Optimal Vascular Care Specifications 2013 (01/01/2012 to 12/31/2012 Dates of Services) Revised 08/10/2012

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1 Summary of Changes Date of birth clarification Added language to clarify date of birth range. Please note the changes in the denominator section. Description Methodology Rationale Measurement Period Denominator Composite ( optimal care) measure of the percentage of adult patients who have ischemic vascular disease (IVD) with optimally managed modifiable risk factors. Population identification is accomplished via a query of a practice management system or Electronic Medical Record (EMR) to identify the population of eligible patients (denominator). Data elements are either extracted from an EMR system or abstracted through medical record review. Clinics that had an EMR in place by 01/01/2011 are required to submit data on their full population. According to the Minnesota Department of Health, vascular disease is a high impact clinical condition in Minnesota. More than 20% of all deaths in Minnesota are due to heart disease and more than 7% are due to stroke, making them the second and third leading causes of death, respectively, in the state behind cancer. Inpatient hospitalization charges alone in Minnesota were $1.7 billion for heart disease patients and $318 million for stroke patients in According to the American Heart Association, more than 81 million Americans (37%) have cardiovascular disease. In every year since 1900 (except the 1918 influenza pandemic), cardiovascular disease accounted for more deaths than any other major cause of death in the United States. In 2006, cardiovascular disease claimed one of every 2.9 deaths in the United States. Measurement period will be a fixed twelve month period: 1/1/2012 to 12/31/2012. Established patient who meets each of the following criteria is included in the population: Patient was age 18 to 75 at the start of the measurement period (date of birth was on or between 01/01/1937 to 1/1/1994. Patient was seen by an eligible provider in an eligible specialty face-to-face at least two times during the last two years (01/01/2011 to 12/31/2012) with visits coded with an IVD ICD-9 diagnosis code (in any position, not only primary). Use this date of service range when querying the practice management or EMR system to allow a count of the visits within this time frame. Patient was seen by an eligible provider in an eligible specialty face-to-face at least one time during the last twelve months (01/01/2012 to 12/31/2012) for any reason. This may or may not include one of the face-to-face IVD visits. Diagnosis of Ischemic Vascular Disease; ICD-9 diagnosis codes include: ; , 414.8, 414.9, 429.2, , 440.1, , 440.4, Eligible specialties: Family Medicine (includes General Practice), Internal Medicine, Geriatric Medicine, Cardiology. Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Nurse Practitioner (NP). Allowable Exclusions Patient was a permanent nursing home resident home during the measurement period. Patient was in hospice at any time during the measurement period. Patient died prior to the end of the measurement period. Documentation that diagnosis was coded in error. Page 1

2 Numerator The number of IVD patients who met ALL of the following targets: The most recent LDL test in the measurement period has a value <100. The most recent Blood Pressure in the measurement period has a systolic value of <140 and a diastolic value of <90 (BOTH values must be less than). There is documentation in the chart that the patient is currently a non-tobacco user. There is documentation in the measurement period that the patient is on daily aspirin OR there is documentation of an accepted contraindication (any date). Page 2

3 Coding Conventions Used in MN Community Measurement Documentation MNCM uses the standard HEDIS coding conventions from HEDIS 2013, Cholesterol Management for Patients with Cardiovascular Conditions. Unless otherwise noted, codes are stated to the minimum specificity required. For example, if a code is presented to the third digit, any valid fourth or fifth digits may be used. When necessary, a code may be specified with an x, which represents a required digit; for example, ICD-9-CM diagnosis code 640.0x indicates a fifth digit is required, but the fifth digit could be any number allowed by the coding manual. This coding convention is used to describe ranges of codes, please refer to the tables included for the complete list of codes. Ischemic Vascular Disease Codes Table 1: ICD-9 Diagnosis Codes for Identifying Ischemic Vascular Disease ICD-9 Diagnosis Code AMI ANTEROLATERAL,UNSPEC AMI ANTEROLATERAL, INITIAL AMI ANTEROLATERAL,SUBSEQ AMI ANTERIOR WALL,UNSPEC AMI ANTERIOR WALL, INITIAL AMI ANTERIOR WALL,SUBSEQ AMI INFEROLATERAL,UNSPEC AMI INFEROLATERAL, INITIAL AMI INFEROLATERAL,SUBSEQ AMI INFEROPOST, UNSPEC AMI INFEROPOST, INITIAL AMI INFEROPOST, SUBSEQ AMI INFERIOR WALL,UNSPEC AMI INFERIOR WALL, INITIAL AMI INFERIOR WALL,SUBSEQ AMI LATERAL NEC, UNSPEC AMI LATERAL NEC, INITIAL AMI LATERAL NEC, SUBSEQ TRUE POST INFARCT,UNSPEC TRUE POST INFARCT, INITIAL TRUE POST INFARCT,SUBSEQ SUBENDO INFARCT, UNSPEC SUBENDO INFARCT, INITIAL SUBENDO INFARCT, SUBSEQ AMI NEC, UNSPECIFIED Page 3

4 ICD-9 Diagnosis Code Optimal Vascular Care Specifications AMI NEC, INITIAL AMI NEC, SUBSEQUENT AMI NOS, UNSPECIFIED AMI NOS, INITIAL AMI NOS, SUBSEQUENT POST MI SYNDROME INTERMED CORONARY SYND ACUTE COR OCCLSN W/O MI AC ISCHEMIC HRT DIS NEC 412 OLD MYOCARDIAL INFARCT ANGINA DECUBITUS PRINZMETAL ANGINA ANGINA PECTORIS NEC/NOS COR ATH UNSP VSL NTV/GFT CRNRY ATHRSCL NATVE VSSL CRN ATH ATLG VN BPS GRFT CRN ATH NONATLG BLG GRFT COR ATH ARTRY BYPAS GRFT COR ATH BYPASS GRAFT NOS COR ATH NATV ART TP HRT COR ATH BPS GRAFT TP HRT CHR TOT OCCLUS COR ARTRY COR ATH DUE TO LIPID RICH PLAQUE CHR ISCHEMIC HRT DIS NEC CHR ISCHEMIC HRT DIS NOS ASCVD OCL BSLR ART WO INFRCT OCL BSLR ART W INFRCT OCL CRTD ART WO INFRCT OCL CRTD ART W INFRCT OCL VRTB ART WO INFRCT OCL VRTB ART W INFRCT OCL MLT BI ART WO INFRCT Page 4

5 ICD-9 Diagnosis Code Optimal Vascular Care Specifications OCL MLT BI ART W INFRCT OCL SPCF ART WO INFRCT OCL SPCF ART W INFRCT OCL ART NOS WO INFRCT OCL ART NOS W INFRCT CRBL THRMBS WO INFRCT CRBL THRMBS W INFRCT CRBL EMBLSM WO INFRCT CRBL EMBLSM W INFRCT CRBL ART OC NOS WO INFRC CRBL ART OCL NOS W INFRC RENAL ARTERY ATHEROSCLER ATHSCL EXTRM NTV ART NOS ATH EXT NTV AT W CLAUDCT ATH EXT NTV AT W RST PN ATH EXT NTV ART ULCRTION ATH EXT NTV ART GNGRENE ATHRSC EXTRM NTV ART OTH CHR TOT OCCL ART EXTREM ABD AORTIC EMBOLISM THORACIC AORTIC EMBOLISM UPPER EXTREMITY EMBOLISM LOWER EXTREMITY EMBOLISM ILIAC ARTERY EMBOLISM ARTERIAL EMBOLISM NEC ARTERIAL EMBOLISM NOS ATHEROEMBOLISM,UPPER EXT ATHEROEMBOLISM,LOWER EXT ATHEROEMBOLISM, KIDNEY ATHEROEMBOLISM, SITE NEC Page 5