#187: Stroke and Stroke Rehabilitation: Thrombolytic Therapy

Quality ID

187

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Emergency Medicine Neurosurgery

Measure description

Percentage of patients aged 18 years and older with a diagnosis of acute ischemic stroke who arrive at thehospital within two hours of time last known well and for whom IV t-PA was initiated within three hours of time last knownwell

 

Instructions

This measure is to be submitted for each episode of acute ischemic stroke for patients who arrive at the hospital within two hours of time last known well and for whom IV t-PA was initiated within three hours of time last knownwell. It is anticipated that eligible clinicians providing care for patients with acute ischemic stroke in the hospital setting will submit this measure.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients aged 18 years and older with a diagnosis of acute ischemic stroke whose time of arrival is withintwo hours (≤ 120 minutes) of time last known well

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for ischemic stroke (ICD-10-CM): I63.00, I63.011, I63.012, I63.013, I63.019, I63.02, I63.031, I63.032, I63.033, I63.039, I63.09, I63.10, I63.111, I63.112, I63.113, I63.119, I63.12, I63.131, I63.132, I63.133, I63.139, I63.19, I63.20, I63.211, I63.212, I63.213, I63.219, I63.22, I63.231, I63.232, I63.233, I63.239, I63.29, I63.30, I63.311, I63.312, I63.313, I63.319, I63.321, I63.322,I63.323, I63.329, I63.331, I63.332, I63.333, I63.339, I63.341, I63.342, I63.343, I63.349, I63.39, I63.40, I63.411, I63.412, I63.413, I63.419, I63.421, I63.422, I63.423, I63.429, I63.431, I63.432, I63.433, I63.439, I63.441, I63.442, I63.443, I63.449, I63.49, I63.50, I63.511, I63.512, I63.513, I63.519, I63.521, I63.522, I63.523, I63.529, I63.531, I63.532, I63.533, I63.539, I63.541, I63.542, I63.543, I63.549, I63.59, I63.6, I63.8, I63.9

AND

Patient encounter during performance period (CPT): 99218, 99219, 99220, 99221, 99222, 99223, 99224,99225, 99226, 99231, 99232, 99233, 99281, 99282, 99283, 99284, 99285, 99291

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Time last known well to arrival in the emergency department less than or equal to two hours (≤ 120 minutes)

 

Numerator

Patients for whom IV thrombolytic therapy was initiated at the hospital within three hours (≤ 180 minutes) of timelast known well

Definition:

Last Known Well – The date and time prior to hospital arrival at which it was witnessed or reported thatthe patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health.

Numerator Options:

Performance Met: IV t-PA initiated within three hours (≤ 180 minutes) of time last known well (G8600)

OR

Denominator Exception: IV t-PA not initiated within three hours (≤ 180 minutes) of time last known well for reasons documented by clinician (e.g., patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention) (G8601)

OR

Performance Not Met: IV t-PA not initiated within three hours (≤ 180 minutes) of time last known well, reason not given (G8602)

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