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Measure of the month: stroke and stroke rehabilitation

From the December ACP Hospitalist, copyright © 2008 by the American College of Physicians

By Lisa Kirkland, FACP

Sidebar: Measure #31: Deep vein thrombosis (DVT) prophylaxis for ischemic stroke or intracranial hemorrhage

In accordance with a law passed by Congress late in 2006, physicians and other eligible professionals are able to receive bonus payments of 1.5% of their total allowed Medicare charges, subject to a cap, by submitting information for defined quality measures. Many of these measures were developed by the AMA-convened Physician Consortium for Performance Improvement®, in collaboration with the National Committee for Quality Assurance (NCQA) and/or a medical specialty society.

In July, CMS reported $36 million in bonus payments to many of the more than 56,700 health professionals who correctly reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI). The average incentive amount for individual professionals was over $600 and average incentive payment for a physician group practice was over $4,700, with the largest payment to a physician group practice totaling over $205,700.

Hospitalists have 11 quality measures available to them for the 2008 PQRI and can choose up to three measures per reporting period:

• ACE inhibitor, ARB in heart failure,
• antiplatelets in CAD,
• beta-blocker in CAD with prior MI,
• DVT prophylaxis in stroke,
• antiplatelets in stroke,
• anticoagulant in stroke with atrial fibrillation,
• tPA considered in stroke,
• dysphagia screen in stroke,
• rehab considered in stroke,
• advance care plan,
• VAP prevention (head elevation), and
• CRBSI prevention (CVC insertion protocol).

The current reporting period ends Dec. 31. The program will continue in 2009.

For a specific measure, the eligible (“denominator”) patient population is identified by both ICD-9 diagnosis codes and CPT evaluation/management (E/M) service codes. If a patient falls into that denominator population, the appropriate CPT-II code(s) and modifiers for the individual patient (“numerator”) are required for submission. A modifier is required if a patient is in the eligible population but does not receive the measure; the explanation must be documented in the chart as a medical, patient, system, or unspecified reason.

Dr. Kirkland is a hospitalist at the Mayo Clinic in Rochester, Minn., and a critical care specialist at Abbott Northwestern Hospital in Minneapolis. She is a member of ACP Hospitalist’s editorial advisory board.

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Measure #31: Deep vein thrombosis (DVT) prophylaxis for ischemic stroke or intracranial hemorrhage

The frequency of this measure is each hospital stay for active treatment for ischemic stroke or intracranial hemorrhage during the reporting period. Specifically, it measures prophylaxis received or not received after hospital day 2 (HD2). DVT prophylaxis includes low molecular weight heparin, low dose unfractionated heparin, intravenous heparin, low dose subcutaneous heparin, or intermittent pneumatic compression devices.

The denominator population encompasses patients with ICD-9 codes for ischemic stroke or intracranial hemorrhage AND CPT E/M service code 99221-3, 99251-5, or 99291. Numerator coding options are shown in the chart below. See the CMS Web site, www.cms.hhs.gov/PQRI, for information about alternative reporting options and very helpful toolkits.

Numerator	CPT II Code	Modifier
DVT prophylaxis received by end of HD2	4070F	none
DVT prophylaxis not received by end of HD2
Medical reason, including patient is ambulatory	4070F	1P
Patient reason	4070F	2P
Unspecified reason	4070F	8P

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated