eClinicalWorks ACO Quick-Reference Setup Guide...eClinicalWorks ACO Quick-Reference Setup Guide ... aco

© eClinicalWorks, 2013. All rights reserved

ACCOUNTABLE CARE ORGANIZATION QUICK-REFERENCE SETUP GUIDE

V 9.0

© Copyright eClinicalWorks, November 2013 ‐ Accountable Care Organization Quick‐Reference Setup Guide 2

Contents

CONTENTS

ACO SETUP _______________________________________________________3

Demographics ___________________________________________________________________3

ACO 12_________________________________________________________________________4

ACO 13_________________________________________________________________________6

ACO 14_________________________________________________________________________7

ACO 15_________________________________________________________________________8

ACO 16_________________________________________________________________________9

ACO 17________________________________________________________________________11

ACO 18________________________________________________________________________13

ACO 19________________________________________________________________________16

ACO 20________________________________________________________________________18

ACO 21________________________________________________________________________20

ACO 22________________________________________________________________________25

ACO 23________________________________________________________________________26

ACO 24________________________________________________________________________27

ACO 25________________________________________________________________________28

ACO 26________________________________________________________________________29

ACO 27________________________________________________________________________31

ACO 28________________________________________________________________________32

ACO 29________________________________________________________________________33

ACO 30________________________________________________________________________35

ACO 31________________________________________________________________________36

ACO 32________________________________________________________________________38

ACO 33________________________________________________________________________41

APPENDIX A: NOTICES _______________________________________________43

Trademarks ____________________________________________________________________43

Copyright ______________________________________________________________________43

ACO SETUP

The following information is related to setting up the eClinicalWorks system for reporting on

Accountable Care Organization measures. All possible setup options are presented here, and not all

are required for every measure. For more detailed information on all available methods of satisfying

each measure, refer to the 2013 Accountable Care Organization Users Guide.

DemographicsSome patients do not qualify for the sample data. Structured data must be created in order to indicate

the patient should not be included in the sample data. This is to ensure that they are not counted

against your compliance percentages.

Structured data setup:

Patient Information > Additional Info > Structured tab > Reason patient not qualified for sample

(ACO Reporting): Structured (single select):

In hospice

Moved out of country

HMO Enrollment

Deceased

Patient Information > Additional Info > Structured tab > Date of Ineligibility (ACO Reporting): Date


ACO Setup ACO 12

ACO 12

ACO Definitions eClinicalWorks Data Points

Denominator All patients aged 65

years and older

discharged from any

inpatient facility (e.g.,

hospital, skilled nursing

facility, or rehabilitation

facility) and seen within

30 days following

discharge in the office

by the physician

providing ongoing care

Setup Requirements:

Structured data in HPI >Interim History > Transition of care

visit from hospital > [questions]:

(Q1) Date of admission to hospital: (Type: Date)

(Q2) Date of receipt of hospital admission report:

(Type: Date)

(Q3) Date of discharge from hospital: (Type: Date)

(Q4) Date of receipt of hospital discharge summary:

(Type: Date)

OR

Structured data in HPI > Interim History > Transition of care

visit from other inpatient facility > [questions]:

(Q1) Type of other inpatient facility other than

hospital: (Type: Structured ‐ single select)

• Rehabilitation Facility

• Skilled Nursing Facility

• Other Inpatient Facility

(Q2) Date of admission to inpatient facility: (Type:

Date)

(Q3) Date of receipt of admission report: (Type: Date)

(Q4) Date of discharge from inpatient facility: (Type:

Date)

(Q5)Date of receipt of discharge summary: (Type:

Date)

Note: The denominator is satisfied by entering information for

either of the structured data options in bold above.


ACO Setup ACO 12

Numerator Patients who had a

reconciliation of the

discharge medications

with the current

medication list in the

outpatient medical

record documented.

The Medical Record

must indicate that the

clinician is aware of the

inpatient facility


and will either keep the

inpatient facility


or change the inpatient

facility discharge

medications or the

dosage of an inpatient

facility discharge

medication.

Setup Requirements:

Structured data in HPI >Interim History > Transition of care

visit from hospital > [questions]:

(Q5) Discharge medications reviewed and reconciled

from hospital: (Type: Structured ‐ multiselect)

• Medications left unchanged

• Medications changed (e.g., discontinued, changed

or added)

OR

Structured data in HPI > Interim History > Transition of care

visit from other inpatient facility > [questions]:

(Q6) Discharge medications reviewed and reconciled

from inpatient facility: (Type: Structured ‐ multiselect)

• Medications left unchanged

• Medications changed (e.g., discontinued, changed

or added)

CPT* II Code: 1111F ‐ Discharge medications reconciled with

the current medication list in outpatient medical record.

Note: The numerator is satisfied by either recording the

structured data information or the CPT II code.

*. CPT copyright 2012 American Medical Association. All rights reserved.



ACO Setup ACO 13

ACO 13



years and older

No eClinicalWorks setup required.

Numerator Patients who were

screened for future fall

risk at least once within

12 months

Setup Requirements:

Structured data in Preventive Medicine > Screening > Fall Risk

Screening > Fall Risk Assessment > (Type: Structured ‐

multiselect):

No falls in the past year

One fall without injury in the past year

Two or more falls with injury in the past year

Two or more falls without injury in the past year

One fall with injury in the past year

Note: Patients are

considered at risk for

future falls if they have

had two or more falls in

the past year or any fall

with injury in the past

year.

CPT* II Codes: 3288F ‐ Fall risk assessment documented

1100F ‐ Patient screened for future fall risk


Note: The numerator is satisfied by either recording the

structured data information or a CPT II code.

Exclusions Documentation of

medical reason(s) for

not screening for future

fall risk (e.g., patient is

not ambulatory)


Note: Exclusions only

apply if the patient was

not screened for future

fall risk.

CPT II Code: 3288F‐1P ‐ Risk assessment for falls not completed

for medical reason


ACO Setup ACO 14

ACO 14


Denominator All patients aged six months and

older seen for a visit between

October 1 and March 31


Numerator Patients who have received an

influenza immunization or who

reported previous receipt of

influenza immunization

Setup Requirements:

Map the Influenza immunization to the following

CVX codes: 111, 135, 140, 141, 144, 149

Note: Previous receipt is defined as

receipt of the current season’s

influenza immunization from

another provider or from the same

provider prior to the visit to which

the measure is applied (typically,

prior vaccination would include

influenza vaccine given since August

1st).

CPT* Codes: 90653, 90654, 90655, 90656, 90658,

90660, 90661, 90662, 90664, 90666, 90667, 90668,

90672

CPT II Code: 4037F ‐ Influenza immunization

ordered or administered

ICD Codes: V04.81, V06.6


Note: The numerator is satisfied by recording an

immunization, CPT code, CPT II code, or ICD code.

Exclusions Documentation of medical

reason(s), patient reason(s), or

system reason(s) for not receiving

an influenza immunization during

the flu season (e.g., patient allergy,

patient refused, immunization not

available, etc.).


Note: Exclusions only apply if the

patient did not receive influenza

immunization during the flu season.

ICD Codes: V15.03

CPT II Codes: 4037F‐1P ‐ Influenza immunization

not ordered or administered, medical reason

4037F‐2P ‐ Influenza immunization not ordered or

administered, patient reason

4037F‐3P ‐ Influenza immunization not ordered or

administered, system reason


ACO Setup ACO 15

ACO 15


Denominator All patients 65 years and

older


Numerator Patients who have ever

received a

pneumococcal

vaccination

Setup Requirements:

The Pneumonia vaccination must be mapped to the following

CVX codes: 100, 133, 33

CPT* Codes: 90669, 90670, 90732

CPT II Code: 4040F ‐ Pneumococcal vaccine administered or

previously received


Note: The numerator is satisfied by recording an immunization,

CPT code, or CPT II code.



not ever receiving

pneumococcal

vaccination



apply if the patient did

not ever receive a

pneumococcal

immunization.

CPT II Code: 4040F‐1P ‐ Pneumococcal vaccine not

administered or previously received, medical reason


ACO Setup ACO 16

ACO 16


Denominator All patients aged 18 years and older at

the beginning of the measurement

period


Numerator Patients with BMI calculated within the

past six months or during the current

visit and a follow‐up plan is

documented within the last six months

or during the current visit if the BMI is

outside of normal parameters

Setup Requirements:

Configure Height, Weight, and BMI fields

from EMR > Vitals > Configure Vitals

(Mandatory) > BMI

Structured data in Preventive Medicine >

Counseling > Provider to provider

communication > Dietary consultation order

provided (Data type: Boolean)


Counseling > Care Goal Follow Up Plan >

BMI management provided (Data type:

Boolean)

Note: Normal parameters are defined

as:

Age 65 and older ‐ BMI > 23 and <

30

Age 18 – 64 BMI > 18.5 and < 25

Follow‐Up BMI Plan:

CPT* Codes: 43644, 43645, 43770, 43771,

43772, 43773, 43774, 43842, 43843, 43845,

43846, 43847, 43848, 97802, 97804, 98960,

98961, 98962, 99078

ICD Codes: V65.3, V65.41

HCPCS Codes: S9449, S9451, S9452, S9470,

G8417, G8418

Medications: Weight loss and weight gain

medications

Note: The numerator is satisfied by recording

vitals and, if applicable, one of the following:

structured data, a CPT code, an ICD code, a

HCPCS code, or a medication.


ACO Setup ACO 16

Exclusions Documentation of medical, or patient

reason(s) for not having a BMI

measurement performed during the

measurement period (e.g., patient is

receiving palliative care, patient is

pregnant or patient is in an urgent or

emergent medical situation where time

is of the essence and to delay

treatment would jeopardize the

patient’s health status; patient refuses

BMI measurement or if there is any

other reason documented in the

medical record by the provider

explaining why BMI measurement was

not appropriate, etc.)

Setup Requirements:


Counseling > Provider to provider

communication > Palliative Care > (Data Type:

Structured ‐ single select):

Admission by palliative care physician

Admission to palliative care department

Referral by palliative care physician

Referral to palliative care physician

Referral to palliative care service

Note: Exclusions only apply if a

calculated BMI was not documented as

normal or was outside parameters with

a follow‐up not performed during the

reporting period.

ICD Codes: V66.5, Pregnancy Dx

HCPCS Codes: G8422 ‐ Patient not eligible for

BMI calculation

G8938 ‐ BMI is calculated, but patient not

eligible for follow‐up plan




ACO Setup ACO 17

ACO 17



years and older



screened for tobacco

use at least once within

24 months and who

received tobacco

cessation counseling

intervention if identified

as a tobacco user

Setup Requirements:

Recording Tobacco Use:

Structured data in Social History > Tobacco Use > Smoking

> are you a: (Data Type: Structured ‐ single select):

Current Smoker

Former Smoker

Non‐Smoker

Current Everyday Smoker

Current Someday Smoker

Smoker current status unknown

Unknown if ever smoked

Structured data in Social History > Tobacco Use > Tobacco

Use Other than smoking > are you an other tobacco user:

(Data Type: Boolean)

AND

Recording Tobacco Cessation Counseling:

Structured data in Preventive Medicine > Counselling >

Smoking > Patient counselled on the dangers of tobacco

use and urged to quit > (Data Type: Date)


Communication to patient > Counselled the patient on

pregnancy smoking effects; education provided > (Data

Type: Date)



smoking cessation; education provided > (Data Type: Date)



smoking effects; education provided > (Data Type: Date)

(continued on next page)

Note: Tobacco Use

includes use of any type

of tobacco.

Cessation Counseling

Intervention includes

brief counseling (three

minutes or less) and/or

pharmacotherapy.


ACO Setup ACO 17

Numerator

(continued)



tobacco use; cessation provided > (Data Type: Date)


Communication to patient > Referral given to patient to a

stop‐smoking clinic > (Data Type: Date)


Communication to patient > Referral to smoking cessation

advisor was given to patient > (Data Type: Date)


Communication to patient > Smoking Cessation Assistance

Provided > (Data Type: Date)

CPT* II Codes: 4004F ‐ Patient screened for tobacco use AND

received tobacco cessation and intervention

Medications: Smoking cessation medications

Note: The numerator is satisfied by recording information for

both structured data options under Recording Tobacco Use

and, if applicable, recording one of the following: a structured

data option under Recording Tobacco Cessation Counseling, a

CPT II code, or a medication.



not screening for

tobacco use (e.g.,

limited life expectancy

or other medical

reasons)




not screened for

tobacco use during the

reporting period or year

prior.

CPT II Code: 4004F‐1P ‐ Documentation of medical reason(s)

for not screening for tobacco use (e.g., limited life expectancy,

other reason)




ACO Setup ACO 18

ACO 18



years and older at the

beginning of the

measurement period


Numerator Patients screened for

clinical depression

during the

measurement period

using an age

appropriate

standardized tool and, if

positive, have had a

follow‐up plan

documented on the

date of the positive

screen

Setup Requirements:

Depression Screening Structured Data:

Structured data in HPI > Depression Screening >

Intervention> Depression Screening Findings > (Data Type:

Structured ‐ single select):

Positive

Negative

Depression Screening Intervention Follow‐Up Structured Data:

Structured data in HPI > Depression Screening >

Intervention > Follow‐Up for Depression > (Data type:

Structured ‐ multi‐select):

Case management follow‐up

Completion of mental health crisis plan

Coping support assessment

Coping support management

Crisis intervention with follow‐up

Discharge by mental health primary care worker

Emotional support assessment

Emotional support education

Emotional support management

Implementation of measures to provide psychological

support

Management of mental health treatment

Mental health care assessment

Mental health care education

Mental health care management

Mental health history taking assessment



ACO Setup ACO 18

Numerator

(continued)

Mental health history taking education

Mental health history taking management

Mental health promotion assessment

Mental health promotion education

Mental health promotion management

Mental health screening assessment

Mental health screening education

Mental health screening management

Mental health treatment assessment

Mental health treatment education

Patient follow‐up to return when and if necessary

Psychiatric follow up

Note: A screening is

defined as the

completion of a clinical

or diagnostic tool used

to identify people at risk

of developing or having

a certain disease or

condition, even in the

absence of symptoms.

A Standardized Clinical

Depression Screening

Tool is defined as a

normalized and

validated depression

screening tool

developed for the

patient population

where it is being

utilized.

Depression Screening:

Smart Forms: PHQ2, PHQ9

ICD Code: V79.0

HCPCS Code: S3005

Screen‐and‐Plan Codes: G8510 ‐ Negative screen for

clinical depression, follow‐up not required

G8431 ‐ Positive screen for clinical depression with a

documented follow‐up plan

Positive for Clinical Depression:

Screen‐and‐Plan Code: G8431

Smart Form: PHQ9

Depression Follow‐Up Plan:

Screen‐and‐Plan Code: G8431

Medications:

Medispan ‐ Antidepressant medications

Multum ‐ Miscellaneous Antidepressant medications

Note: The numerator is satisfied by recording Depression

Screening structured data, recording a Smart Form, or an ICD/

HCPCS/Screen‐and‐Plan code under either the Depression

Screening or Positive for Clinical Depression sections, and, if

applicable, recording one of the following: a Depression

Screening Intervention Follow‐Up structured data option or

coding/medication under the Depression Follow‐Up Plan

section



ACO Setup ACO 18


medical or patient

reason(s) for not having

a screening for clinical

depression performed

during the reporting

period (e.g., patient is in

an urgent or emergent

medical situation where

time is of the essence

and to delay treatment

would jeopardize the

patient’s health status,

situations where the

patient’s functional

capacity or motivation

to improve may impact

the accuracy of results

of standardized

depression assessment

tools [e.g., certain court

appointed cases or cases

of delirium], or patient

has an active diagnosis

of depression or bipolar

disorder; patient refuses

to participate, etc.)




not receive a screening

for clinical depression

using an age

appropriate

standardized tool.

ICD Codes: Depression/Bipolar Dx codes

HCPCS Codes: G8940 ‐ Screening for clinical depression

documented, follow‐up plan not documented, patient not

eligible/appropriate

G8433 ‐ Screening for clinical depression not documented,

patient not eligible/appropriate



ACO Setup ACO 19

ACO 19



through 75 years


Numerator Patients who had at

least one or more

screenings for colorectal

cancer during or prior to

the reporting period

Setup Requirements:

Map the Colonoscopy diagnostic imaging test to the

community Colonoscopy ID from:

EMR > Community Mapping > DI > Colonoscopy

Note: Patients are

considered to have had

an appropriate

screening for colorectal

cancer if any of the

following are

documented:

Fecal occult blood

test (FOBT) within

the last 12 months

Flexible

sigmoidoscopy

during the reporting

period or the four

years prior to the

reporting period

Colonoscopy during

the reporting

period or the nine

years prior to the

reporting period

CPT* II Code: 3017F ‐ Colorectal cancer screening documented

and reviewed

Flexible Sigmoidoscopy:

CPT Codes: 45330, 45331, 45332, 45333, 45334, 45335,

45337, 45338, 45339, 45340, 45341, 45342, 45345

ICD Code: 45.24

Colonoscopy:

CPT Codes: 44388, 44389, 44390, 44391, 44392, 44393,

44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382,

45383, 45384, 45385, 45386, 45387, 45391, 45392

HCPCS Codes: G0105, G0121

ICD Codes: 45.22, 45.23, 45.25, 45.42, 45.43

Fecal Occult Blood Test:

LOINC Codes: 29771‐3, 2335‐8, 14563‐1, 14564‐9, 14565‐

6, 12503‐9, 12504‐7, 27401‐9, 27925‐7, 27926‐5, 27396‐1

CPT Codes: 82270, 82274

HCPCS Code: G0328

ICD Code: V76.51

Note: The numerator is satisfied by recording a colonoscopy,

flexible sigmoidoscopy, FOBT, CPT code, HCPCS code, ICD code,

or CPT II code.


ACO Setup ACO 19



not performing

colorectal cancer

screening (e.g., total

colectomy or other

medical reason)




not screened for

colorectal cancer.

ICD Codes: 45.81, 45.82, 45.83, 153.0, 153.1, 153.2, 153.3,

153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 197.5,

V10.05, V66.5

CPT Codes: 44150, 44151, 44152, 44153, 44155, 44156, 44157,

44158, 44210, 44211, 44212

CPT II Code: 3017F‐1P ‐ Colorectal cancer screening results not

documented and reviewed, medical reason




ACO Setup ACO 20

ACO 20


Denominator All female patients aged

40 through 69 years


Numerator Patients who had a

mammogram at least

once within 24 months

Setup Requirements:

Map the Mammogram diagnostic imaging test to the

community Mammogram ID from:

EMR > Community Mapping > DI > Mammogram Screening

EMR > Community Mapping > DI > Mammogram, Diagnostics

EMR > Community Mapping > DI > Mammogram, Uni Left

EMR > Community Mapping > DI > Mammogram, Uni Right

HCPCS Codes: G0202, G0204, G0206

ICD Codes: V76.11, V76.12, 87.36, 87.37

CPT* Codes: 77055, 77056, 77057

CPT II Code: 3014F ‐ Screening mammography results

documented and reviewed

Note: If using an ICD/CPT/HCPCS code to indicate a

mammogram was performed, documentation in the medical

record MUST also include a diagnostic imaging test for a

mammogram with both of the following documented:

The date the breast cancer screening was performed

The result of the findings

Note: The numerator is satisfied by recording a mammogram

diagnostic imaging test, a HCPCS code, an ICD code, a CPT

code, or a CPT II code.


ACO Setup ACO 20



not performing a

mammogram within 24

months (e.g., women

who had a bilateral

mastectomy or two

unilateral mastectomies)



apply if a mammogram

was not performed

within 24 months.

ICD Codes: 85.41, 85.42, 85.43, 85.44, 85.45, 85.46, 85.47,

85.48

CPT Codes: 19303, 19303‐50, 19304, 19304‐50, 19305, 19305‐

50, 19306, 19306‐50, 19307, 19307‐50

CPT II Codes: 3014F‐1P ‐ Screening mammography not

documented and not reviewed, medical reason




ACO Setup ACO 21

ACO 21


Denominator All patients aged 18 years and

older at the beginning of the

measurement period


Numerator Patients who were screened for

high blood pressure and a

recommended follow‐up plan is

documented as indicated if the

blood pressure is pre‐

hypertensive or hypertensive

Setup Requirements:

Configure the blood pressure vital from: EMR >

Vitals > Configure Vitals (Mandatory) > BP

(1) Structured data in Preventive Medicine >

Counseling > BP Management > Pre‐Hypertensive

BP Follow‐Up Plan (Type: Structured ‐ single select):

Follow‐Up 1 day

Follow‐Up 2‐3 days


Follow‐Up 1 week

Follow‐Up 2 weeks

Follow‐Up 3 weeks

Follow‐Up 1 month

Follow‐Up 6 weeks

Follow‐Up 2 ‐3 months


Follow‐Up 6 months


Follow‐Up 1 year



ACO Setup ACO 21

Numerator

(continued)


Counseling > BP Management > First Hypertensive

BP Follow‐Up Plan (Type: Structured ‐ single select):

Follow‐Up 1 day



Follow‐Up 1 week

Follow‐Up 2 weeks

Follow‐Up 3 weeks

Follow‐Up 1 month


Counseling > BP Management > Referral to

alternative/primary care provider > (Type:

Structured ‐ multiselect)

Urgent referral

Referral to general medical service

Referral to general practitioner

Referral to hypertension clinic

Referral to service

Referral to doctor

Referral to general physician


Counseling > BP Management > Physical Activity >

(Type: Structured ‐ multiselect)

Recommendation to exercise

Exercise education

Given encouragement to exercise

Exercise promotion: strength training

Exercise promotion: stretching

Nutrition therapy

Prescribed activity/exercise education

Exercises education, guidance, and counseling




ACO Setup ACO 21

Numerator

(continued)


Counseling > BP Management > Weight Reduction

Recommendation > (Type: Structured ‐ multiselect)

Follow‐up obesity assessment

Weight‐reducing diet education

Target weight discussed

Refer to weight management program

Weight control education


Counseling > BP Management > Dietary

Recommendation > (Type: Structured ‐ multiselect)

Patient referral to dietitian

Diet education

Dietary regime

Dietary prophylaxis

Low carbohydrate diet – prophylaxis

Low calorie diet – prophylaxis

Unsaturated fat diet – prophylaxis

Low fat diet education

Low carbohydrate diet education

Vegetarian diet education

Vegan diet education

Sugar‐free diet education

Dietary treatment for disorder

Obesity diet education

Dietary education for disorder

Referral to dietetics service

Prescribed dietary intake

Dietary needs education

Prescribed diet education

Dietary compliance education

Nutrition care education

Special diet education

Nutritionist education, guidance, and

counseling




ACO Setup ACO 21

Numerator

(continued)

Nutrition / feeding management

Feeding regime

Dietary management education, guidance, and

counseling

Lifestyle education regarding diet

Nutrition education


Counseling > BP Management > Moderation of

ETOH Consumption Recommendation > (Type:

Structured ‐ multiselect)

Alcoholism counseling

Patient referral for alcoholism rehabilitation

Referral to community alcohol team

Alcohol abuse prevention education

Counseling about alcohol consumption

Referral to community drug and alcohol team

Referral to specialist alcohol treatment service

BP Follow‐Up Plan:

Dietary Recommendations:

HCPCS Codes: S9452, S9470

ICD Codes: Z71.3, V65.3

Physical Activity Recommendation:

HCPCS Code: S9451

ICD Code: V65.41

Weight Management Classes:

HCPCS Code: S9449

Second Hypertensive Reading Interventions:

Map one of the following LOINC codes from EMR >

Labs/DI/Procedures > Labs: 24321‐2, 24323‐8,

24356‐6, 24362‐6, 2888‐6, 57021‐8, 57782‐5,

58410‐2, 80047, 80048, 80050, 80053, 80069

Medications: Anti‐Hypertensives

Map one of the following LOINC codes from EMR >

Labs/DI/Procedures > ECG: 11524‐6, 34534‐8




ACO Setup ACO 21

Numerator

(continued)

Note: No follow‐up is needed for a normal BP reading.

The following readings require follow‐ups:

Pre‐Hypertensive Reading ‐ Structured data (1) +

(one or more) Structured Data (4), (5), (6), (7) OR

Structured data (3) only

1st Hypertensive Reading ‐ Structured data (2) +

(one or more) Structured Data (4), (5), (6), (7) OR

Structured data (3) only

2nd Hypertensive Reading ‐ (one or more)

Structured data (4), (5), (6), (7) + (one or more)

(Anti‐Hypertensive Medications, Lab tests, or ECG)

OR Structured Data (3) only

Note: The numerator is satisfied by recording vitals and,

if applicable, one of the following: structured data, a

medication, a CPT II code, or an ICD code.

Exclusions Documentation of medical or

patient reason(s) for not

receiving screening for high

blood pressure (e.g., patient

has an active diagnosis of

hypertension, patient is in an

urgent or emergent situation

where time is of the essence

and to delay treatment would

jeopardize the patient’s health

status. This may include, but is

not limited to severely elevated

BP when immediate medical

treatment is indicated; patient

refuses BP measurement, etc.)


Note: Exclusions only apply if

the patient did not receive a

screening for high blood

pressure during the

measurement period.

ICD Codes: Hypertension Dx

HCPCS Codes: G8784 ‐ Blood pressure not documented,

patient not eligible/not appropriate

G8951 ‐ Pre‐hypertensive or hypertensive blood

pressure reading documented, indicated follow‐up not

documented, patient not eligible/not appropriate



ACO Setup ACO 22

ACO 22


Denominator Patients 18 to 75 years

of age with a diagnosis

of diabetes mellitus with

two or more face‐to‐

face visits for diabetes in

the last two years and at

least one visit for any

reason in the last 12

months


ICD Codes: Diabetes Dx

Numerator Patients with most

recent hemoglobin A1c

<8.0 percent

Setup Requirements:

The Hemoglobin A1c lab attribute must be mapped to one of

the following LOINC codes: 4548‐4, 4549‐2, 17856‐6

Note: Hemoglobin A1c lab should be ordered during the

reporting period. Lab results must be entered in the yellow

grid on the Lab Results window and the Received box must be

checked.

IMPORTANT! Do not enter special characters in the results

field. Only numbers and the percentage sign (%) are

recognized by the system when calculating measure

compliance.

Exclusions Diagnosis of polycystic

ovaries, gestational

diabetes or steroid‐

induced diabetes


ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, or

Steroid Induced Diabetes Dx


ACO Setup ACO 23

ACO 23










months




recent low density

lipoprotein <100 mg/dL

Setup Requirements:

Map the following LOINC codes to the LDL‐C lab attribute:

2089‐1, 12773‐8, 13457‐7, 18261‐8, 18262‐6, 22748‐8,

39469‐2, 49132‐4, 55440‐2

Map the following LOINC codes to the Total Cholesterol lab

attribute: 14647‐2, 2093‐3

Map the following LOINC codes to the Triglycerides lab

attribute: 12951‐0, 14927‐8, 2571‐8, 47210‐0

Map the following LOINC codes to the HDL lab attribute:

14646‐4, 18263‐4, 2085‐9

IMPORTANT! All four components of LDL, Total Cholesterol,

HDL, and Triglycerides must be linked to a corresponding LOINC

code and their values entered into the Lab Result window to

satisfy this measure.

Note: The LDL‐C lab should be ordered during the reporting

period. Lab results must be entered in the yellow grid on the

Lab Results window and the Received box must be checked.


field. Only numbers and mg/dL are recognized by the system

when calculating measure compliance.



diabetes or steroid

induced diabetes





ACO Setup ACO 24

ACO 24










months




recent blood pressure

<140/90 mmHg

Setup Requirements:

Configure the blood pressure vital from: EMR > Vitals >

Configure Vitals (Mandatory) > BP

Note: The BP value should be ordered during the reporting

period.

IMPORTANT! When entering a BP value on the Vitals window,

special characters should not be entered right next to numeric

values (e.g., BP 120/80 AH).

The only allowable special character is unit of measure mmHg.



diabetes or steroid

induced diabetes





ACO Setup ACO 25

ACO 25










months




identified as non‐users

of tobacco

Setup Requirements:

Structured data in Social History > Tobacco Use > Smoking

> are you a: > (Data Type: Structured ‐ single select):

Current Smoker

Former Smoker

Non‐Smoker

Current Everyday Smoker

Current Someday Smoker

Smoker current status unknown

Unknown if ever smoked

Structured data in Social History > Tobacco Use > Tobacco

Use Other than smoking > are you an other tobacco user: >

(Data Type: Boolean)

Note: The numerator is satisfied by recording information for

both structured data options.



diabetes or steroid

induced diabetes





ACO Setup ACO 26

ACO 26


Denominator Patients 18 to 75 years of age with a diagnosis of diabetes

mellitus with two or more face‐to‐face visits for diabetes in

the last two years and at least one visit for any reason in

the last 12 months and a diagnosis of ischemic vascular

disease

No eClinicalWorks setup

required.

ICD Codes: Diabetes Dx and

Ischemic Vascular Disease Dx

Numerator Patients with the diagnosis of diabetes and ischemic

vascular disease with documentation of taking daily aspirin

or antiplatelet medication or have a documented

contraindication in the measurement year


required.

ICD Codes: Diabetes Dx and

Ischemic Vascular Disease Dx

Note: The following are accepted contraindications for this

measure:

Anticoagulant use, Lovenox (enoxaparin) or Coumadin

(warfarin)

Any history of gastrointestinal (GI)* or intracranial

bleed (ICB)

Allergy to aspirin (ASA)

Gastroesophogeal reflux disease (GERD) is not

automatically considered a contraindication but may

be included if specifically documented as a

contraindication by the physician.

The following may be exclusions if specifically documented

by the physician:

Use of non‐steroidal anti‐inflammatory agents

Documented risk for drug interaction

Uncontrolled hypertension defined as 180 systolic, 110

diastolic

Other provider documented reason for not being on

ASA therapy

Note: The numerator is

satisfied by recording an ICD

code and a medication.


ACO Setup ACO 26

Exclusions Patients may be excluded for one of the following reasons:

Diagnosis of polycystic ovaries, gestational diabetes or

steroid induced diabetes


required.

ICD Codes: Polycystic Ovaries

Dx, Gestational Diabetes Dx,

or Steroid Induced Diabetes

Dx

CPT* II Code: 4086F‐1P ‐

Documentation of medical

reason(s) for not prescribing

Aspirin or Clopidogrel

Note: This exclusion only applies if the patient was

not prescribed daily aspirin or antiplatelet

medication.

Documentation of medical reason(s) for not

prescribing daily aspirin or antiplatelet medication




ACO Setup ACO 27

ACO 27


Denominator Patients aged 18

through 75 years with

the diagnosis of

diabetes




recent hemoglobin A1c

level >9.0%

Setup Requirements:

Map one of the following LOINC codes to the Hemoglobin A1c

lab attribute: 4548‐4, 4549‐2, 17856‐6

Note: The Hemoglobin A1c lab should be ordered during the

reporting period. Lab results must be entered in the yellow

grid on the Lab Results window and the Received box must be

checked.


field. Only numbers and the percentage sign (%) are

recognized by the system when calculating measure

compliance.



diabetes or steroid

induced diabetes


ICD Codes: Polycystic Ovaries Dx, Gestational Diabetes Dx, and



ACO Setup ACO 28

ACO 28


Denominator Patients aged 18

through 85 years with

the diagnosis of

hypertension


ICD Codes: 362.11, 401, 401.1, 401.9, 402.00, 402.01, 402.10,

402.11, 402.90, 402.91, 403.00, 403.01, 403.10, 403.11, 403.90,

403.91, 404.00, 404.01, 404.02, 404.03, 404.10, 404.11,

404.12, 404.13, 404.90, 404.91, 404.92, 404.93, 405.01,

405.09, 405.11, 405.19, 405.91, 405.99

Numerator Patients whose most

recent blood pressure

<140/90 mmHg

Setup Requirements:

Configure the blood pressure vital from: EMR > Vitals >

Configure Vitals (Mandatory) > BP

Note: The BP value should be ordered during the reporting

period.

IMPORTANT! When entering a BP value on the Vitals window,

special characters should not be entered right next to numeric

values (e.g., BP 120/80 AH).

The only allowable special character is unit of measure mmHg.



not recording a blood

pressure measurement

(diagnosis for End‐Stage

Renal Disease [ESRD]

and pregnancy are the

only acceptable

exclusions)




not receive a blood

pressure measurement.

ICD Codes: ESRD Dx and Pregnancy Dx

CPT Codes: ESRD related procedures

HCPCS Codes: G0257 (UNSCHD/EMERG DIALYSIS TX), S9339

(ESRD PT HOS OP NOT CERT)


ACO Setup ACO 29

ACO 29


Denominator Patients aged 18 years

and older with the

diagnosis of ischemic

vascular disease, or who

were discharged alive

for acute myocardial

infarction (AMI),

coronary artery bypass

graft (CABG) or

percutaneous coronary

interventions (PCI)


ICD Codes: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51,

410.61, 410.71, 410.81, 410.91, 411, 411.1, 411.81, 411.89,

412, 413, 413.1, 413.9, 414, 414.01, 414.02, 414.03, 414.04,

414.05, 414.06, 414.07, 414.2, 414.3, 414.8, 414.9, 429.2, 433,

433.01, 433.1, 433.11, 433.2, 433.21, 433.3, 433.31, 433.8,

433.81, 433.9, 433.91, 434, 434.01, 434.1, 434.11, 434.9,

434.91, 440, 440.1, 440.2, 440.21, 440.22, 440.23, 440.24,

440.29, 440.4, 444, 444.01, 444.09, 444.1, 444.21, 444.22,

444.81, 444.89, 444.9, 445.01, 445.02, 445.81, 0.66, 36.06,

36.07, 36.09, 36.1, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16,

36.17, 36.19, 36.2

CPT* Codes: 33510, 33511, 33512, 33513, 33514, 33516,

33517, 33518, 33519, 33140, 33521, 33522, 33523, 33533,

33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937,

92941, 92943

HCPCS Codes: S2205, S2206, S2207, S2208, S2209

Note: The denominator is satisfied by recording an ICD code, a

CPT code, or a HCPCS code.


ACO Setup ACO 29

Numerator Patients who received at

least one lipid profile (or

ALL component tests)

with most recent LDL‐C

<100 mg/dL

Setup Requirements:

Map the following LOINC codes to the LDL‐C lab attribute:

2089‐1, 12773‐8, 13457‐7, 18261‐8, 18262‐6, 22748‐8,

39469‐2, 49132‐4, 55440‐2


attribute: 14647‐2, 2093‐3


attribute: 12951‐0, 14927‐8, 2571‐8, 47210‐0


14646‐4, 18263‐4, 2085‐9

IMPORTANT! All four components of LDL, Total Cholesterol,

HDL, and Triglycerides must be linked to a corresponding LOINC

code and their values entered into the Lab Result window to

satisfy this measure.

Note: Lipid Panel includes an LDL‐C lab should be ordered

during the reporting period. Lab results must be entered in the

yellow grid on the Lab Results window and the Received box

must be checked.


field. Only numbers and mg/dL are recognized by the system

when calculating measure compliance.




ACO Setup ACO 30

ACO 30


Denominator Patients aged 18 years

and older with the

diagnosis of ischemic

vascular disease, or who

were discharged alive

for acute myocardial

infarction (AMI),

coronary artery bypass

graft (CABG) or

percutaneous coronary

interventions (PCI)


ICD Codes: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51,

410.61, 410.71, 410.81, 410.91, 411, 411.1, 411.81, 411.89,

412, 413, 413.1, 413.9, 414, 414.01, 414.02, 414.03, 414.04,

414.05, 414.06, 414.07, 414.2, 414.3, 414.8, 414.9, 429.2, 433,

433.01, 433.1, 433.11, 433.2, 433.21, 433.3, 433.31, 433.8,

433.81, 433.9, 433.91, 434, 434.01, 434.1, 434.11, 434.9,

434.91, 440, 440.1, 440.2, 440.21, 440.22, 440.23, 440.24,

440.29, 440.4, 444, 444.01, 444.09, 444.1, 444.21, 444.22,

444.81, 444.89, 444.9, 445.01, 445.02, 445.81, 0.66, 36.06,

36.07, 36.09, 36.1, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16,

36.17, 36.19, 36.2

CPT* Codes: 33510, 33511, 33512, 33513, 33514, 33516,

33517, 33518, 33519, 33140, 33521, 33522, 33523, 33533,

33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937,

92941, 92943

HCPCS Codes: S2205, S2206, S2207, S2208, S2209


Note: The denominator is satisfied by recording an ICD code, a

CPT code, or a HCPCS code.

Numerator Patients who are using

aspirin or another

antithrombotic therapy



ACO Setup ACO 31

ACO 31



years and older with a

diagnosis of heart

failure with a current or

prior LVEF <40%

Setup Requirements:

Structured data in HPI > Echocardiogram > Left ventricular

assessment > Result (%) (Data Type: Number)

OR

Structured data in HPI > Echocardiogram > Ejection fraction

> Result (%) (Data Type: Number)

ICD Codes: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11,

404.13, 404.91, 404.93, 428, 428.1, 428.2, 428.21, 428.22,

428.23, 428.3, 428.31, 428.32, 428.33, 428.4, 428.41, 428.42,

428.43, 428.9

CPT* Codes: 78414, 78451, 78452, 78453, 78454, 78468,

78472, 78473, 78481, 78483, 78494, 78496, 93303, 93304,

93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316,

93317, 93350, 93351, 93352, 93452, 93453, 93458, 93459,

93460, 93461

HCPCS Codes: G8923 ‐ Left ventricular ejection fraction (LVEF)

<40% or documentation of moderately or severely depressed

left ventricular systolic function

G8934 ‐ Left ventricular ejection fraction (LVEF) <40% or

documentation of moderately or severely depressed left

ventricular systolic function

Note: Both Heart Failure Diagnosis and LVEF % must be

documented for the denominator

Note: The denominator is satisfied by recording structured data

information, an ICD code, a CPT code, or a HCPCS code.


prescribed beta‐blocker

therapy either within a

12 month period when

seen in the outpatient

setting OR at EACH

hospital discharge



ACO Setup ACO 31


medical, patient, or

system reason(s) for not

prescribing beta‐blocker

therapy (e.g., low blood

pressure, fluid overload,

asthma, patients

recently treated with an

intravenous positive

inotropic agent, allergy,

intolerance, other

medical reasons; patient

declined; other reasons

attributable to the

healthcare system, etc.)




not prescribed beta‐

blocker therapy.

ICD Codes: 337.09, 427.81, 427.89, 458.0, 458.1, 458.21,

458.29, 458.8, 458.9, 493.00, 493.01, 493.02, 493.10, 493.11,

493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90,

493.91, 493.92, 440.0, 426.0, 426.12, 426.13, V45.01

CPT II Codes: 4008F‐1P ‐ Beta‐Blocker therapy not prescribed

or being currently taken, medical reason

4008F‐2P ‐ Beta‐Blocker therapy not prescribed or being

currently taken, patient reason

4008F‐3P ‐ Beta‐Blocker therapy not prescribed or being

currently taken, system reason




ACO Setup ACO 32

ACO 32


Denominator All patients aged

18 years and older

with a diagnosis of

coronary artery

disease seen within

a 12 month period


ICD Codes: 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20,

410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42,

410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71,

410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 411, 411.1,

411.81, 411.89, 412, 413, 413.1, 413.9, 414, 414.01, 414.02, 414.03,

414.04, 414.05, 414.06, 414.07, 414.2, 414.3, 414.8, 414.9, V45.81,

V45.82

CPT* Codes: 33140, 33510, 33511, 33512, 33513, 33514, 33516,

33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535,

33536, 92980, 92981, 92982, 92984, 92995, 92996

Note: The denominator is satisfied by recording an ICD code or a

CPT code.


ACO Setup ACO 32

Numerator Patients who have

an LDL‐C result

<100 mg/dL OR

patients who have

an LDL‐C result

>=100 mg/dL AND

have a

documented plan

of care to achieve

LDL‐C <100 mg/dL,

including at a

minimum the

prescription of a

statin

Setup Requirements:

Map one of the following LOINC codes to the LDL‐C lab

attribute: 2089‐1, 2090‐9, 2091‐7, 2092‐5, 2569‐2, 3046‐0,

3047‐8, 12773‐8, 13457‐7, 13458‐5, 14155‐6, 16615‐7, 16616‐

5, 18261‐8, 18262‐6, 22748‐8, 24331‐1, 25371‐6, 35198‐1,

35199‐9, 39469‐2, 39229‐0, 49132‐4, 55440‐2


attribute: 14647‐2, 2093‐3


attribute: 12951‐0, 14927‐8, 2571‐8, 47210‐0


14646‐4, 18263‐4, 2085‐9

Structured data in Preventive Medicine > Intervention/High

Risk > Coronary Artery Disease: Lipid Control > Plan of care to

bring LDL‐C under control > (Data Type: Structured ‐

multiselect):

Discussed lifestyle modification(s) (diet and exercise)

Scheduled re‐assessment of LDL‐C

Medications: Statins

IMPORTANT! The documented plan of care MUST include, at a

minimum, the prescription of a Statin medication. It may also

include the documentation of lifestyle modifications or a scheduled

reassessment of LDL‐C.

Note: The LDL‐C lab should be ordered during the reporting period.

Lab results must be entered in the yellow grid on the Lab Results

window and the Received box must be checked.

IMPORTANT! Do not enter special characters in the results field.

Only numbers and mg/dL are recognized by the system when

calculating measure compliance.

Note: The numerator is satisfied by recording a lab and, if

applicable, a statin medication and/or structured data.

IMPORTANT! All four components of LDL, Total Cholesterol, HDL,

and Triglycerides must be linked to a corresponding LOINC code and

their values entered into the Lab Result window to satisfy this

measure.



ACO Setup ACO 32



system reason(s)

for not prescribing

statin therapy (e.g.,

allergy, intolerance

to statin

medication(s),

other medical

reasons; patient

declined; financial

reasons, etc.)


Note: Exclusions

only apply if the

patient was not

prescribed statin

therapy.

CPT II Codes: 4013F‐1P ‐ Documentation of medical reason(s) for

statin therapy not prescribed or currently being taken

4013F‐2P ‐ Documentation of patient reason(s) for statin therapy

not prescribed or currently being taken

4013F‐3P ‐ Documentation of system reason(s) for statin therapy

not prescribed or currently being taken




ACO Setup ACO 33

ACO 33




diagnosis of coronary

artery disease seen

within a 12 month

period who also have a

current or prior LVEF

<40%

OR

All patients aged 18


diagnosis of coronary

artery disease seen

within a 12 month

period who also have a

diagnosis of diabetes

Setup Requirements:

Structured data in HPI > Echocardiogram > Left ventricular

assessment > Result (%) > (Data Type: Number)

ICD Codes: 410.00, 410.01, 410.02, 410.10, 410.11, 410.12,

410.20, 410.21, 410.22, 410.30, 410.31, 410.32, 410.40,

410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62,

410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90,

410.91, 410.92, 411, 411.1, 411.81, 411.89, 412, 413, 413.1,

413.9, 414, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06,

414.07, 414.2, 414.3, 414.8, 414.9, V45.81, V45.82, 250.00,

250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20,

250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40,

250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60,

250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80,

250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93,

CPT* Codes: 33140, 33510, 33511, 33512, 33513, 33514,

33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533,

33534, 33535, 33536, 92980, 92981, 92982, 92984, 92995,

92996, 78414, 78451, 78452, 78453, 78454, 78468, 78472,

78473, 78481, 78483, 78494, 78496, 93303, 93304, 93306,

93307, 93308, 93312, 93313, 93314, 93315, 93317, 93350,

93351, 93352, 93452, 93453, 93458, 93459, 93460, 93461

HCPCS Codes: G8934 ‐ Left Ventricular Ejection Fraction (LVEF)

<40% or documentation of moderately or severely depressed

left ventricular systolic function

G8923 ‐ Left Ventricular Ejection Fraction (LVEF) <40% or

documentation of moderately or severely depressed left

ventricular systolic function

Note: The denominator can be satisfied using any of the

following methods:

record structured data and an ICD or CPT code

record an ICD or CPT code and a HCPCs Code

record an ICD or CPT code


ACO Setup ACO 33


prescribed ACE inhibitor

or ARB therapy




system reason(s) for not

prescribing ACE or ARB

therapy (e.g., allergy,

intolerance, patient

declined, lack of drug

availability, etc.)




not prescribed ACE or

ARB therapy.

ICD Codes: 395.0, 395.2, 396.0, 396.2, 396.8, 403.01, 403.11,

403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 440.1,

584.5, 584.6, 584.7, 584.8, 584.9, 585.1, 585.2, 585.3, 585.4,

585.5, 585.6, 586, 440.0, 747.22, 788.5, V56.0, V56.8, 39.95,

54.98, 249.00, 249.01, 249.10, 249.11, 249.20, 249.21, 249.30,

249.31, 249.40, 249.41, 249.50, 249.51, 249.60, 249.61, 249.70,

249.71, 249.80, 249.81, 249.90, 249.91, 251.8, 256.4, 648.80,

648.81, 648.82, 648.83, 648.84, 962.0, Pregnancy Dx codes

CPT II Codes: 4010F‐1P ‐ ACE/ARB therapy not prescribed or

being currently taken, medical reason

4010F‐2P ‐ ACE/ARB therapy not prescribed or being currently

taken, patient reason

4010F‐3P ‐ ACE/ARB therapy not prescribed or being currently

taken, system reason





APPENDIX A: NOTICES

TrademarkseClinicalWorks®

eClinicalWorks is a registered trademark of eClinicalWorks, LLC. All other trademarks or service marks

contained herein are the property of their respective owners.

LOINC®

LOINC is a registered trademark

CopyrightCPT Copyright Notice

CPT only © 2012 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by

the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not

directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for

data contained or not contained herein.

CPT® is a registered trademark of the American Medical Association

Documents

eClinicalWorks ACO Quick-Reference Setup Guide...eClinicalWorks ACO Quick-Reference Setup Guide ... aco