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Coronary Artery Disease
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease (CAD)
This measure is to be reported for all patients aged 18 years and older with coronary artery disease —
a minimum of once per reporting period.
What if this process or outcome of care is not
Percentage of patients aged 18 years and older with a appropriate for your patient?
diagnosis of coronary artery disease who were prescribed There may be times when it is not appropriate to prescribe oral oral antiplatelet therapy antiplatelet therapy, due to:n Medical reasons (eg, not indicated, contraindicated, other What will you need to report for each patient with
medical reason) OR coronary artery disease for this measure?
n Patient reasons (eg, patient declined, economic, social, If you select this measure for reporting, you will report: religious, other patient reason) OR n System reasons (eg, resources to perform the services not n Whether or not you prescribed oral antiplatelet therapy (eg, aspirin, clopidogrel/Plavix, or combination of aspirin available, insurance coverage/payer-related limitations, other reason attributable to health care delivery system) In these cases, you will need to indicate which reason applies, specify the reason on the worksheet and in the medical chart. The office/billing staff will then report a code with a modifier that represents these valid reasons (also called exclusions).
PQRI 2007 Measure 6, Effective Date 07/01/2007 2005 American Medical Association. All rights reserved. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference) Coronary Artery Disease
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease (CAD)
PQRI Data Collection Sheet
Practice Medical Record Number (MRN) Birth Date (mm/dd/yyyy) National Provider Identifier (NPI) Step 1 Is patient eligible for this measure?
Code Required on Claim Form
Patient is aged 18 years and older.
Verify date of birth on claim form.
Patient has a diagnosis of coronary artery disease.
Refer to coding specifications document for list There is a CPT E/M Service Code for this visit.
of applicable codes.
If No is checked for any of the above, STOP. Do not report
a CPT category II code.
Step 2 Does patient meet or have an acceptable reason
for not meeting the measure?
Code to be Reported on Line 24D of Paper Claim Form,
Oral Antiplatelet Therapy
if Yes (or Service Line 24 of Electronic Claim Form)
Not prescribed for one of the following reasons:• Medical (eg, not indicated, contraindicated, other medical reason) • Patient (eg, patient declined, economic, social, religious, other patient reason) • System (eg, resources to perform the services not available, other reason attributable to healthcare delivery system) Document reason here and in medical chart.
If No is checked for all of the above, report
4011F–8P
(Oral antiplatelet therapy [eg, aspirin, clopidogrel/Plavix,
or combination of aspirin and dipyridamole/Aggrenox]
not prescribed, reason not otherwise specified.)
PQRI 2007 Measure 6, Effective Date 07/01/2007 2005 American Medical Association. All rights reserved. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference) CPT® copyright 2006 American Medical Association.
Coronary Artery Disease
Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease (CAD)
Quality codes for this measure (one of the following for every Codes required to document patient has coronary artery eligible patient): disease and a visit occurred: CPT II Code descriptors
An ICD-9 diagnosis code for coronary artery disease and a (Data Collection sheet should be used to determine appropriate CPT E/M service code are required to identify patients to be combination of codes.) included in this measure.
n CPT II 4011F: Oral antiplatelet therapy prescribed
(eg, aspirin, clopidogrel/Plavix, or combination of aspirin Coronary artery disease ICD-9 diagnosis codes
n 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, n CPT II 4011F–1P: Documentation of medical reason(s)
410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, for not prescribing oral antiplatelet therapy (eg, aspirin, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, clopidogrel/Plavix, or combination of aspirin and 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92 (acute myocardial infarction), n CPT II 4011F–2P: Documentation of patient reason(s)
n 411.0, 411.1, 411.81, 411.89 (other acute and subacute forms for not prescribing oral antiplatelet therapy (eg, aspirin, of ischemic heart disease), clopidogrel/Plavix, or combination of aspirin and n 412 (old myocardial infarction), n 413.0, 413.1, 413.9 (angina), n CPT II 4011F–3P: Documentation of system reason(s)
n 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, for not prescribing oral antiplatelet therapy (eg, aspirin, 414.8, 414.9 (coronary artery disease), clopidogrel/Plavix, or combination of aspirin and n V45.81 (aortocoronary bypass status), n CPT II 4011F–8P: Oral antiplatelet therapy (eg, aspirin,
n V45.82 (PTCA status) clopidogrel/Plavix, or combination of aspirin and dipyridamole/Aggrenox) not prescribed, reason not otherwise specified CPT E/M service codes
n 99201, 99202, 99203, 99204, 99205 (office — new patient),
n 99212, 99213, 99214, 99215 (office — established patient), n 99238, 99239 (discharge), n 99241, 99242, 99243, 99244, 99245 (outpatient consult), n 99304, 99305, 99306, 99307, 99308, 99309, 99310 (nursing facility), n 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337 (domiciliary), n 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350 (home visit) Physician Performance Measures (Measures) and related data specifications, developed by the Physician Consortium for Performance Improvement® (the Consortium), are intended to facilitate quality improvement activities by physicians. These Measures are intended to assist physicians in enhancing quality of care. Measures are designed for use by any physician who manages the care of a patient for a specific condition or for prevention. These performance Measures are not clinical guidelines and do not establish a standard of medical care. The Consortium has not tested its Measures for all potential applications. The Consortium encourages the testing and evaluation of its Measures.
Measures are subject to review and may be revised or rescinded at any time by the Consortium. The Measures may not be altered without the prior written approval of the Consortium. Measures developed by the Consortium, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and American Medical Association, on behalf of the Consortium. Neither the Consortium nor its members shall be responsible for any use of these Measures.
THE MEASURES ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND 2005 American Medical Association. All Rights Reserved.
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the Consortium and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.
THE SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
CPT® contained in the Measures specifications is copyright 2006 American Medical Association.
PQRI 2007 Measure 6, Effective Date 07/01/2007 2005 American Medical Association. All Rights Reserved CPT® copyright 2006 American Medical Association

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