2023 # 326 Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy

CMS Measure ID: #326

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for patients with nonvalvular AF or atrial flutter seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Description

Percentage of patients aged 18 years and older with atrial fibrillation (AF) or atrial flutter who were prescribed an FDA-approved oral anticoagulant drug for the prevention of thromboembolism during the measurement period.

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: No

Decile 0: 0 – 37.99
Decile 1: 38 – 67.07
Minimum: 67.08 – 74.31
Decile 3: 74.32 – 80.64
Decile 4: 80.65 – 86.1
Decile 5: 86.11 – 96.14
Decile 6: 96.15 – 99.68
Decile 7: 99.69 – 99.99
Decile 10: 100 – 100

Denominator

All patients aged 18 years and older with AF or atrial flutter who do not have a documented CHA₂DS₂-VASc risk score of 0 or 1 for men; or 0, 1, or 2 for women.

Definition:

Comfort Care Only – Refers to medical treatment of a dying person where the natural dying process is permitted to occur while assuring maximum comfort. It includes attention to the psychological and spiritual needs of the patient and support for both the dying patient and the patient’s family. Comfort Measures Only is commonly referred to as “comfort care” by the general public. It may be completed in an inpatient, outpatient or home environment. Comfort Measures Only includes hospice, palliative and supportive treatment for patients who are suffering from a terminal illness—e.g., AIDS, cancer—or who have refused life-sustaining treatment. In order to use G9930, a patient must be on comfort care measures only and not be receiving any other types of care. It is not equivalent to a physician order to withhold emergency resuscitative measures such as Do Not Resuscitate (DNR)

CHA₂DSC₂-VASc Stroke Risk Assessment – The assessment of patients with AF or atrial flutter, assessment of thromboembolic risk should include:

DENOMINATOR NOTE: Denominator Exclusions are determined on the date of the denominator eligible encounter. The intent of the denominator exclusion G9931 is to allow patients with a low risk for a thromboembolic event (i.e. a CHA₂DS₂-VASc score of 0 or 1 for men; or 0, 1, or 2 for women) to be excluded from the sample. This denominator exclusion serves as documentation that a patient’s risk for a thromboembolic event was appropriately assessed using the CHA₂DS₂-VASc scoring tool and that the risk was low enough to not warrant anticoagulation treatment. In order to exclude low risk patients, eligible clinicians must use the CHA₂DS₂-VASc assessment tool to determine a patient’s risk score and must document either the numeric score (i.e. 0 or 1 for men; or 0, 1, or 2 for women) or all the individual risk factors assessed to support an assessment of the CHA₂DS₂-VASc score.

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for atrial fibrillation or atrial flutter (ICD-10-CM): I48.0, I48.3, I48.4, I48.11, I48.19, I48.20, I48.21, I48.91, I48.92

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99315, 99316, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99426

AND NOT

DENOMINATOR EXCLUSIONS:

Patient with transient or reversible cause of AF (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery): G9929

OR

Patients who are receiving comfort care only: G9930

OR

Documentation of CHA₂DS₂-VASc risk score of 0 or 1 for men; or 0, 1, or 2 for women: G9931

OR

Patients with moderate or severe mitral stenosis: G0044

OR

Patients with mechanical prosthetic heart valve: G0043

Numerator

Patients with AF or atrial flutter for whom an FDA-approved oral anticoagulant was prescribed

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Definition:

Prescribed – Also satisfied by documentation in current medication list.

Numerator Options:

Performance Met:

FDA-approved oral anticoagulant is prescribed (G8967)

OR

Denominator Exception:

Documentation of medical reason(s) for not prescribing an FDA-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation) (G8968)

OR

Denominator Exception:

Documentation of patient reason(s) for not prescribing an oral anticoagulant that is FDA approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)  (G8969)

OR

Denominator Exception:

Documentation of system reason(s) for not prescribing an FDA-approved anticoagulation due to patient being currentlyenrolled in a clinical trial related to AF/atrial flutter treatment (G9927)

OR

Performance Not Met:

FDA-approved anticoagulant not prescribed, reason not given (G9928)