PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS. HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate
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1 PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate Measure Title Description Measure Type Data Source Level of Analysis Numerator HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate Physician-specific risk-standardized rates of procedural complications following the implantation of an ICD. Outcome Electronic administrative data/claims, registry data, Medicare enrollment data Physician Number of patients from the denominator with one or more of the following complications or mortality within 30 or 90 days (depending on the complication) following ICD implantation. Complications measured for 30 days: 1. Death 2. Pneumothorax or hemothorax plus a chest tube 3. Hematoma plus a blood transfusion or evacuation 4. Cardiac tamponade or pericardiocentesis Denominator Statement Exclusions Risk Adjustment Complications measured for 90 days: 5. Mechanical complications requiring a system revision 6. Device related infection 7. Additional ICD implantation All inpatient and outpatient ICD implants for Medicare Fee-For-Service (FFS) beneficiaries at least 65 years of age at the time of implantation who have matching information in the National Cardiovascular Disease Registry (NCDR) ICD Registry. 1. Non-Medicare FFS patients. 2. Claims that are not the first in the same claim bundle. 3. Patient stays that lack 90 days of Medicare FFS enrollment post-discharge. 4. Patients with prior ICD implantation. Hierarchical logistic regression. Risk adjustment variables: 1. Age (10-year increments) 2. Gender 3. Reason admitted for this procedure (cardiac vs. non-cardiac) 4. New York Heart Association (NYHA) Class Current Status NYHA I
2 Reporting NYHA II NYHA III NYHA IV 5. Previous Coronary Artery Bypass Graft (CABG) 6. Chronic Lung Disease 7. Hypertension 8. Renal Failure, Dialysis 9. Atrioventricular Conduction (AVC) Normal Abnormal 1 st Degree Heart Block Only Abnormal 2 nd /3 rd Degree Heart Block Paced (any) 10. BUN >30mg/dl 11. Sodium <135mg/dl 135 to 145mg/dl >145mg/dl 12. Systolic Blood Pressure <100mmHG 13. ICD Type Single Chamber Dual Chamber Biventricular N/a 2
3 CODE KEY Diagnosis/Procedure ICD-9 Codes CPT Codes DENOMINATOR Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (crt-p) Implantation of cardiac resynchronization defibrillator, total system (crt-d) Implantation of replacement of transvenous lead (electrode) into left ventricular coronary venous system Implantation or replacement of cardiac resynchronization pacemaker pulse generator only (crt-p) Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only (crt-d) Implantation or replacement of automatic cardioverter/defibrillator, total system (aicd) Insertion, single chamber transverse electrode ICD Insertion, dual chamber transverse electrode ICD Repair, single chamber transverse electrode ICD Repair, dual chamber transverse electrode ICD Pocket revision ICD Insertion of single or dual chamber ICD pulse generator Removal of single or dual chamber ICD pulse generator Insertion or repositioning of electrode lead(s) for single or dual chamber pacing ICD and insertion of pulse generator NUMERATOR Complications Measured for 30 Days (1) Death Medicare enrollment data (2) Pneumothorax (requires code for chest tube [2a] for inclusion in numerator) 512, (2) Hemothorax (requires code for chest tube [2a] for inclusion in numerator) (2a) Chest tube (requires code[s] for pneumothorax and/or hemothorax for inclusion in numerator) 34.04, 34.05, 34.06, (procedure codes) (3) Hematoma complicating a procedure (requires code for blood transfusion [3a] and/or hematoma evacuation [3b] for inclusion in numerator) (3a) Blood transfusion (requires code for hematoma complicating a procedure for inclusion in numerator) 998.1, , 287.4, V59.01, V58.2 (diagnosis codes) or 99.00, 99.03, (procedure codes) 34.03, (procedure codes) (3b) Hematoma evacuation (requires code for hematoma complicating a procedure for inclusion in numerator) (4a) Cardiac tamponade OR 420, 423.0, 423.3, (4b) Pericardiocentesis 37.0, (procedure codes) Complications Measured for 90 Days (5) Mechanical complications requiring a system revision (diagnosis code) AND any of the following procedure codes: 37.75, 37.79, 3
4 Diagnosis/Procedure ICD-9 Codes CPT Codes 37.97, 37.99, (6) Device-related infection (diagnosis code) (7a) Additional ICD implantation (inpatient or outpatient) A. Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (crt-p) (procedure code) B. Implantation of cardiac resynchronization defibrillator, total system (crt-d) (procedure code) C. Implantation or replacement of transvenous lead (electrode) into left ventricular coronary venous (procedure code) system D. Implantation or replacement of cardiac resynchronization pacemaker pulse generator only (crt-p) (procedure code) E. Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only (procedure code) (crt-d) F. Implantation or replacement of automatic cardioverter/defibrillator, total system (aic) (procedure code) (7b) Additional ICD implantation (outpatient) A. Insertion, single chamber transverse electrode ICD B. Insertion, dual chamber transverse electrode ICD C. Repair, single chamber transverse electrode ICD D. Repair, dual chamber transverse electrode ICD E. Pocket revision ICD F. Insertion of single or dual chamber ICD pulse generator G. Removal of single or dual chamber ICD pulse generator H. Insertion or repositioning of electrode lead(s) for single or dual chamber pacing ICD and insertion of pulse generator
5 HRS-4: In-Person Evaluation Following Implantation of a Cardiovascular Implantable Electronic Device (CIED) 1 Measure Title Description Measure Type Data Source Level of Analysis Numerator HRS-4: In-person Evaluation Following Implantation of a Cardiovascular Implantable Electronic Device (CIED) Proportion of adult patients with a new CIED with an in-person evaluation within 2 to 12 weeks following implantation. Process Electronic administrative data/claims Physician The number of patients from the denominator with an in-person evaluation within 2-12 weeks following implantation. For the purposes of this measure, an in-person evaluation is defined as an in-person interrogation device evaluation either with or without iterative adjustment, as clinically indicated. Denominator Statement Exclusions Stratification Reporting The in-person evaluation can be provided by any trained physician or Clinically Employed Allied Professional (CEAP) in a designated CIED follow-up clinic, medical institution, or physician office. All patients aged 18 years and older with implantation of a new CIED during the reporting period. CIEDs encompassed for this measure are the following devices: Pacemakers (PMs) Implantable cardioverter-defibrillators (ICDs) Cardiac resynchronization devices (CRTs) Exclude patients with any of the following diagnoses/conditions: 1. Patients with Implantable Loop Recorders or Implantable Cardiovascular Monitors. 2. Patients with pulse generator exchange only. 3. Patients with prior CIED implantation. 4. Patient preference for other or no treatment. N/a N/a 1 Wilkoff BL et al. HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations. Heart Rhythm. 2008;5(6):
6 Diagnosis/Procedure CODE KEY ICD-9 Procedure Codes DENOMINATOR Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (CRT-P) Implantation of cardiac resynchronization defibrillator, total system (CRT-D) Insertion, replacement, removal, or revision of pacemaker device 37.8 Insertion of permanent pacemaker, initial or revision, type of device not specified Initial insertion of single-chamber pacemaker device, not specified as rate responsive Initial insertion of single-chamber pacemaker device, rate responsive Initial insertion of dual-chamber pacemaker device Implantation or replacement of automatic cardioverter-defibrillator (AICD), total system Insertion of new or replacement of permanent pacemaker with transvenous electrode(s): atrial Insertion of new or replacement of permanent pacemaker with transvenous electrode(s): ventricular Insertion of new or replacement of permanent pacemaker with transvenous electrode(s): atrial and ventricular Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber EXCLUSIONS Cardiac pacemaker in situ V45.01 Automatic cardioverter-defibrillator (AICD), in situ V45.02 Fitting and adjustment of cardiac pacemaker V53.31 Fitting and adjustment of AICD V53.32 Patient refusal of treatment V62.6 Replacement of any type pacemaker device with single chamber device, not specified as rate responsive Replacement of any type pacemaker device with single chamber device, rate responsive Replacement of any type pacemaker device with dual chamber device Revision or removal of pacemaker device Replacement of automatic cardioverter-defibrillator (AICD), pulse generator only Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) Removal and replacement of permanent pacemaker pulse generator; single lead system Removal and replacement of permanent pacemaker pulse generator; dual lead system Removal and replacement of permanent pacemaker pulse generator; multiple lead system Removal of permanent pacemaker pulse generator Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system Removal of single or dual-chamber pacing cardioverter-defibrillator pulse generator Removal of single or dual-chamber pacing cardioverter-defibrillator pulse generator by transvenous extraction Removal and replacement of pacing cardioverter-defibrillator pulse generator; single lead system Removal and replacement of pacing cardioverter-defibrillator pulse generator; dual lead system Removal and replacement of pacing cardioverter-defibrillator pulse generator; multiple lead system CPT Codes 6
7 Diagnosis/Procedure NUMERATOR PACEMAKER SYSTEMS Interrogation device evaluation (in person) with physician analysis, review, and report, includes connection, recording, and disconnection per patient encounter; single, dual, or multiple lead pacemaker system select optimal permanent programmed values with physician analysis, review, and report; single lead pacemaker system select optimal permanent programmed values with physician analysis, review, and report; dual lead pacemaker system select optimal permanent programmed values with physician analysis, review, and report; multiple lead pacemaker system ICD SYSTEMS Interrogation device evaluation (in person) with physician analysis, review, and report, includes connection, recording, and disconnection per patient encounter; single, dual, or multiple lead ICD system, including analysis of heart rhythm derived data elements select optimal permanent programmed values with physician analysis, review, and report; single lead ICD system select optimal permanent programmed values with physician analysis, review, and report; dual lead ICD system select optimal permanent programmed values with physician analysis, review, and report; multiple lead ICD system ICD-9 Procedure Codes CPT Codes 7
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