed guidance related to the intent of the logic related to IV heparin. This guidance is no longer needed due to updates to the content of the unfractionated heparin value set.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Removed unit of measurement language from Guidance. HQMF now has a header field, 'measure item count', where the unit of measurement can be identified in a computable fashion.

    Measure Section: Guidance

    Source of Change: Measure Lead

Logic

  • Added logic to expand allowable timing for VTE and obstetrics diagnoses to the ED visit. This allows patients who are diagnosed with a VTE or obstetrics diagnosed in the ED to be excluded from the initial population.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-581)

  • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

    Measure Section: Initial Population

    Source of Change: QDM Standards

  • Introduced the operator 'Intersection of' to condense logic and reduce complexity.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: Initial Population

    Source of Change: QDM Standards

  • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

    Measure Section: Numerator

    Source of Change: QDM Standards

  • Introduced the operator 'Intersection of' to condense logic and reduce complexity.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: Numerator

    Source of Change: QDM Standards

  • Replaced datatypes 'Diagnosis, Inactive'; 'Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: Numerator

    Source of Change: QDM Standards

  • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

    Measure Section: QDM Data Elements

    Source of Change: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: QDM Data Elements

    Source of Change: QDM Standards

  • Replaced datatypes 'Diagnosis, Inactive'; 'Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: QDM Data Elements

    Source of Change: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Measure Section: QDM Variables

    Source of Change: QDM Standards

Value Set

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

  • Value set General or Neuraxial Anesthesia (2.16.840.1.113883.3.666.5.1743): Added 3 SNOMEDCT codes (50697003, 74527005, 82776005).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set General Surgery (2.16.840.1.113883.3.117.1.7.1.255): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.362) including 214 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Gynecological Surgery (2.16.840.1.113883.3.117.1.7.1.257): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.312) including 21 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hip Fracture Surgery (2.16.840.1.113883.3.117.1.7.1.258): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.324) including 1 code.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hip Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.259): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.320) including 11 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Injectable Factor Xa Inhibitor for VTE Prophylaxis (2.16.840.1.113883.3.117.1.7.1.211): Deleted 2 RXNORM codes (349308, 545076).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Intermittent pneumatic compression devices (IPC) (2.16.840.1.113883.3.117.1.7.1.214): Added 2 SNOMEDCT codes (469317002, 469365001).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Intracranial Neurosurgery (2.16.840.1.113883.3.117.1.7.1.260): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.345) including 13 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Knee Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.261): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.316) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Low Dose Unfractionated Heparin for VTE Prophylaxis (2.16.840.1.113762.1.4.1045.39): Added 4 RXNORM codes (1658634, 1658637, 1659260, 1659263) and deleted 2 RXNORM codes (1361568, 1362837).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Low Molecular Weight Heparin for VTE Prophylaxis (2.16.840.1.113883.3.117.1.7.1.219): Deleted 3 RXNORM codes (854258, 978717, 978761).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Medical Reason (2.16.840.1.113883.3.117.1.7.1.473): Deleted 1 SNOMEDCT code (161590003).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Obstetrics (2.16.840.1.113883.3.117.1.7.1.263): Deleted 5 SNOMEDCT codes (200015003, 200016002, 200026009, 308551004, 405235009). Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.272) including 828 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment (2.16.840.1.113883.3.117.1.7.1.134): Added 3 RXNORM codes (1599543, 1599551, 1599555).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Unfractionated Heparin (2.16.840.1.113883.3.117.1.7.1.218): Added 4 RXNORM codes (1658717, 1658720, 1659195, 1659197) and deleted 9 RXNORM codes (1361048, 1361226, 1361568, 1361574, 1361577, 1361613, 1361615, 1362831, 1362837).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Urological Surgery (2.16.840.1.113883.3.117.1.7.1.272): Removed ICD9CM extensional value set (2.16.840.1.113883.3.117.1.7.1.332) including 31 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hip Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.259): Added 8 ICD10PCS codes (0SPA0JZ, 0SPE0JZ, 0SPR0JZ, 0SPS0JZ, 0SWA0JZ, 0SWE0JZ, 0SWR0JZ, 0SWS0JZ).

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Knee Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.261): Added 18 ICD10PCS codes.

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Obstetrics (2.16.840.1.113883.3.117.1.7.1.263): Added 67 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Glycoprotein IIb/IIIa Inhibitors (2.16.840.1.113762.1.4.1045.41): Added 5 RXNORM codes (1736470, 1736477, 1737466, 1737471, 1813035) and deleted 3 RXNORM codes (200326, 200348, 205253).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set General Surgery (2.16.840.1.113883.3.117.1.7.1.255): Deleted 48 ICD10PCS codes. Deleted 1 SNOMEDCT code (45608007).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Intracranial Neurosurgery (2.16.840.1.113883.3.117.1.7.1.260): Deleted 4 ICD10PCS codes (0N9200Z, 0N920ZZ, 0N9800Z, 0N980ZZ).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Obstetrics VTE (2.16.840.1.113883.3.117.1.7.1.264): Deleted 35 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279): Deleted 14 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93): Added 3 SNOMEDCT codes (183946001, 183956002, 609589008).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set General or Neuraxial Anesthesia (2.16.840.1.113883.3.666.5.1743): Deleted 6 ICD10PCS codes (3E0F7DZ, 3E0F8DZ, 3E0R3CZ, 3E0S3CZ, 3E0T3CZ, 3E0X3CZ).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Direct Thrombin Inhibitor (2.16.840.1.113883.3.117.1.7.1.205): Added 3 RXNORM codes (1804735, 1804737, 1804738) and deleted 1 RXNORM code (1110708).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Obstetrics (2.16.840.1.113883.3.117.1.7.1.263): Added 78 ICD10CM codes and deleted 12 ICD10CM codes. Added 4 SNOMEDCT codes (459166009, 459167000, 713575004, 713576003) and deleted 6 SNOMEDCT codes (199094009, 200074009, 200080001, 237088009, 237246007, 66064007).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

External Resources