2023 # 415 Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older

CMS Measure ID: #415

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: No

High Priority: Yes

NQS Domain: Efficiency and Cost Reduction

Measure Age: > 2 years

Instructions

This measure is to be submitted for each denominator eligible visit for patients aged 18 years and older who present to the emergency department with a minor blunt head trauma during the performance period. It is anticipated that eligible clinicians who provide care in the emergency department will submit this measure.

Measure Submission Type:

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 for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care clinician who have an indication for a head CT

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: No

Decile 0: 0 – 81.69
Decile 1: 81.7 – 93.93
Minimum: 93.94 – 96.3
Decile 3: 96.31 – 97.53
Decile 4: 97.54 – 98.32
Decile 5: 98.33 – 98.93
Decile 6: 98.94 – 99.38
Decile 7: 99.39 – 99.99
Decile 10: 100 – 100

Denominator

All emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider*

DENOMINATOR NOTE: *This measure looks to determine if an emergency care provider ordered head CT services typically provided under CPT code 70450.

Definition:

Minor Blunt Head Trauma – Includes only non-penetrating injuries

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

AND

Diagnosis for minor blunt head trauma (ICD-10-CM): S00.03XA, S00.33XA, S00.431A, S00.432A, S00.439A, S00.531A, S00.532A, S00.83XA, S00.93XA, S06.A0XA, S06.A1XA, S06.0XAA, S06.0X0A, S06.0X1A, S06.0X9A, S06.1XAA, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X9A, S06.2XAA, S06.2X0A, S06.2X1A, S06.2X2A, S06.2X3A, S06.2X4A, S06.2X9A, S06.30AA, S06.300A, S06.301A, S06.302A, S06.303A, S06.304A, S06.309A, S06.31AA, S06.32AA, S06.33AA, S06.34AA, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.349A, S06.35AA, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.359A, S06.36AA, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.369A, S06.37AA, S06.38AA, S06.4XAA, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X9A, S06.5XAA, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X9A, S06.6XAA, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X9A, S06.81AA, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.819A, S06.82AA, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.829A, S06.89AA, S06.890A, S06.891A, S06.892A, S06.893A, S06.894A, S06.899A, S06.9XAA, S06.9X0A, S06.9X1A, S06.9X2A, S06.9X3A, S06.9X4A, S06.9X9A, S09.11XA, S09.19XA, S09.8XXA

AND

Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

AND

Patient presented with a minor blunt head trauma and had a head CT ordered for trauma by an emergency care provider: G9530

AND NOT

DENOMINATOR EXCLUSION:

Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar: G9531

Numerator

Emergency department visits for patients who have an indication for a head CT

Definitions:

Indications for a head CT in patients presenting to the emergency department for minor blunt head trauma:

Patients with no loss of consciousness (LOC) AND no post-traumatic amnesia AND any one of the following:

• GCS score less than 15

• Severe headache

• Vomiting

• Age 65 years and older

• Physical signs of a basilar skull fracture (signs include haemotympanum, “raccoon” eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)

• Focal neurological deficit

• Coagulopathy

• Thrombocytopenia

• Currently taking any of the following anticoagulant medications**: apixaban, argatroban, betrixaban, bivalirudin, dabigatran, dalteparin, desirudin, edoxaban, enoxaparin, fondaparinux, heparin, rivaroxaban, warfarin

• Dangerous mechanism of injury (i.e., ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs)

OR

Patients with either LOC OR posttraumatic amnesia AND any one of the following:

• GCS score less than 15

• Headache

• Age 60 years and older, and less than 65 years

• Drug/alcohol intoxication

• Short-term memory deficits

• Evidence of trauma above the clavicles (physical location, any trauma to the head or neck [i.e., laceration, abrasion, bruising, ecchymosis, hematoma, swelling, fracture])

• Posttraumatic seizure 

**The aforementioned list of medications/drug names is based on clinical guidelines and other evidence and may not be all-inclusive or current. Physicians and other health care professionals should refer to the FDA’s web site page entitled Drug Safety Communications for up-to-date drug recall and alert information when prescribing medications. As part of the measure maintenance process, the measure and specifications will be updated routinely to account for newly released and FDA approved pharmacologic agents.

Numerator Options:

Performance Met:

Patient with minor blunt head trauma had an appropriate indication(s) for a head CT (G9529)

OR

Performance Not Met:

Patient with minor blunt head trauma did not have an appropriate indication(s) for a head CT (G9533)