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Measure #7: Coronary Artery Disease (CAD): Beta-Blocker Therapy - Prior
Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)

2012 PHYSICIAN QUALITY REPORTING OPTIONS FOR INDIVIDUAL MEASURES:
REGISTRY ONLY

DESCRIPTION:
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have prior MI OR a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy
INSTRUCTIONS:
This measure is to be reported a minimum of once per reporting period for patients with a diagnosis of coronary artery disease (who also have a prior myocardial infarction (MI) or a current or prior LVEF < 40%) seen during the reporting period. This measure may be reported by clinicians who perform the quality actions described in the measure based on the services provided and the Measure Reporting via Registry:
ICD-9-CM diagnosis codes, CPT codes, and patient demographics are used to identify patients who are included in the measure's denominator. The listed numerator options are used to report the numerator of the measure. The quality-data codes have been provided for registry only measures for use by registries that utilize claims data. It is not necessary to submit these codes for registry-based submissions. Do not report this measure via claims.
There are two reporting criteria for this measure:
(1) Patients who are 18 years and older with a diagnosis of CAD who have prior MI
(2) Patients who are 18 years and older with a diagnosis of CAD who have a current or prior
LVEF < 40%
The eligible professional should submit data on one of the reporting criteria, depending on the clinical findings. If the patient has CAD (and who have prior MI), use Denominator Reporting Criteria 1. If the patient has CAD and a current or prior LVEF < 40%, use Denominator Reporting Criteria 2. If the patient has both prior MI and LVEF < 40%, the eligible professional may report quality data for Reporting Criteria 2 and this wil count as appropriate reporting for
REPORTING CRITERIA 1: Al patients with a diagnosis of CAD who have prior MI

DENOMINATOR (REPORTING CRITERIA 1):
Al patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 CPT only copyright 2011 American Medical Association. Al rights reserved Page 30 of 655 Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter Diagnosis for CAD* (ICD-9-CM): 410.00*, 410.01*, 410.02*, 410.10*, 410.11*, 410.12*,
410.20*, 410.21*, 410.22*, 410.30*, 410.31*, 410.32*, 410.40*, 410.41*, 410.42*, 410.50*, 410.51*, 410.52*, 410.60*, 410.61*, 410.62*, 410.70*, 410.71*, 410.72*, 410.80*, 410.81*, 410.82*, 410.90*, 410.91*, 410.92*, 411.0, 411.1, 411.81, 411.89, 412*, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.2, 414.3, Diagnosis for MI - includes patient that had a prior MI at any time: (ICD-9-CM):
410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 412 Patient encounter during reporting period (CPT): 99201, 99202, 99203, 99204, 99205,
99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344,
*DENOMINATOR NOTE: Inclusion for this reporting criteria requires the presence of a
prior MI diagnosis AND at least one E/M code during the measurement period. Diagnosis codes for Coronary Artery Disease (which include MI diagnosis codes) may also accompany the MI diagnosis code, but are not required for inclusion in the measure.
NUMERATOR (Reporting Criteria 1):
Patients who were prescribed beta-blocker therapy Definition:
Prescribed - May include prescription given to the patient for beta-blocker therapy at one
or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. Beta-blocker therapy - For patients with prior MI, no recommendations or evidence cited
in current chronic stable angina guidelines for preferential use of specific agents
Numerator Options:
Beta-blocker therapy prescribed or currently being taken (4008F)
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons) (4008F with 1P)
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons) (4008F with 2P)
CPT only copyright 2011 American Medical Association. Al rights reserved Page 31 of 655 Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system) (4008F with 3P)
Beta-blocker therapy not prescribed, reason not specified (4008F with 8P)

Reporting Criteria 2: All patients with a diagnosis of CAD who have a current or prior LVEF

DENOMINATOR (Reporting Criteria 2):
Al patients aged 18 years and older with a diagnosis of coronary artery disease who have a current or prior LVEF < 40% seen within a 12 month period Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter Diagnosis for CAD (ICD-9-CM): 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20,
410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90*, 410.91, 410.92, 411.0, 411.1, 411.81, 411.89, 412, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.2, 414.3, 414.8, 414.9, V45.81, V45.82 Patient encounter during reporting period (CPT): 99201, 99202, 99203, 99204, 99205,
99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344,
NUMERATOR (Reporting Criteria 2):
Patients who were prescribed beta-blocker therapy Definition:
Prescribed - May include prescription given to the patient for beta-blocker therapy at one
or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. Beta-blocker therapy - For patients with prior LVEF < 40%, beta-blocker therapy should
include bisoprolol, carvedilol, or sustained release metoprolol succinate
Numerator Options:
Beta-blocker therapy prescribed or currently being taken (4008F)
Left ventricular ejection fraction (LVEF) < 40% (G8694)
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons) (4008F with 1P)
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons) (4008F with 2P)
CPT only copyright 2011 American Medical Association. Al rights reserved Page 32 of 655 Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system) (4008F with 3P)
Left ventricular ejection fraction (LVEF) < 40% (G8694)
Left ventricular ejection fraction (LVEF) ≥ 40% or documentation as mildly depressed left ventricular systolic function or normal (G8695)
Beta-blocker therapy not prescribed, reason not specified (4008F with 8P)
Left ventricular ejection fraction (LVEF) < 40% (G8694)
RATIONALE:
Nonadherence to cardioprotective medications is prevalent among outpatients with coronary artery disease and can be associated with a broad range of adverse outcomes, including al -cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization A patient with a diagnosis of coronary artery disease seen within a 12 month period and LVEF < 40% should be taking either bisoprolol, carvedilol, or sustained release metoprolol succinate. While all beta-blockers appear to be of equal efficacy in patients with chronic stable coronary artery disease, these three medications have specifically shown to reduce mortality in patients with CLINICAL RECOMMENDATION STATEMENTS:
The following evidence statements are quoted verbatim from the referenced clinical guidelines. It is beneficial to start and continue beta-blocker therapy indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Class I Recommendation, Level A Evidence) (ACC/AHA, 2007) Beta-blockers (using 1 of the 3 proven to reduce mortality, i.e., bisoprolol, carvedilol, and sustained release metoprolol succinate) are recommended for all stable patients with current or prior symptoms of heart failure and reduced LVEF, unless contraindicated. (Class I, Level of Evidence: CPT only copyright 2011 American Medical Association. Al rights reserved Page 33 of 655

Source: http://mdinteractive.info/files/uploaded/7_2012_PhysQualRptg_MeasureSpecificationsManual_122311.pdf