2026 #392 MIPS Measure Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation

2026 COLLECTION TYPE:

MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) CLINICAL QUALITY MEASURE (CQM)

‌MEASURE TYPE:

Outcome – High Priority

• INVERSE MEASURE: LOWER SCORE – BETTER

‌DESCRIPTION:

Rate of cardiac tamponade and/or pericardiocentesis following atrial fibrillation ablation. This measure is submitted as four rates stratified by age and gender:

• • Submission Age Criteria 1: Females 18-64 years of age
  • Submission Age Criteria 2: Males 18-64 years of age
  • Submission Age Criteria 3: Females 65 years of age and older
  • ‌Submission Age Criteria 4: Males 65 years of age and older

INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted a minimum of once per performance period for denominator eligible cases as defined in the denominator criteria.

‌Intent and Clinician Applicability:

This measure is intended to reflect the quality of services provided for patients who underwent atrial fibrillation ablation. 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.

‌Measure Strata and Performance Rates:

This measure contains four strata defined by four submission criteria. This measure produces five performance rates.

There are four Submission Criteria for this measures:

1. Females 18-64 years of age

AND

1. Males 18-64 years of age

AND

1. Females 65 years of age and older

AND

1. Males 65 years of age and older

This measure will be calculated with 5 performance rates:

1. Females 18-64 years of age
2. Males 18-64 years of age
3. Females 65 years of age and older
4. Males 65 years of age and older
5. Overall percentage of patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days

MIPS eligible clinicians should continue to submit the measure as specified, with no additional steps needed to account for multiple performance rates. For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 5 is used for performance.

‌Implementation Considerations:

For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code (QDC) will be used if the measure is submitted more than once.

This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Include only patients that have had atrial fibrillation ablation performed by November 30, 2026 for evaluation of cardiac tamponade and/or pericardiocentesis occurring within 30 days within the performance period. This will allow the evaluation of cardiac tamponade and/or pericardiocentesis complications within the performance period. A minimum of 30 cases is recommended by the measure owner to ensure a volume of data that accurately reflects provider performance; however, this minimum number is not required for purposes of QPP submission.

Telehealth:

NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting. This measure is procedure based and therefore doesn’t allow for the denominator criteria to be conducted via telehealth. It would be appropriate to remove these patients from the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

‌Measure Submission:

The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic. When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

‌DENOMINATOR:

All patients aged 18 years and older with atrial fibrillation ablation performed during the reporting period.

‌Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Females 18-64 years old

OR 

SUBMISSION CRITERIA 2: Males 18-64 years old

OR

SUBMISSION CRITERIA 3: Females 65 years of age and older

OR 

SUBMISSION CRITERIA 4: Males 65 years of age and older

AND

Diagnosis code for atrial fibrillation during the reporting period (ICD-10-CM): I48.0, I48.11, I48.19, I48.20, I48.21, I48.91

AND

Procedure code for atrial fibrillation ablation during the reporting period (ICD-10-PCS): 02583ZZ, 02584ZZ

AND/OR

Ablation procedures that have been performed by November 30 of current performance period (CPT): 93656

‌NUMERATOR:

The number of patients from the denominator with cardiac tamponade and/or pericardiocentesis occurring within 30 days following atrial fibrillation ablation.

Numerator Instructions:

INVERSE MEASURE – see Implementation Considerations

‌Numerator Options:‌

Performance Not Met: Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days (G9409)

‌OR

Performance Met: Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days (G9408)

RATIONALE:

Cardiac tamponade is one of the most serious complications of atrial fibrillation ablation that can lead to substantial morbidity due to a significant drop in the cardiac output and blood pressure leading to hypo-perfusion of important organs such as the brain, heart, and kidneys. In many cases, cardiac tamponade has to be treated surgically, and it invariably prolongs hospital stay. If not treated promptly, cardiac tamponade can lead to death. The risk of this dreaded complication has been reported to range from 2 to 6%; however, these rates were observed in tertiary referral centers where the procedure was performed by experienced and skillful operators. Given that the occurrence of cardiac tamponade is largely dependent on the operator’s level of experience and, therefore, is in most cases preventable, higher rates are expected to occur when less experienced operators perform the procedure. These issues prove the need to measure performance in this area.