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WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Measure Description
The percentage of patients age 18 through 75 with one of the following conditions:
1) Two diagnoses related visits with Coronary Artery Disease (CAD) or a CAD risk-equivalent condition, or
2) Acute Coronary Event consisting of an acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous
coronary intervention (PCI) from a hospital visit, who had each of the following during the one year measurement year:





Documentation in the medical record of daily Aspirin or daily other antiplatelet medication usage, unless contraindicated.
Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
Most recent Tobacco Status is Tobacco-Free
Documentation in the medical record of Statin Use
All or None Outcome Measure (Optimal Control) composite of BP <140/90, Tobacco Non-User, Daily Aspirin or Other Antiplatelet
and Statin Use.
Patients are classified uniquely to one of the three condition subgroups in the order of Coronary Artery Disease, Coronary Artery Disease
Risk-Equivalent condition, or Acute Coronary Event.
Disclaimer: Measures reported by WCHQ healthcare organizations represent a specific aspect of care in relation to an evidence-based standard, but are not clinical guidelines
and do not establish standards of care. All providers should have an individual care plan established with their patient.
General Information/Rationale
There has been important evidence from clinical trials that further supports and broadens the merits of risk-reduction therapies for patients with
established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid
artery disease.
The American College of Cardiology (ACC) and the American Heart Association (AHA) recommends that high-intensity statin therapy should be
initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical atherosclerotic
cardiovascular disease, unless contraindicated.
In November 2013, the ACC and AHA Task Force on Practice Guidelines released updated guidance for the treatment of blood cholesterol.
The new recommendations remove treatment targets for LDL-C for the primary or secondary prevention of atherosclerotic cardiovascular
disease (ASCVD) and recommend high or moderate intensity statin therapy based on patient risk factors. Four major statin benefit groups were
identified for whom ASCVD risk clearly outweighs the risk of adverse events. Individuals with ASCVD are one of the identified groups.
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
1
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Based on trials involving other secondary prevention therapies, the ACC and AHA recommends aspirin in all patients, unless contraindicated,
with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and
carotid artery disease. The ACC and AHA also recommend the use of other antiplatelet agents based on disease type and clinical conditions.
Patients with blood pressure greater than or equal to 140/90 mm Hg should be treated, as tolerated, with blood pressure medication, treating
initially with beta blockers and/or ACE inhibitors, with addition of other drugs as needed to achieve goal blood pressure.
The ACC and AHA recommends secondary prevention for patients with Coronary and other Vascular Disease that includes strongly
encouraging patient and family to stop smoking and to avoid secondhand smoke through the provision of counseling, pharmacological therapy
and formal smoking cessation programs as appropriate. The goal is for complete smoking cessation.
References: Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero
ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the
American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;00:000–000.
https://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf
AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular
Disease: 2001 Update http://content.onlinejacc.org/article.aspx?articleid=1127560
http://circ.ahajournals.org/content/early/2011/11/01/CIR.0b013e318235eb4d.full.pdf
Definitions
12 Months: Measurement Period
24 Months: Measurement Period plus Prior Year
Primary Care Office Visit: Office visit in an outpatient, non-urgent care setting
PCP: For WCHQ measure purposes, a primary care provider is defined as any General Practice, Internal Medicine, Family Medicine, Pediatrics
provider with the following degree types (MD, DO, PA, and NP), and any other practitioners identified by the healthcare system as primary care
practitioners. The rationale for the additional practitioner(s) must be documented and must be applied consistently across all preventive care
and chronic care measures by the organization.
Measure Specific Specialists: For this measure, visits to a Cardiologist qualify as an office visit for the denominator population
Age Range 18-75: Patients born between 01/01/1941 and 01/01/1998.
Denominator Description
Patients whose age at the beginning of the one year measurement period is at least 18 and whose age at the end of the measurement period is
less than 76 and are alive as of the last day of the Measurement Period. Expired patients for whom a specific date of expiration cannot be found
are excluded from the denominator population
The rationale for the denominator population is built from the following criteria:
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
2
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
[Question 1] – Is this a patient with the disease or condition?
[Question 2] – Is this patient whose care is managed within the physician group?
[Question 3] – Is this a patient currently managed in our system?
Encounter data
Patients eligible for inclusion in the denominator include:
[Question 1] – Is this a patient with the disease, or condition?
CORONARY ARTERY DISEASE (OR CAD RISK EQUIVALENT) DIAGNOSIS RELATED OUTPATIENT VISITS
Those patients with a total of two or more visits during the last 24 months [Measurement Period + Prior Year] from Table IVD-4
(Office Visit Encounter Codes-Outpatient) with
any provider (MD, DO, PA, NP) within the Physician Group on different dates of service coded (including primary and secondary
diagnoses) with diagnosis codes from Table
IVD-1 (Coronary Artery Disease) or Table IVD-2 (CAD Risk-Equivalent Conditions). The following criteria apply:
Any combination of two or more diagnosis codes from either Table IVD-1 or Table IVD-2, on different dates of service.
OR
ACUTE CORONARY EVENT- RELATED HOSPITAL VISITS
Those patients who had a minimum of one hospital related visit (excluding Emergency and Lab Only visits) for an Acute Coronary
Event from Table IVD-3 during the last 24 Months [Measurement Period + Prior Year].
[Question 2] – Is this a patient whose care is managed within the physician group?
Those patients who have at least two Primary Care Office Visit (Table IVD-4) in an ambulatory setting, regardless of diagnosis code, on
different dates of service, to a PCP or Cardiologist in the past 24 months [Measurement Period + Prior Year]. If Cardiologist is not
considered a PCP, at least one of the two office visits must be to a PCP.
[Question 3] – Is this a patient current in our system?
Those patients who had at least one Primary Care Office Visit (Table IVD-4) in an ambulatory setting, regardless of diagnosis code, with a
PCP or a Cardiologist during the last 12 Months [Measurement Period].
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
3
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
NUMERATOR DESCRIPTIONS
 DAILY ASPIRIN OR OTHER ANTIPLATELET MEDICATIONS THERAPY UNLESS
CONTRAINDICATED
This measure assesses the percentage of patients with documentation within the medical record of
daily Aspirin or daily other antiplatelet agent at any time during the measurement period demonstrated
through any of the following:
1. Documentation of an active prescription for daily Aspirin (see suggested list in Table IVD-6) or
daily or other antiplatelet medications (see acceptable medications in Table IVD-7)
2. Documentation on the patient’s medication list of active daily usage of Aspirin (see suggested
list in Table IVD-6) or daily other antiplatelet medications (see acceptable medications in Table
IVD-7)
3. Contraindication to Aspirin
a. Contraindications will count as numerator compliant. Any valid contraindication date
prior to the end of the measure end date will count as compliant. There is no limit on the
look back date, but the date of documentation or onset date must occur prior to the end
of the measurement period.
b. Accepted contraindications:
i. History of gastrointestinal (GI) bleed (see codes in Table IVD-8)
ii. History of intracranial bleed (ICB) (see codes in Table IVD-8)
iii. History of GI Bleed or ICB from an ICD-9 diagnosis-based problem list or past
medical history. There is no limit on the look back date, but the date of
documentation or onset date must occur prior to the end of the measurement
period.
iv. Anticoagulant Use (see acceptable list of Medications in Table IVD-9). There
must be documentation of an active anticoagulant at any time during the
Measurement Period.
 BLOOD PRESSURE CONTROL
The number of patients in the denominator whose blood pressure (BP) is adequately controlled during
the Measurement Period. Adequate control is a representative systolic Blood Pressure less than 140
mm Hg and a representative diastolic Blood Pressure less than 90 mm Hg.
IDENTIFYING A REPRESENTATIVE BLOOD PRESSURE
Blood Pressure Selection Criteria:
a) Blood Pressure reading must have been obtained during the Measurement Period.
b) Systolic and Diastolic numbers must be from the same BP reading.
c) A controlled BP requires that both the systolic and diastolic readings must be less than140/90.
d) Exclusions: Inpatient Stays, Emergency Room Visits, Urgent Care Visits, and Patient SelfReported BP’s (Home and Health Fair Blood Pressures)
e) Inclusions: Any office visit encounter, including Nurse Only BP Checks, not listed under
Exclusions above.
 Select the Blood Pressure from the most recent visit.
 In the event that multiple Blood Pressures are recorded in the same day of service, select any
reading that is controlled. If none are in control, select an uncontrolled reading.
 If no Blood Pressure is recorded during the Measurement Period, the patient is assumed to be
“not controlled”.
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
4
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
3. TOBACCO FREE
The number of patients in the denominator whose most recent tobacco documentation status with any
provider within the 12 month measurement period is Tobacco Free.
Tobacco Use Definition:
 Cigarette
 Cigar
 Pipe Smoking
 Smokeless Tobacco (Chewing Tobacco, Snuff, etc.)
Tobacco Use Status can be identified by any of the following criteria:
1. Documentation stating that the patient has been asked if they are one of the following during the
Measurement Period with the numerator compliant goal of Tobacco-Free:
1. Tobacco-Free (see examples below):
a. Former tobacco user
b. Never used
c. Non-tobacco user
d. Passive smoker
2. Non Tobacco-Free
a. Current tobacco user
3. No Documentation: The subset of denominator patients who did not have documentation of
tobacco status during the last 12 Months [Measurement Period]
2. ICD-9, CPT, HCPCS and CPT-II Codes indicating tobacco use status during the Measurement
Period) from billing or encounter data only. Do not use the problem list for these codes. (Table
IVD-10)
4. STATIN USE
This measure assesses the percentage of patients with documentation within the medical record of
statin use at any time during the measurement period demonstrated through any of the following:
1. Documentation of an active prescription for a statin (see acceptable medications in Table IVD11)
2. Documentation on the patient’s medication list of active usage of a statin (see acceptable
medications in Table IVD-11)
5. ALL OR NONE OUTCOME MEASURE
IVD All-or-None Measure
The IVD All-or-None Measure is one outcome measure (optimal control). The measure contains three
goals. All three goals within a measure must be reached in order to meet that measure. The numerator
for the all-or-none measure should be collected from the organization’s total IVD denominator.
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
5
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
All-or-None Outcome Measure (Optimal Control) - Using the IVD denominator optimal results
include:
 Most recent blood pressure measurement is less than 140/90 mm Hg
And

Most recent tobacco status is Tobacco Free
NOTE: If there is No Documentation of Tobacco Status the patient is not compliant for
this measure.
And
 Daily Aspirin or Other Antiplatelet Unless Contraindicated
And
 Statin Use
Why use an All-or-None method?
This method was chosen because of the benefits it provides to both the patient and the practitioner.
First, this methodology more closely reflects the interests and likely desires of the patient. With the data
collected in two scores (optimal testing and optimal results), patients can easily look and see how their
provider group is performing on these criteria rather than trying to make sense of multiple scores on
individual measures. Second, this method represents a systems perspective emphasizing the
importance of optimal care through a patient’s entire healthcare experience. Third, this method gives a
more sensitive scale for improvement. For those organizations scoring high marks on individual
measures, the All-or-None measure will give room for benchmarks and additional improvements to be
made.
Nolan T, Berwick DM. All-or-none measurement raises the bar on performance. JAMA. 2006 Mar
8;295(10):1168-70.
Methodology Criteria for All or None Scores:
 Total Population Methodology: Based on entire IVD Denominator
 Random Sample Methodology: Based on Sample Population
 Hybrid Methodology: Based on Administrative Review Denominator and Manual Review
Sample
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
6
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
INTERNALLY DEVELOPED CODES – DATA TRANSLATION/MAPPING REQUIREMENTS
If a medical group utilizes internally generated codes to identify specific services or events required for
a given WCHQ performance measure, the group may translate or map the information to the WCHQ
performance measurement specifications. The medical group must assure that the internally generated
code matches the clinical specificity of the standard (ICD-9, CPT) codes included in the WCHQ
performance measurement specifications.
In order to use internally developed codes for WCHQ performance measure reporting, the medical
group needs to document the translation/mapping to the codes in the specifications. This
documentation should include the internally generated code, a description of the internally developed
code, any additional clinical information for the internally developed code, and the equivalent standard
code with description from the WCHQ performance measurement specifications. Once the translation/
mapping documentation is established, the medical group’s WCHQ performance measurement team
must review the mapping on a yearly basis and document that internally developed codes have not
changed and are being used in the manner described in the translation/ mapping document.
The medical group must have documented processes in place for adding codes to the medical group’s
administrative data system and procedures to implement the internally developed codes.
MEDICAL RECORD REVIEW FOR NUMERATOR INCLUSION/DENOMINATOR EXCLUSION
If appropriate, and/or when necessary, every organization may complement their electronic capture of
patient medical history with electronic or manual record review. The following criteria apply only to data
captured/reviewed during medical record review.
For WCHQ Chronic Condition Measures, proof of Numerator compliance requires:
 Date test was performed.
 Value of lab result
 Documentation of active medication
 Value of Blood Pressure test
Denominator Exclusion
For all WCHQ Measures, proof of Denominator exclusion requires:
 Existence of exclusion criteria.
These data may be retrieved, in whole or in part, from any of the following:
 Notation in Progress Note
 Notation in Medical History or Surgical History
 Flag/Field in Electronic Medical Record
 Documentation in Patient Chart
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
7
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
REQUIRED DATA SUBMISSION FIELDS
Fields required for data submission for this measure depend upon the methodology used. The fields
are as follows:
TOTAL POPULATION METHODOLOGY:
 Population Denominator (N) (CAD or CAD Risk-Equivalent patients 18-75 years of age)
 Numerators
1. Daily Aspirin or daily other Antiplatelet Medication Therapy unless contraindicated documented in the
medical record as active at anytime during the measurement period.
2. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
3. Most recent Tobacco Status
4. Statin Use
5. All or None Optimal Control
Upon entry of these numbers, the rate is automatically calculated
RANDOM SAMPLE METHODOLOGY:
 Population Denominator (N) (CAD or CAD Risk-Equivalent patients 18-75 years of age)
 Population Sample (n) (r) (Patients in Denominator Population whose records will be reviewed)
o
o

(n)=Population Sample and (r)=Patients Reviewed equal the same number
The Population Sample size must be determined using the WCHQ Sample Calculator
http://www.wchq.org/calculator/index.php
Numerators
1. Daily Aspirin or daily other Antiplatelet Medication Therapy unless contraindicated documented in the
medical record as active at any time during the measurement period
2. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
3. Most recent Tobacco Status
4. Statin Use
5. All or None Optimal Control
Upon entry of these numbers, the rate is automatically calculated
HYBRID METHODOLOGY:
 Population Denominator (N) (CAD or CAD Risk-Equivalent patients 18-75 years of age)
 Administrative Review Denominator (Patients in Total Denominator Population whose numerator
information is obtained through administrative data)

Administrative Review Numerators
1. Daily Aspirin or daily other Antiplatelet Medication Therapy unless contraindicated documented in the
medical record as active at any time during the measurement period
2. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
3. Most recent Tobacco Status
4. Statin Use
5. All or None Optimal Control

Manual Review Denominator (Patients in Total Denominator Population whose numerator
information cannot be obtained through administrative data)

Manual Review Sample Size (Patients in Manual Review Denominator Population whose records
will be reviewed)
o The Manual Review Sample size must be determined using the WCHQ Sample Calculator plus a
10% over sample http://www.wchq.org/calculator/index.php
 Manual Review Numerators
1. Daily Aspirin or daily other Antiplatelet Medication Therapy unless contraindicated documented in the
medical record as active at any time during the measurement period
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
8
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
2. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
3. Most recent Tobacco Status
4. Statin Use
5. All or None Optimal Control
Upon entry of these numbers for each numerator, the Rates, Weight Factors and Total Reviewed are
automatically calculated. Total Reviewed equals Administrative Review Denominator + Manual Review Sample
Size.
FIELDS REQUIRED FOR MEASURE VALIDATION
Validation of this measure will require patient level data files for Administrative Data and/or for Manual Review.
The following indicates fields needed for validation, which may be helpful to consider when querying the measure:
Denominator Data File fields:
1. Generic Patient Identifier (can be medical record number or other ID)
2.
3.
4.
5.
6.
Primary Care Office Visit Dates
Inpatient Visit Date (if applicable)
Provider Specialty
Patient Date of Birth
CAD or CAD Risk-Equivalent Diagnosis Codes
Numerator Data File fields:
1. Daily Aspirin or Daily Other Antiplatelet Therapy documented as active in the medical record at any time
during the measurement period with data entry including:
 Generic Patient Identifier (can be medical record number or other ID)
 Aspirin or other Antiplatelet medication drug name
 Drug frequency
 Medication status indicated as active during the measurement period
 Contraindications (if any apply)
2. Blood Pressure Control within the last 12 months
 Patient Identifier
 Blood Pressure Date(s) of Service
 Blood Pressure Result(s)
3. Most Recent Tobacco Status
 Patient Identifier (Can be medical record number or other ID)
 Tobacco Status
 Encounter Date of Service Associated with Tobacco Status
4. Statin Use
 Patient Identifier (Can be medical record number or other ID)
 IVD Diagnosis, if applicable
 Statin Medication name
 Medication status indicated as active during the measurement period
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
9
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Appendix A
Primary Payer
In keeping with the changing atmosphere of quality measurement and reporting, WCHQ would like for
participating organizations to include the primary payer source with their data submissions for the
ambulatory care measures.
The primary payer source should be identified in the denominator upon answering the question, “Is this
patient current in our system?” Once it has been determined that a patient is current because of a visit
to their physician within the specified time period (12 months for chronic care measures and 24 months
for preventive care measures), the payer should be “pulled” into the query. The primary payer should
be the payer at the most recent office visit within the measurement period.
There will be four categories of primary payer that will need to be submitted to WCHQ via the data
submission tool: Medicare FFS, Medicaid (all types), Commercial (including Medicare HMO) and
Uninsured/Self-Pay. The raw numbers for the denominator and numerator should be included for all
three types of data submission, total population, hybrid, and sample.
Rationale
Opportunities exist for WCHQ to collect and report data on specific populations, like the Medicare
population, through grant applications to begin to understand the disparities in quality of care. The
purpose of this is to begin to understand the challenges of putting in additional data elements and
complexities of data display for public reporting. At this time, the primary payer information will not be
publicly reported.
Definitions:
Commercial: All plans not Medicaid or Medicare FFS (Includes VA, DoD, etc.)
FFS Medicare: FFS plans, not Medicare HMO (Medicare Railroad is FFS Medicare)
Medicaid: All Medicaid plans including those managed by commercial plans
Uninsured: Self-pay individuals
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
10
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
APPENDIX B
Code tables with descriptions. Reference also “WCHQ Measure Spec Code List.xls”
Table IVD-1: Diagnosis Codes to Identify Patients with CAD (Coronary Artery Disease)
Description
ICD-9-CM
Diagnosis Codes
410.xx
Acute myocardial infarction - any episode of care
410.00
Acute myocardial infarction of anterolateral wall episode of care unspecified
410.01
Acute myocardial infarction of anterolateral wall initial episode of care
410.02
Acute myocardial infarction of anterolateral wall subsequent episode of care
410.10
Acute myocardial infarction of other anterior wall episode of care unspecified
410.11
Acute myocardial infarction of other anterior wall initial episode of care
410.12
Acute myocardial infarction of other anterior wall subsequent episode of care
410.20
Acute myocardial infarction of inferolateral wall episode of care unspecified
410.21
Acute myocardial infarction of inferolateral wall initial episode of care
410.22
Acute myocardial infarction of inferolateral wall subsequent episode of care
410.30
Acute myocardial infarction of inferoposterior wall episode of care
unspecified
410.31
Acute myocardial infarction of inferoposterior wall initial episode of care
410.32
Acute myocardial infarction of inferoposterior wall subsequent episode of
care
410.40
Acute myocardial infarction of other inferior wall episode of care unspecified
410.41
Acute myocardial infarction of other inferior wall episode of care unspecified
410.42
Acute myocardial infarction of other inferior wall subsequent episode of care
410.50
Acute myocardial infarction of other lateral wall episode of care unspecified
410.51
Acute myocardial infarction of other lateral wall initial episode of care
410.52
Acute myocardial infarction of other lateral wall subsequent episode of care
410.60
True posterior wall infarction episode of care unspecified
410.61
True posterior wall infarction initial episode of care
410.62
True posterior wall infarction subsequent episode of care
410.70
Subendocardial infarction episode of care unspecified
410.71
Subendocardial infarction initial episode of care
410.72
Subendocardial infarction subsequent episode of care
410.80
Acute myocardial infarction of other specified sites episode of care
unspecified
410.81
Acute myocardial infarction of other specified sites initial episode of care
410.82
Acute myocardial infarction of other specified sites subsequent episode of
care
410.90
Acute myocardial infarction of unspecified site episode of care unspecified
410.91
Acute myocardial infarction of unspecified site initial episode of care
410.92
Acute myocardial infarction of unspecified site subsequent episode of care
411.xx
Other acute and subacute forms of ischemic heart disease
411.0
Postmyocardial infarction syndrome
411.1
Intermediate coronary syndrome
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
11
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
411.81
411.89
412
413.x
413.0
413.1
413.9
414.0x
414.00
414.01
414.02
414.03
414.04
414.05
414.06
414.07
414.2
414.3
414.8
414.9
429.2
V45.81
V45.82
Acute coronary occlusion without myocardial infarction
Other acute and subacute forms of ischemic heart disease other
Old myocardial infarction
Angina Pectoris
Angina decubitus
Prinzmetal angina
Other and unspecified angina pectoris
Coronary Atherosclerosis
Coronary atherosclerosis of unspecified type of vessel native or graft
Coronary atherosclerosis of native coronary artery
Coronary atherosclerosis of autologous vein bypass graft
Coronary atherosclerosis of nonautologous biological bypass graft
Coronary atherosclerosis of artery bypass graft
Coronary atherosclerosis of unspecified bypass graft
Coronary atherosclerosis of native coronary artery of transplanted heart
Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
Chronic Total Occlusion of Coronary Artery
Coronary Atherosclerosis due to lipid rich plaque
Other specified forms of chronic ischemic heart disease
Chronic ischemic heart disease unspecified
Cardiovascular disease, unspecified
Postsurgical Aortocoronary Bypass status
Percutaneous transluminal coronary angioplasty (PTCA) status
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
I21.09
I21.19
I21.11
I21.29
I21.4
I21.3
I24.1
I20.0
I24.0
I24.8
I25.2
I20.8
I20.1
I20.9
I25.10
I25.810
Description
ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior
wall
ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior
wall
ST elevation (STEMI) myocardial infarction involving right coronary artery
ST elevation (STEMI) myocardial infarction involving other sites
Non-ST elevation (NSTEMI) myocardial infarction
ST elevation (STEMI) myocardial infarction of unspecified site
Dressler's syndrome
Unstable angina
Acute coronary thrombosis not resulting in myocardial infarction
Other forms of acute ischemic heart disease
Old myocardial infarction
Other forms of angina pectoris
Angina pectoris with documented spasm
Angina pectoris, unspecified
Atherosclerotic heart disease of native coronary artery without angina pectoris
Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
12
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
I25.811
I25.812
I25.82
I25.83
I25.5
I25.89
I25.9
Z95.1
Z98.61
Atherosclerosis of native coronary artery of transplanted heart without angina
pectoris
Atherosclerosis of bypass graft of coronary artery of transplanted heart without
angina pectoris
Chronic total occlusion of coronary artery
Coronary atherosclerosis due to lipid rich plaque
Ischemic cardiomyopathy
Other forms of chronic ischemic heart disease
Chronic ischemic heart disease, unspecified
Presence of aortocoronary bypass graft
Coronary angioplasty status
Table IVD-2: Diagnosis Codes to Identify Patients with CAD Risk Equivalent Conditions1
Description
ICD-9-CM
Codes
433.xx
Occlusion and stenosis of precerebral arteries
433.00
Occlusion and stenosis of basilar artery without cerebral infarction
433.01
Occlusion and stenosis of basilar artery with cerebral infarction
433.10
Occlusion and stenosis of carotid artery without cerebral infarction
433.11
Occlusion and stenosis of carotid artery without cerebral infarction
433.20
Occlusion and stenosis of vertebral artery without cerebral infarction
433.21
Occlusion and stenosis of vertebral artery with cerebral infarction
433.30
Occlusion and stenosis of multiple and bilateral precerebral arteries without
cerebral infarction
433.31
Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral
infarction
433.80
Occlusion and stenosis of other specified precerebral artery without cerebral
infarction
433.81
Occlusion and stenosis of other specified precerebral artery with cerebral infarction
433.90
Occlusion and stenosis of unspecified precerebral artery without cerebral infarction
433.91
Occlusion and stenosis of unspecified precerebral artery with cerebral infarction
434.xx
Occlusion of Cerebral Arteries
434.00
Cerebral thrombosis without cerebral infarction
434.01
Cerebral thrombosis with cerebral infarction
434.10
Cerebral embolism without cerebral infarction
434.11
Cerebral embolism with cerebral infarction
434.90
Cerebral artery occlusion unspecified without cerebral infarction
434.91
Cerebral artery occlusion unspecified with cerebral infarction
440.1
Atherosclerosis of renal artery
440.2x
Atherosclerosis of native arteries of the extremities
440.20
Atherosclerosis of native arteries of the extremities unspecified
440.21
Atherosclerosis of native arteries of the extremities with intermittent claudication
440.22
Atherosclerosis of native arteries of the extremities with rest pain
440.23
Atherosclerosis of native arteries of the extremities with ulceration
440.24
Atherosclerosis of native arteries of the extremities with gangrene
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
13
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
440.29
440.3x
440.30
440.31
440.32
440.4
444.xx
444.0
444.01
444.09
444.1
444.2
444.21
444.22
444.81
444.89
444.9
445.xx
445.01
445.02
445.81
445.89
Other atherosclerosis of native arteries of the extremities
Atherosclerosis of bypass graft of extremities
Atherosclerosis of bypass graft of extremities, unspecified graft
Atherosclerosis of bypass graft of extremities, autologous vein bypass graft
Atherosclerosis of bypass graft of extremities, nonautologous biological bypass
graft
Chronic Total Occlusion of Artery of the Extremities
Arterial embolism and thrombosis
Embolism and thrombosis of abdominal aorta
Saddle embolus of abdominal aorta
Other arterial embolism and thrombosis of abdominal aorta
Embolism and thrombosis of thoracic aorta
Embolism and thrombosis of arteries of the extremities
Arterial embolism and thrombosis of upper extremity
Arterial embolism and thrombosis of lower extremity
Embolism and thrombosis of iliac artery
Embolism and thrombosis of other artery
Embolism and thrombosis of unspecified artery
Atheroembolism
Atheroembolism of upper extremity
Atheroembolism of lower extremity
Atheroembolism of kidney
Atheroembolism of other site
1non-coronary
atherosclerosis
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
I65.1
I63.22
I65.29
I63.139
I63.239
I65.09
I63.019
I63.119
I63.219
I65.8
I63.59
I65.9
I63.20
I66.09
Description
Occlusion and stenosis of basilar artery
Cerebral infarction due to unspecified occlusion or stenosis of basilar arteries
Occlusion and stenosis of unspecified carotid artery
Cerebral infarction due to embolism of unspecified carotid artery
Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid
arteries
Occlusion and stenosis of unspecified vertebral artery
Cerebral infarction due to thrombosis of unspecified vertebral artery
Cerebral infarction due to embolism of unspecified vertebral artery
Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral
arteries
Occlusion and stenosis of other precerebral arteries
Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
Occlusion and stenosis of unspecified precerebral artery
Cerebral infarction due to unspecified occlusion or stenosis of unspecified
precerebral arteries
Occlusion and stenosis of unspecified middle cerebral artery
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
14
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
I66.19
I66.29
I63.30
I66.9
I64.30
I63.50
I70.1
I70.209
I70.219
I70.229
I70.25
I70.269
I70.339
I70.449
I70.559
I70.2
I74.01
I74.09
I74.11
I74.2
I74.3
I74.5
I74.8
I74.9
I75.019
I75.029
I75.81
I75.89
Occlusion and stenosis of unspecified anterior cerebral artery
Occlusion and stenosis of unspecified posterior cerebral artery
Cerebral infarction due to thrombosis of unspecified cerebral artery
Occlusion and stenosis of unspecified cerebral artery
Cerebral infarction due to embolism of unspecified cerebral artery
Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral
artery
Atherosclerosis of renal artery
Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
Atherosclerosis of native arteries of extremities with intermittent claudication,
unspecified extremity
Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
Atherosclerosis of native arteries of other extremities with ulceration
Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
Other atherosclerosis of unspecified type of bypass graft(s) of the extremities,
unspecified extremity
Other atherosclerosis of autologous vein bypass graft(s) of the extremities,
unspecified extremity
Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities,
unspecified extremity
Chronic total occlusion of artery of the extremities
Saddle embolus of abdominal aorta
Other arterial embolism and thrombosis of abdominal aorta
Embolism and thrombosis of thoracic aorta
Embolism and thrombosis of arteries of the upper extremities
Embolism and thrombosis of arteries of the lower extremities
Embolism and thrombosis of iliac artery
Embolism and thrombosis of other arteries
Embolism and thrombosis of unspecified artery
Atheroembolism of unspecified upper extremity
Atheroembolism of unspecified lower extremity
Atheroembolism of kidney
Atheroembolism of other site
Table IVD-3: Codes to Identify Patients with Acute Coronary Event (AMI, PCI, CABG)
AMI – Acute Myocardial Infarction
ICD-9-CM
Diagnosis Codes
410.x1
410.01
410.11
410.21
410.31
410.41
410.51
Description
Acute myocardial infarction - initial episode of care
Acute myocardial infarction of anterolateral wall initial episode of care
Acute myocardial infarction of other anterior wall initial episode of care
Acute myocardial infarction of inferolateral wall initial episode of care
Acute myocardial infarction of inferoposterior wall initial episode of care
Acute myocardial infarction of other inferior wall episode of care unspecified
Acute myocardial infarction of other lateral wall initial episode of care
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
15
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
410.61
410.71
410.81
410.91
True posterior wall infarction initial episode of care
Subendocardial infarction initial episode of care
Acute myocardial infarction of other specified sites initial episode of care
Acute myocardial infarction of unspecified site initial episode of care
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
Description
I21.09
ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior
wall
ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior
wall
ST elevation (STEMI) myocardial infarction involving right coronary artery
ST elevation (STEMI) myocardial infarction involving other sites
Non-ST elevation (NSTEMI) myocardial infarction
ST elevation (STEMI) myocardial infarction of unspecified site
I21.19
I21.11
I21.29
I21.4
I21.3
PCI – Percutaneous Coronary Intervention (including PTCA)
CPT Codes
92980
Description
Transcatheter placement of an intracoronary stent(s), percutaneous, with or without
other therapeutic intervention
Percutaneous transluminal coronary balloon angioplasty, single vessel
Percutaneous transluminal coronary atherectomy, by mechanical or other method,
with or without balloon angioplasty, single vessel
92982
92995
HCPCS Codes
G0290
Description
Trans catheter placement of a drug-eluting intracoronary stent(s), percutaneous, with
our without other therapeutic intervention, any method; single vessel
Description
ICD-9-CM
Procedure Codes
00.66
36.03
36.01
PTCA or Coronary Atherectomy
Open chest coronary artery obstruction and insertion of stents
Single vessel percutaneous transluminal coronary angioplasty (PTCA) or
coronary atherectomy without mention of thrombolytic agent
Single vessel percutaneous transluminal coronary angioplasty (PTCA) or
coronary atherectomy with mention of thrombolytic agent
Multiple vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary
atherectomy performed during the same operation, with or without mention of
thrombolytic agent
Insertion of non-drug-eluting coronary artery stent(s)
Insertion of drug-eluting coronary artery stent(s)
(Deleted 10/01/05)
36.02
(Deleted 10/01/05)
36.05
(Deleted 10/01/05)
36.06
36.07
Effective 10/01/2015
ICD-10-PCS
Procedure Codes
02703ZZ
02704ZZ
Description
Dilation of Coronary Artery, One Site, Percutaneous Approach
Dilation of Coronary Artery, One Site, Percutaneous Endoscopic Approach
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
16
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
02713ZZ
02714ZZ
02723ZZ
02724ZZ
02733ZZ
02733ZZ
02700ZZ
02710ZZ
02720ZZ
02730ZZ
02C00ZZ
02C10ZZ
02C20ZZ
02C30ZZ
Dilation of Coronary Artery, Two Sites, Percutaneous Approach
Dilation of Coronary Artery, Two Sites, Percutaneous Endoscopic Approach
Dilation of Coronary Artery, Three Sites, Percutaneous Approach
Dilation of Coronary Artery, Three Sites, Percutaneous Endoscopic Approach
Dilation of Coronary Artery, Four or More Sites, Percutaneous Approach
Dilation of Coronary Artery, Four or More Sites, Percutaneous Endoscopic
Approach
Dilation of Coronary Artery, One Site, Open Approach
Dilation of Coronary Artery, Two Sites, Open Approach
Dilation of Coronary Artery, Three Sites, Open Approach
Dilation of Coronary Artery, Four or More Sites, Open Approach
Extirpation of Matter from Coronary Artery, One Site, Open Approach
Extirpation of Matter from Coronary Artery, Two Sites, Open Approach
Extirpation of Matter from Coronary Artery, Three Sites, Open Approach
Extirpation of Matter from Coronary Artery, Four or More Sites, Open Approach
CABG – Coronary Artery Bypass Graft
CPT Codes
Description
33510-33516
33510
33511
33512
33513
33514
33516
33517-33523
33517
Coronary artery bypass, vein only, coronary venous graft(s)
Coronary artery bypass, vein only, single coronary venous graft
Coronary artery bypass, vein only, two coronary venous grafts
Coronary artery bypass, vein only, three coronary venous grafts
Coronary artery bypass, vein only, four coronary venous grafts
Coronary artery bypass, vein only, five coronary venous grafts
Coronary artery bypass, vein only, six or more coronary venous grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s)
Coronary artery bypass, using venous graft(s) and arterial graft(s);single vein
graft
Coronary artery bypass, using venous graft(s) and arterial graft(s);two venous
grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s);three
venous grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s);four venous
grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s);five venous
grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s);six or more
venous grafts
Coronary artery bypass, using arterial graft(s)
Coronary artery bypass, using arterial graft(s);single arterial graft
Coronary artery bypass, using arterial graft(s);two arterial grafts
Coronary artery bypass, using arterial graft(s);three arterial grafts
Coronary artery bypass, using arterial graft(s);four or more arterial grafts
33518
33519
33521
33522
33523
33533-33536
33533
33534
33535
33536
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
17
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
HCPCS Codes
Description
S2205-S2209
Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or
mini-sternotomy surgery, performed under direct vision; using single arterial and/or
venous graft(s)
Coronary artery bypass surgery, direct, with coronary artery grafts only, single
Coronary artery bypass surgery, direct, with coronary artery grafts only, two
grafts
Coronary artery bypass surgery, direct, with coronary venous grafts only,
single
Coronary artery bypass surgery, direct, with coronary arterial and venous
grafts, single each
Coronary artery bypass surgery, direct, with coronary arterial and venous
grafts, two arterial and single venous
Description
S2205
S2206
S2207
S2208
S2209
ICD-9-CM
Procedure Codes
36.1x
36.10
36.11
36.12
36.13
36.14
36.15
36.16
36.17
36.19
36.2
Bypass anastomosis for heart revascularization
Aortocoronary bypass for heart revascularization, not otherwise specified
(Aorto)coronary bypass of one coronary artery
(Aorto)coronary bypass of two coronary arteries
(Aorto)coronary bypass of three coronary arteries
(Aorto)coronary bypass of four coronary arteries
Single internal mammary-coronary artery bypass
Double internal mammary-coronary artery bypass
Abdominal-coronary artery bypass
Other bypass anastomosis for heart revascularization
Heart revascularization by arterial implant
Effective 10/01/2015
ICD-10-PCS
Procedure Codes
0210093
02100A3
02100J3
02100K3
02100Z3
0210493
02104A3
02104J3
02104K3
Description
Bypass Coronary Artery, One Site from Coronary
Tissue, Open Approach
Bypass Coronary Artery, One Site from Coronary
Tissue, Open Approach
Bypass Coronary Artery, One Site from Coronary
Substitute, Open Approach
Bypass Coronary Artery, One Site from Coronary
Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Coronary
Bypass Coronary Artery, One Site from Coronary
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
18
Artery with Autologous Venous
Artery with Autologous Arterial
Artery with Synthetic
Artery with Nonautologous
Artery, Open Approach
Artery with Autologous Venous
Artery with Autologous Arterial
Artery with Synthetic
Artery with Nonautologous
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
0210473
021009W
02100AW
02100JW
02100KW
021049W
02104AW
02104JW
02104KW
021109W
02110AW
02110JW
02110KW
021149W
02114AW
02114JW
02114KW
021209W
02120AW
02120JW
02120KW
021249W
02124AW
02124JW
02124KW
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary Artery, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, One Site from Aorta with Autologous Venous Tissue,
Open Approach
Bypass Coronary Artery, One Site from Aorta with Autologous Arterial Tissue,
Open Approach
Bypass Coronary Artery, One Site from Aorta with Synthetic Substitute, Open
Approach
Bypass Coronary Artery, One Site from Aorta with Nonautologous Tissue
Substitute, Open Approach
Bypass Coronary Artery, One Site from Aorta with Autologous Venous Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Aorta with Autologous Arterial Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Aorta with Synthetic Substitute,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Aorta with Nonautologous Tissue
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Aorta with Autologous Venous Tissue,
Open Approach
Bypass Coronary Artery, Two Sites from Aorta with Autologous Arterial Tissue,
Open Approach
Bypass Coronary Artery, Two Sites from Aorta with Synthetic Substitute, Open
Approach
Bypass Coronary Artery, Two Sites from Aorta with Nonautologous Tissue
Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Aorta with Autologous Venous Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Aorta with Autologous Arterial Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Aorta with Synthetic Substitute,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Aorta with Nonautologous Tissue
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Aorta with Autologous Venous Tissue,
Open Approach
Bypass Coronary Artery, Three Sites from Aorta with Autologous Arterial Tissue,
Open Approach
Bypass Coronary Artery, Three Sites from Aorta with Synthetic Substitute, Open
Approach
Bypass Coronary Artery, Three Sites from Aorta with Nonautologous Tissue
Substitute, Open Approach
Bypass Coronary Artery, Three Sites from Aorta with Autologous Venous Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Aorta with Autologous Arterial Tissue,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Aorta with Synthetic Substitute,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Aorta with Nonautologous Tissue
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
19
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
021309W
02130AW
02130JW
02130KW
021349W
02134AW
02134JW
02134KW
0210098
0210099
021009C
02100A8
02100A9
02100AC
02100J8
02100J9
02100JC
02100K8
02100K9
02100KC
02100Z8
02100Z9
02100ZC
0210498
0210499
021049C
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Venous
Tissue, Open Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Arterial
Tissue, Open Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Synthetic Substitute,
Open Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Venous
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Autologous Arterial
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Synthetic Substitute,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Aorta with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous
Venous Tissue, Open Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous
Venous Tissue, Open Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Venous
Tissue, Open Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous
Arterial Tissue, Open Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous
Arterial Tissue, Open Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Arterial
Tissue, Open Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Synthetic Substitute,
Open Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with
Nonautologous Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with
Nonautologous Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Right Internal Mammary, Open Approach
Bypass Coronary Artery, One Site from Left Internal Mammary, Open Approach
Bypass Coronary Artery, One Site from Thoracic Artery, Open Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous
Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous
Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Venous
Tissue, Percutaneous Endoscopic Approach
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
20
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
02104A8
02104A9
02104AC
02104J8
02104J9
02104JC
02104K8
02104K9
02104KC
02104Z8
02104Z9
02104ZC
0211098
0211099
021109C
02110A8
02110A9
02110AC
02110J8
02110J9
02110JC
02110K8
02110K9
02110KC
02110Z8
Bypass Coronary Artery, One Site from Right Internal Mammary with Autologous
Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Autologous
Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Autologous Arterial
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Synthetic Substitute,
Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Right Internal Mammary with
Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Left Internal Mammary with
Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Thoracic Artery with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Right Internal Mammary, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, One Site from Left Internal Mammary, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, One Site from Thoracic Artery, Percutaneous Endoscopic
Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Autologous Venous Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous
Venous Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Venous
Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Autologous Arterial Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous
Arterial Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Arterial
Tissue, Open Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Nonautologous Tissue Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with
Nonautologous Tissue Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary, Open
Approach
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
21
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
02110Z9
02110ZC
0211498
0211499
021149C
02114A8
02114A9
02114AC
02114J8
02114J9
02114JC
02114K8
02114K9
02114KC
02114Z8
02114Z9
02114ZC
021209C
02120AC
02120JC
02120KC
02120ZC
021249C
02124AC
02124JC
02124KC
02124ZC
Bypass Coronary Artery, Two Sites from Left Internal Mammary, Open Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery, Open Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Autologous Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous
Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Venous
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Autologous Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Autologous
Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Autologous Arterial
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary with
Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary with
Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Two Sites from Right Internal Mammary, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, Two Sites from Left Internal Mammary, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, Two Sites from Thoracic Artery, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous
Venous Tissue, Open Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous
Arterial Tissue, Open Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery, Open Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous
Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Autologous
Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Three Sites from Thoracic Artery, Percutaneous
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
22
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
021309C
02130AC
02130JC
02130KC
02130ZC
021349C
02134AC
02134JC
02134KC
02134ZC
021009F
02100AF
02100JF
02100KF
02100ZF
021049F
02104AF
02104JF
02104KF
02104ZF
0210093
02100A3
02100J3
02100K3
02100Z3
0210493
Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous
Venous Tissue, Open Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous
Arterial Tissue, Open Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with
Nonautologous Tissue Substitute, Open Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery, Open Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous
Venous Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Autologous
Arterial Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery with
Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, Four or More Sites from Thoracic Artery, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Venous
Tissue, Open Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Arterial
Tissue, Open Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Abdominal Artery, Open Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Venous
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Autologous Arterial
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Abdominal Artery with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Abdominal Artery, Percutaneous
Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary Artery with Autologous Venous
Tissue, Open Approach
Bypass Coronary Artery, One Site from Coronary Artery with Autologous Arterial
Tissue, Open Approach
Bypass Coronary Artery, One Site from Coronary Artery with Synthetic
Substitute, Open Approach
Bypass Coronary Artery, One Site from Coronary Artery with Nonautologous
Tissue Substitute, Open Approach
Bypass Coronary Artery, One Site from Coronary Artery, Open Approach
Bypass Coronary Artery, One Site from Coronary Artery with Autologous Venous
Tissue, Percutaneous Endoscopic Approach
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
23
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
02104A3
02104J3
02104K3
02104Z3
021K0Z8
021K0Z9
021K0ZC
021K0ZW
021K4Z8
021K4Z9
021KZC
021K4ZW
021L0Z8
021L0Z9
021L0ZC
021L4Z8
021L4Z9
021L4ZC
Bypass Coronary Artery, One Site from Coronary Artery with Autologous Arterial
Tissue, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary Artery with Synthetic
Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary Artery with Nonautologous
Tissue Substitute, Percutaneous Endoscopic Approach
Bypass Coronary Artery, One Site from Coronary Artery, Percutaneous
Endoscopic Approach
Bypass Right Ventricle to Right Internal Mammary, Open Approach
Bypass Right Ventricle to Left Internal Mammary, Open Approach
Bypass Right Ventricle to Thoracic Artery, Open Approach
Bypass Right Ventricle to Aorta, Open Approach
Bypass Right Ventricle to Right Internal Mammary, Percutaneous Endoscopic
Approach
Bypass Right Ventricle to Left Internal Mammary, Percutaneous Endoscopic
Approach
Bypass Right Ventricle to Thoracic Artery, Percutaneous Endoscopic Approach
Bypass Right Ventricle to Aorta, Percutaneous Endoscopic Approach
Bypass Left Ventricle to Right Internal Mammary, Open Approach
Bypass Left Ventricle to Left Internal Mammary, Open Approach
Bypass Left Ventricle to Thoracic Artery, Open Approach
Bypass Left Ventricle to Right Internal Mammary, Percutaneous Endoscopic
Approach
Bypass Left Ventricle to Left Internal Mammary, Percutaneous Endoscopic
Approach
Bypass Left Ventricle to Thoracic Artery, Percutaneous Endoscopic Approach
Table IVD-4: Office Visit Encounter Codes (Outpatient)
CPT-Codes
99201-99205
99212-99215
99241-99245
99347-99350
99384-99387
99394-99397
99401-99404
99411
99412
99420
99429
99488
(Deleted 01/01/15)
99495
99496
Description
Office or OP visit E&M , new patient
Office or OP visit E&M, established patient
Office or other OP consultations
Home visit for evaluation and management of an established patient
Initial preventive medicine E&Mb
Periodic preventive medicine E&Mb
Preventive medicine counseling
Preventive medicine counseling, group
Preventive medicine counseling, group
Risk assessment, admin and interpretation
Unlisted preventive medicine service
Complex chronic care coordination services; first hour of clinical staff time
directed by a physician or other qualified health care professional with one faceto-face visit, per calendar month.
Transitional Care Management Services (Moderate Complexity)
Transitional Care Management Services (High Complexity)
a
b
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
24
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
HCPCS Code
G0344
(effective 01/01/2005)
G0402
(Effective 01/01/09)
G0438
G0439
a
b
Description
Initial preventive physical examination; face-to-face visit services limited to new
beneficiary during the first six months of Medicare enrollments
Initial preventive physical examination; face-to-face visit, services limited to new
beneficiary during the first 12 months of Medicare enrollment
Annual wellness visit; includes a personalized prevention plan of service, initial
visit
Annual wellness visit; includes a personalized prevention plan of service,
subsequent visit
outpatient
evaluation and management
Table IVD-6: Acceptable Aspirin Medications
NOTE: The purpose of this list is to serve as a reference. If an organization finds a product not
on this list that is appropriate for this patient population, it can be included. Non-aspirin and
Aspirin Free medications should not be included.
Products Containing Aspirin
Arthritis BC Powder Packet
Arthritis Pain
ASA
ASA Baby
ASA Baby Chewable
ASA Baby Coated
ASA Bayer
ASA Bayer Children's
ASA Buffered
ASA Children’s
ASA EC
ASA Enteric Coated
Ascriptin
Ascriptin Enteric
Aspergum
Aspir 81 EC
Aspir-Low
Aspirin
Aspirin Antacid
Aspirin Baby
Aspirin Bayer
Aspirin Bayer Children's
Aspirin Buffered
Aspirin Child
Aspirin Child Chewable
Aspirin Children's
Aspirin-dipyridamole
Aspirin EC
Aspirin Enteric Coated
Aspirin Litecoat
Aspirin Lo-Dose
Aspirin Low Strength
Bayer 8-hour
Bayer Aspirin
Bayer Aspirin PM Extra Strength
Bayer Children’s
Bayer EC
Bayer Enteric Coated
Bayer Low Strength
Bayer Plus
Bayer Therapy EC
BL Adult Aspirin
BL Aspirin
Buffered ASA
Buffered Aspirin
Buffered Baby ASA
Bufferin
Bufferin Arthritis Strength
Bufferin Extra Strength
Coated Aspirin
Table IVD-7: Acceptable Other Antiplatelet Medications
Oral Antiplatelet Medications
Aggrenox® (Persantine and ASA)
Pletal® (cilostazol)
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
25
Easprin
EC ASA
Ecotrin
Ecotrin Low Strength Adult
Ecotrin Maximum Strength
Empirin
Enteric Coated Aspirin
Enteric Coated Baby Aspirin
Excedrin – with aspirin
Extra Strength Bayer
Fastprin
Genacote
Gennin
Gennin FC
Genprin
Halfprin
Norwich Aspirin
St. Joseph Aspirin
St. Joseph Aspirin EC
St. Joseph Aspirin Children
Stanback Analgesic
Tri Buffered Aspirin
YSP Aspirin
Zorprin
Zorprin SA
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Plavix® (clopidogrel)
Brilinta® (ticagrelor)
Persantine® (dipyridamole)
Ticlid® (ticlopidine)
Effient® (prasugrel)
Agrylin® (anagrelide)
Table IVD-8: Codes to identify contraindications
ICD-9
Description
Diagnosis
Codes
430
Subarachnoid hemorrhage
431
Intracerebral hemorrahage
432.0
Nontraumatic extradural hemorrhage
432.1
Subdural hemorrhage
432.9
Unspecified intracranial hemorrhage
456.0
Esophageal varices with bleeding
456.20
Esophageal varices in diseases classified elsewhere with bleeding
530.21
Ulcer of esophagus with bleeding
530.4
Perforation of esophagus
530.7
Gastroesophageal laceration-hemorrhage syndrome
530.82
Esophageal hemorrhage
531.00
Acute gastric ulcer with hemorrhage without obstruction
531.01
Acute gastric ulcer with hemorrhage with obstruction
531.10
Acute gastric ulcer with perforation without obstruction
531.11
Acute gastric ulcer with perforation with obstruction
531.20
Acute gastric ulcer with hemorrhage and perforation without obstruction
531.21
Acute gastric ulcer with hemorrhage and perforation with obstruction
532.00
Acute duodenal ulcer with hemorrhage without obstruction
532.01
Acute duodenal ulcer with hemorrhage with obstruction
532.10
Acute duodenal ulcer with perforation without obstruction
532.11
Acute duodenal ulcer with perforation with obstruction
532.20
Acute duodenal ulcer with hemorrhage and perforation without obstruction
532.21
Acute duodenal ulcer with hemorrhage and perforation with obstruction
533.00
Acute peptic ulcer of unspecified site with hemorrhage without obstruction
533.01
Acute peptic ulcer of unspecified site with hemorrhage with obstruction
533.10
Acute peptic ulcer of unspecified site with perforation without obstruction
533.11
Acute peptic ulcer of unspecified site with perforation with obstruction
533.20
Acute peptic ulcer of unspecified site with hemorrhage and perforation without
obstruction
533.21
Acute peptic ulcer of unspecified site with hemorrhage and perforation with obstruction
534.00
Acute gastrojejunal ulcer with hemorrhage without obstruction
534.01
Acute gastrojejunal ulcer with hemorrhage with obstruction
534.10
Acute gastrojejunal ulcer with perforation without obstruction
534.11
Acute gastrojejunal ulcer with perforation with obstruction
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
26
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
534.20
534.21
531.40
531.41
531.50
531.51
531.60
531.61
532.40
532.41
532.50
532.51
532.60
532.61
533.40
533.41
533.50
533.51
533.60
533.61
534.40
534.41
534.50
534.51
534.60
534.61
535.01
535.11
535.41
535.51
535.61
537.83
578.0
569.83
569.3
562.12
562.13
562.02
562.03
569.85
569.86
Acute gastrojejunal ulcer with hemorrhage and perforation without obstruction
Acute gastrojejunal ulcer with hemorrhage and perforation with obstruction
Chronic or unspecified gastric ulcer with hemorrhage without obstruction
Chronic or unspecified gastric ulcer with hemorrhage with obstruction
Chronic or unspecified gastric ulcer with perforation without obstruction
Chronic or unspecified gastric ulcer with perforation with obstruction
Chronic or unspecified gastric ulcer with hemorrhage and perforation without obstruction
Chronic or unspecified gastric ulcer with hemorrhage and perforation with obstruction
Chronic or unspecified duodenal ulcer with hemorrhage without obstruction
Chronic or unspecified duodenal ulcer with hemorrhage with obstruction
Chronic or unspecified duodenal ulcer with perforation without obstruction
Chronic or unspecified duodenal ulcer with perforation with obstruction
Chronic or unspecified duodenal ulcer with hemorrhage and perforation without
obstruction
Chronic or unspecified duodenal ulcer with hemorrhage and perforation with obstruction
Chronic or unspecified peptic ulcer of unspecified site with hemorrhage without
obstruction
Chronic or unspecified peptic ulcer of unspecified site with hemorrhage with obstruction
Chronic or unspecified peptic ulcer of unspecified site with perforation without obstruction
Chronic or unspecified peptic ulcer of unspecified site with perforation with obstruction
Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation
without obstruction
Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation
with obstruction
Chronic or unspecified gastrojejunal ulcer with hemorrhage without obstruction
Chronic or unspecified gastrojejunal ulcer with hemorrhage with obstruction
Chronic or unspecified gastrojejunal ulcer with perforation without obstruction
Chronic or unspecified gastrojejunal ulcer with perforation with obstruction
Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation without
obstruction
Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation with
obstruction
Acute gastritis with hemorrhage
Atrophic gastritis with hemorrhage
Other specified gastritis with hemorrhage
Unspecified gastritis and gastroduodenitis with hemorrhage
Duodenitis with hemorrhage
Angiodysplasia of stomach and duodenum with hemorrhage
Hematemesis
Perforation of intestine
Hemorrhage of rectum and anus
Diverticulosis of colon with hemorrhage
Diverticulitis of colon with hemorrhage
Diverticulosis of small intestine with hemorrhage
Diverticulitis of small intestine with hemorrhage
Angiodysplasia of intestine with hemorrhage
Dieulafoy lesion (hemorrhagic) of intestine
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
27
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
578.1
578.9
Blood in stool (Hematochezia/Melena)
Hemorrhage of gastrointestinal tract unspecified
Effective 10/01/2015
ICD-10 CM
Diagnosis Codes
I60.9
I61.9
I62.1
I62.00
I62.9
I85.01
I85.11
K22.11
K22.3
K22.6
K22.8
K25.0
K25.1
K25.2
K26.0
K26.1
K26.2
K27.0
K27.1
K27.2
K28.0
K28.1
K28.2
K25.4
K25.5
K25.6
K26.4
K26.5
K26.6
K27.4
K27.5
K27.6
K28.4
K28.5
K28.6
K29.01
K29.41
K29.51
K29.61
K29.71
K29.91
Description
Nontraumatic subarachnoid hemorrhage, unspecified
Nontraumatic intracerebral hemorrhage, unspecified
Nontraumatic extradural hemorrhage
Nontraumatic subdural hemorrhage, unspecified
Nontraumatic intracranial hemorrhage, unspecified
Esophageal varices with bleeding
Secondary esophageal varices with bleeding
Ulcer of esophagus with bleeding
Perforation of esophagus
Gastro-esophageal laceration-hemorrhage syndrome
Other specified diseases of esophagus
Acute gastric ulcer with hemorrhage
Acute gastric ulcer with perforation
Acute gastric ulcer with both hemorrhage and perforation
Acute duodenal ulcer with hemorrhage
Acute duodenal ulcer with perforation
Acute duodenal ulcer with both hemorrhage and perforation
Acute peptic ulcer, site unspecified, with hemorrhage
Acute peptic ulcer, site unspecified, with perforation
Acute peptic ulcer, site unspecified, with both hemorrhage and perforation
Acute gastrojejunal ulcer with hemorrhage
Acute gastrojejunal ulcer with perforation
Acute gastrojejunal ulcer with both hemorrhage and perforation
Chronic or unspecified gastric ulcer with hemorrhage
Chronic or unspecified gastric ulcer with perforation
Chronic or unspecified gastric ulcer with both hemorrhage and perforation
Chronic or unspecified duodenal ulcer with hemorrhage
Chronic or unspecified duodenal ulcer with perforation
Chronic or unspecified duodenal ulcer with both hemorrhage and perforation
Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage
Chronic or unspecified peptic ulcer, site unspecified, with perforation
Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and
perforation
Chronic or unspecified gastrojejunal ulcer with hemorrhage
Chronic or unspecified gastrojejunal ulcer with perforation
Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation
Acute gastritis with bleeding
Chronic atrophic gastritis with bleeding
Unspecified chronic gastritis with bleeding
Other gastritis with bleeding
Gastritis, unspecified, with bleeding
Gastroduodenitis, unspecified, with bleeding
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
28
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
K29.81
K31.811
K92.0
K63.1
K62.5
K57.31
K57.33
K57.11
K57.13
K55.21
K63.81
K92.1
K92.2
Duodenitis with bleeding
Angiodysplasia of stomach and duodenum with bleeding
Hematemesis
Perforation of intestine (nontraumatic)
Hemorrhage of anus and rectum
Diverticulosis of large intestine without perforation or abscess with bleeding
Diverticulitis of large intestine without perforation or abscess with bleeding
Diverticulosis of small intestine without perforation or abscess with bleeding
Diverticulitis of small intestine without perforation or abscess with bleeding
Angiodysplasia of colon with hemorrhage
Dieulafoy lesion of intestine
Melena
Gastrointestinal hemorrhage, unspecified
Table IVD-9: Acceptable Anticoagulant Medications
Warfarin (Coumadin, Jantoven)
Rivaroxaban (Xarelto)
Dabigatran (Pradaxa)
Apixaban (Eliquis)
TABLE IVD-10: Codes to Identify Tobacco Use Status
ICD-9 Diagnosis
Description
Codes
305.1
Tobacco Use Disorder
649.0x
Tobacco Use Disorder Complicating Pregnancy
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
F17.200
O99.330
O99.331
O99.332
O99.333
O99.334
O99.335
Description
Nicotine dependence, unspecified, uncomplicated
Smoking (tobacco) complicating pregnancy, unspecified trimester
Smoking (tobacco) complicating pregnancy, first trimester
Smoking (tobacco) complicating pregnancy, second trimester
Smoking (tobacco) complicating pregnancy, third trimester
Smoking (tobacco) complicating childbirth
Smoking (tobacco) complicating the puerperium
CPT Codes
99406
99407
HCPCS Codes
C9801
Added 08/25/2010 and
deleted 12/31/2010.
Description
Smoking and Tobacco Use Cessation counseling visit; intermediate, greater than 3
minutes up to 10 minutes
Smoking and Tobacco Use Cessation counseling visit; intensive, greater than 10
minutes
Description
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intermediate, greater than 3 minutes, up to 10 minutes
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
29
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Replaced with G0436
C9802
Added 08/25/2010 and
deleted 12/31/2010.
Replaced with G0437
D1320
G0436
G0437
G8402
G8403
G8453
G8454
G8455
G8456
G8457
G8686
G8687
G8688
G8690
G8691
G8692
S4995
S9075
S9453
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intensive, greater than 10 minutes
Tobacco Counseling for the Control and Prevention of Oral Disease
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intermediate, greater than 3 minutes, up to 10 minutes
Smoking and Tobacco Cessation counseling visit for the asymptomatic patient;
intensive, greater than 10 minutes
Tobacco (smoke) use cessation intervention, counseling
Tobacco (smoke) use cessation intervention not counseled
Tobacco use cessation intervention, counseling
Tobacco use cessation intervention not counseled, reason not specified
Current Tobacco Smoker
Current Smokeless Tobacco User
Tobacco Non-User
Currently a tobacco smoker or current exposure to secondhand smoke
Currently a tobacco non-user and no exposure to secondhand smoke
Currently a smokeless tobacco user (e.g. chew, snuff) and no exposure to
secondhand smoke
Current tobacco smoker or current exposure to secondhand smoke
Current tobacco nonuser and no exposure to secondhand smoke
Current smokeless tobacco user (e.g. chew, snuff) and no exposure to secondhand
smoke
Smoking Cessation Gum
Smoking Cessation Treatment
Smoking classes, nonphysician provider, per session
CPT Category II
Codes
**1034 F
**1035 F
**4000 F
**4001 F
**4004F
Description
Current Tobacco Smoker
Current Smokeless Tobacco User (eg. chew, snuff)
Tobacco use cessation intervention, counseling
Tobacco use cessation intervention, pharmacological therapy
Patient screened for tobacco use AND received tobacco cessation counseling, if
identified as a tobacco user.
**Codes can be included at the organization’s discretion. If included, the date the
service was performed must be provided. If an 8P modifier is included with the CPT
II code, it does not qualify as numerator compliant.
Table IVD-11: Acceptable Statin Medications
Advicor
Altoprev
Atorvastatin
Atorvastatin/amlodipine
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
30
WCHQ Ambulatory Measure Specification
WCHQ 24 – IVD Care – All or None Outcome
Measurement Period: 01/01/2016 – 12/31/2016
Outcome Measure Type
NQS Domain: Clinical Process/Effectiveness
Atorvastatin/ezetimibe
Caduet
Crestor
Fluvastatin
Fluvastatin XL
Juvisync
Lescol
Lescol XL
Lipitor
Liptruzet
Livalo
Lovastatin
Lovastatin/niacin
Mevacor
Pitavastatin
Pravachol
Pravafenix
Pravastatin
Pravastatin/fenofibrate
Rosuvastatin
Simcor
Simvastatin
Simvastatin/ezetimibe
Simvastatin/niacin
Simvastatin/sitagliptin
Vytorin
Zocor
Ischemic Vascular Disease Care Performance Measures –Final 2016
This specification is updated annually; refer to previous versions for coding and other changes
31