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Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation

CBE ID
0084
1.4 Project
Cardiovascular
Endorsed
Endorsement Status
Endorsement Removed
1.1 New or Maintenance
Maintenance
E&M Cycle
Full Year 2010
Is Under Review
No
1.3 Measure Description

Percentage of patients with HF who also have paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy.

    • 1.14 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.

    • 1.15 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

    • Most Recent Endorsement Activity
      Measure Retired and Endorsement Removed Cardiovascular Project 2010-2013
      Initial Endorsement
      Last Updated
      Removal Date