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Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

Compare Versions of: "Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)"

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Measure Information 2023 Reporting Period 2024 Reporting Period
Title Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
CMS eCQM ID CMS996v3 CMS996v4
Short Name OP-40 (STEMI)

OP-40 (STEMI)

NQF Number 3613e 3613e
Description

Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival

Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival

Initial Population

All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period

All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period

Denominator

Equals Initial Population

Equals Initial Population

Denominator Exclusions Patients with the following conditions are excluded from measure denominator:• Expired in the ED• Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseWithin 90 days before start of ED encounter:• Ischemic stroke• Significant facial and/or closed head trauma• Peptic ulcer• Intracranial or intraspinal surgeryWithin 21 days before end of ED encounter:• Major surgeryWithin 24 hours before start of ED encounter and during ED encounter:• Suspected aortic dissection• Severe neurologic impairment• Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device• Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation• Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPRAt the start of ED encounter:• Bleeding or bleeding diathesis (excluding menses)• Known malignant intracranial neoplasm (primary or metastatic)• Known structural cerebral vascular lesion (e.g., AVM)• Advanced dementia• Pregnancy• Active oral anticoagulant therapy Patients with the following conditions are excluded from measure denominator:During ED encounter:- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseAt the start of ED encounter:- Bleeding or bleeding diathesis (excluding menses)- Known malignant intracranial neoplasm (primary or metastatic)- Known structural cerebral vascular lesion (e.g., arteriovenous malformation)- Advanced dementia- Pregnancy- Active oral anticoagulant therapyWithin 24 hours before start of ED encounter or during ED encounter:- Aortic dissection or ruptured aortic aneurysm- Severe neurologic impairment- Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device- Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation- Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPRWithin 21 days before start of or starts during ED encounter:- Major surgeryWithin 90 days before start of or at start of ED encounter:- Ischemic stroke- Significant facial and/or closed head trauma- Peptic ulcerWithin 90 days before start of ED encounter:- Intracranial or intraspinal surgeryExpired in the ED
Numerator

Emergency department encounters with a diagnosis of STEMI:

- where time from ED arrival to fibrinolysis is 30 minutes or fewer;

OR

- where PCI is performed within 90 minutes of arrival for non-transfer patients;

OR

- where the patient is transferred within 45 minutes of ED arrival.

Emergency department encounters with a diagnosis of STEMI:

- where time from ED arrival to fibrinolysis is 30 minutes or fewer;

OR

- where PCI is performed within 90 minutes of arrival for non-transfer patients;

OR

- where the patient is transferred within 45 minutes of ED arrival

Numerator Exclusions

Not Applicable

Not Applicable

Denominator Exceptions

None

None

Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure Proportion measure
Measure Type Process measure Process measure
Improvement Notation

Improvement noted as an increase in the rate

Improvement noted as an increase in the rate

Guidance

This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.

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

This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.

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

Telehealth Eligible No No
Next Version No Version Available
Previous Version No Version Available
Notes

There are known issues on CMS996v3. See issues EKI-24 and EKI-26 on the ONC eCQM Known Issues Dashboard for details.

There are known issues on CMS996v4. See issues EKI-25 and EKI-26 on the ONC eCQM Known Issues Dashboard for details.

Header

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

    Measure Section: Description

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated description of Initial Population timing to align with measure logic and intent.

    Measure Section: Initial Population

    Source of Change: Test Case Review

  • Updated the Initial Population language to indicate the Emergency Department visits that end during the measurement period are captured in this measure.

    Measure Section: Initial Population

    Source of Change: ONC Project Tracking System (JIRA): CQM-5380

  • Updated timing of major surgical procedure denominator exclusion to '21 days or less before start of ED Encounter' to align with other definitions.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated Denominator Exclusion to clarify aortic dissection or ruptured aortic aneurysm satisfies the exclusion criteria to align with measure intent; suspected aortic dissection is not a valid denominator exclusion.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated Denominator Exclusion to clarify the diagnosis of ischemic stroke, significant facial and/or closed head trauma, and peptic ulcer may start within 90 days before the start of the ED encounter or at the start of the ED encounter to better align with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5803

  • Added timing to denominator exclusion to align with measure logic to add 'during ED encounter' for allergic reaction to Thrombolytics.

    Measure Section: Denominator Exclusions

    Source of Change: Test Case Review

  • Revised the order of denominator exclusions in the measure header and logic for readability and listed the exclusions in the header from earliest to latest.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Updated timing of the 'Emergency Department Evaluation and Management Visti' to require the end of the ED visit occur during the measurement period.

    Measure Section: Denominator

    Source of Change: ONC Project Tracking System (JIRA): CQM-5380

  • Updated Denominator Exclusion to clarify the diagnosis of ischemic stroke, significant facial and/or closed head trauma, and peptic ulcer may start within 90 days before the start of the ED encounter or at the start of the ED encounter to better align with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5803

  • Updated logic to exclude patients who have taken oral anticoagulants before the start of ED encounter.

    Measure Section: Denominator Exclusions

    Source of Change: Test Case Review

  • Updated timing of major surgical procedure denominator exclusion to '21 days or less before start of ED Encounter' to align with other definitions.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

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

    Measure Section: Definitions

    Source of Change: Standards/Technical Update

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 (2.16.840.1.113883.3.3157.4036): Renamed to Active Bleeding Excluding Menses or Bleeding Diathesis based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Active Bleeding Excluding Menses or Bleeding Diathesis (2.16.840.1.113883.3.3157.4036): Added 4 ICD-10-CM codes (D68.311, D68.312, S06.347A, S06.348A) based on review by technical experts, SMEs, and/or public feedback. Added 8 ICD-10-CM codes (S06.34AA, S06.35AA, S06.36AA, S06.37AA, S06.38AA, S06.4XAA, S06.5XAA, S06.6XAA) based on terminology update.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Acute Peptic Ulcer (2.16.840.1.113883.3.3157.4031): Deleted 1 ICD-10-CM code (K27.9) based on review by technical experts, SMEs, and/or public feedback. Deleted 16 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.3157.4031): Renamed to Acute Peptic Ulcer based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Oral Anticoagulant Medications (2.16.840.1.113883.3.3157.4045): Added 2 RxNorm codes (1992427, 2059015) based on review by technical experts, SMEs, and/or public feedback. Added 7 RxNorm codes (2588062, 2590616, 2590620, 2590623, 2590627, 2590631, 2590635) based on terminology update. Deleted 83 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Aortic Dissection or Ruptured Aortic Aneurysm (2.16.840.1.113883.3.3157.4028): Added 7 ICD-10-CM codes (I71.10, I71.11, I71.12, I71.13, I71.50, I71.51, I71.52) based on terminology update. Deleted 2 ICD-10-CM codes (I71.1, I71.5) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113883.3.3157.4028): Renamed to Aortic Dissection or Ruptured Aortic Aneurysm based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Cardiopulmonary Arrest (2.16.840.1.113883.3.3157.4048): Added 3 ICD-10-CM codes (I47.20, I47.21, I47.29) based on terminology update. Deleted 1 ICD-10-CM code (I47.2) based on terminology update. Deleted 1 SNOMED CT code (429046004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Cerebral Vascular Lesion (2.16.840.1.113883.3.3157.4025): Added 151 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Added 265 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (230718007, 24551003, 733927008) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Dementia and Related Intracranial Pathologies (2.16.840.1.113883.3.3157.4043): Added 69 ICD-10-CM codes based on terminology update. Deleted 1 SNOMED CT code (230283005) based on terminology update. Deleted 1 SNOMED CT code (161465002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.3157.4043): Renamed to Dementia and Related Intracranial Pathologies based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1010): Renamed to Emergency Department Evaluation and Management Visit based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Fibrinolytic Therapy (2.16.840.1.113883.3.3157.4019): Deleted 54 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.3157.4052): Renamed to Insertion or Replacement of Mechanical Circulatory Assist Device based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Insertion or Replacement of Mechanical Circulatory Assist Device (2.16.840.1.113883.3.3157.4052): Added 5 CPT codes (33981, 33993, 33982, 33983, 33995) based on review by technical experts, SMEs, and/or public feedback. Deleted 4 CPT codes (0451T, 0452T, 0453T, 0454T) based on terminology update. Deleted 2 CPT codes (1006349, 1029971) based on review by technical experts, SMEs, and/or public feedback. Deleted 14 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Intracranial or Intraspinal surgery (2.16.840.1.113762.1.4.1170.2): Added 1 SNOMED CT code (1201979001) based on terminology update. Deleted 3 SNOMED CT codes (171446006, 244238001, 82443007) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Major Surgical Procedure (2.16.840.1.113883.3.3157.4056): Added 79 SNOMED CT codes based on terminology update. Deleted 5579 SNOMED CT codes based on terminology update. Deleted 18 ICD-10-PCS codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Malignant Intracranial Neoplasm Group (2.16.840.1.113762.1.4.1170.3): Deleted 39 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (189162003) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.3157.4045): Renamed to Oral Anticoagulant Medications based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113762.1.4.1170.6): Renamed to Thrombolytics Adverse Event based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Thrombolytics Adverse Event (2.16.840.1.113762.1.4.1170.6): Added 1 SNOMED CT code (218568007) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024