Percentage of patients with HF who also have paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy.
Measure Specs
General Information
Numerator
Patients who were prescribed warfarin therapy
(drug list available at www.ama-assn.org/ama/pub/category/4837.html) Or
CPT-II code: 4012F Warfarin therapy prescribed.
Denominator
All HF patients > 18 years of age with paroxysmal or chronic atrial fibrillation
Patient Selection:
ICD-9-CM codes for HF: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43, 428.9
And
ICD-9-CM code for Atrial Fibrillation: 427.31
And
Patient’s age is > 18 years of age
Exclusions
Documentation of medical reason(s) for not prescribing warfarin therapy:
•Allergy/intolerance
995.0 and E934.2, 995.1 and E934.2, 995.2 and E934.2; Or
•Risk of bleeding or bleeding disorder
ICD-9-CM exclusion codes: 203.00-208.91, 280.0, 280.9, 285.1, 286.0-286.7, 286.9, 287.30, 287.31, 287.32, 287.33, 287.39, 287.4, 287.5, 430, 431, 432.0, 432.1, 432.9, 437.3, 459.0, 530.7, 531.00-531.01, 531.20-531.21, 531.40-531.41, 531.60-531.61, 532.00-532.01, 532.20-532.21, 532.40-532.41, 532.60-532.61, 533.00-533.01, 533.20-533.21, 533.40-533.41, 533.60-533.61, 534.00- 534.01, 534.20-534.21, 534.40-534.41, 534.60-534.61, 569.3, 570, 571.2, 571.5, 578.0, 578.1, 578.9, 599.7, 786.3;
Or
•Other medical reason(s) documented by the practitioner for not prescribing warfarin therapy;
Or
•CPT-II code w/modifier: 4012F 1P
Documentation of patient reason(s) (e.g., economic, social, religious)
Or
CPT-II code w/modifier: 4012F 2P
Documentation of system reason(s) for not prescribing warfaring therapy
OR
CPT II code 4012F 3P
Public Comments