* Measure #28: Aspirin at Arrival for Acute Myocardial Infarction (AMI)
2009 PQRI REPORTING OPTIONS: CLAIMS-BASED, REGISTRY
DESCRIPTION:
Percentage of patients, regardless of age, with an emergency department discharge diagnosis of AMI who had documentation of receiving aspirin within 24 hours before emergency department arrival or during emergency department stay
INSTRUCTIONS:
This measure is to be reported each time during the reporting period a patient has been discharged from the emergency department with a diagnosis of AMI. Patients who are discharged from the emergency department with a diagnosis of AMI should have documentation in the medical record of having received aspirin 24 hours before emergency department arrival or during emergency department stay. It is anticipated that clinicians who provide care in the emergency department will submit this measure. The Part B claim form place of service field must indicate that the encounter has taken place in the emergency department.
Measure Reporting via Claims:
Line-item ICD-9-CM diagnosis codes and CPT codes are used to identify patients who are included in the measure's denominator. CPT Category II codes are used to report the numerator of the measure.
When reporting the measure via claims, submit the listed ICD-9-CM diagnosis codes, CPT codes, and the appropriate CPT Category II code OR the CPT Category II code with the modifier. The modifiers allowed for this measure are: 1P- medical reasons, 2P- patient reasons, 8P- reason not otherwise specified. All measure-specific coding should be reported ON THE SAME CLAIM.
NUMERATOR:
Patients who had documentation of receiving aspirin within 24 hours before emergency department arrival or during emergency department stay
Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Aspirin Received or Taken 24 Hours Before Emergency Department Arrival or During Emergency Department StayCPT II 4084F: Aspirin received within 24 hours before emergency department arrival or during emergency department stay
OR
Aspirin not Received or Taken 24 Hours Before Emergency Department Arrival or During Emergency Department Stay for Medical or Patient Reasons
Append a modifier (1P or 2P) to CPT Category II code 4084F to report documented circumstances that appropriately exclude patients from the denominator.
4084F with 1P: Documentation of medical reason(s) for not receiving or taking aspirin within 24 hours before emergency department arrival or during emergency department stay
4084F with 2P: Documentation of patient reason(s) for not receiving or taking aspirin within 24 hours before emergency department arrival or during emergency department stay
OR
Aspirin not Received or Taken 24 Hours Before Emergency Department Arrival or During Emergency Department Stay, Reason not Specified
Append a reporting modifier (8P) to CPT Category II code 4084F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
4084F with 8P: Aspirin was not received within 24 hours before emergency department arrival or during emergency department stay, reason not otherwise specified
DENOMINATOR:
All patients, regardless of age, with an emergency department discharge diagnosis of acute myocardial infarction
Denominator Criteria (Eligible Cases):
Diagnosis for acute myocardial infarction (line-item ICD-9-CM): 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91
AND
Patient encounter during the reporting period (CPT): 99281, 99282, 99283, 99284, 99285, 99291
AND
Place of Service Indicator: 23
(The Part B claim form place of service field must indicate emergency department)
RATIONALE:
The emergency physician should document that the patient received aspirin no matter where or when the aspirin was taken.
CLINICAL RECOMMENDATION STATEMENTS:
Aspirin should be chewed by patients who have not taken aspirin before presentation with STEMI. The initial dose should be 162 mg (Level A) to 325 mg (Level C). Although some trials have used enteric-coated aspirin for initial dosing, more rapid buccal absorption occurs with non–enteric-coated aspirin formulations. (ACC/AHA)
