2021 HCPR14: Venous Thromboembolism (VTE) Prophylaxis

Measure Description

Percentage of Adult Patients Who Had VTE Prophylaxis Ordered at the Time of Admission OR Have Documentation of Reason for No VTE Prophylaxis

Denominator

• Inpatients ≥ 18 years of age evaluated by the Eligible Professional (E/M Codes 99221- 99223, 99231-99233, 99238-99239, 99291-99292 AND Place of Service Indicator: 21)

PLUS

• LOS ≥ 2 days and ≤ 120 days
• Patients with Comfort Measures Only documented: PRO02
• Patients enrolled in clinical trials are excluded: PRO03

Numerator

Patients who had VTE prophylaxis ordered at the time of admission OR have documentation of reason for no VTE prophylaxis orders

Numerator Options

• Performance Met (either of below qualify):
  • Acceptable VTE Prophylaxis (Note: This is not meant to be an inclusive list of all available anticoagulants; rather it represents current information available at the time of publication):
    • Pharmacologic Prophylaxis: Low dose unfractionated heparin (LDUH), Low molecular weight heparin (LMWH), Warfarin/Coumadin, IV Factor Xa Inhibitor such as Arixtra/Fondaparinux, Oral Factor Xa Inhibitor such as Xarelto/Rivaroxaban (must document why oral factor Xa was used for VTE Prophylaxis [acceptable reasons are: Atrial fibrillation, Atrial flutter, Hip arthoplasty/replacement, Total knee arthoplasty/replacement, or history of treatment for VTE or current VTE treatment])
    • Mechanical Prophylaxis: Intermittent pneumatic compression devices (IPC), Graduated compression stockings (GCS), Venous foot pumps (VFP)
  • Acceptable Reason(s) For No VTE Prophylaxis:
    • There is explicit documentation indicating that the patient is at low risk for VTE (i.e. Patient at low risk for VTE, No VTE Prophylaxis needed) OR
    • There is explicit documentation of a contraindication to both mechanical prophylaxis AND documentation of a contraindication to pharmacological 3 of 35 prophylaxis.
• Performance Not Met: No VTE prophylaxis ordered at the time of admission AND no documentation of reason for no VTE prophylaxis order

Numerator Exclusions

None

NQF ID Number

N/A

NQS Domain

Patient Safety

High Priority Measure

Yes

Includes Telehealth?

Yes

Inverse Measure

No

Proportional Measure

Yes

Continuous Variable Measure

No

Ratio Measure

No

Number of performance rates to be calculated and submitted

1

Risk-Adjusted Status?

No