Merit-based Incentive Payment System (MIPS) Value Pathway G0054 is titled “Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes,” and it focuses on the clinical theme of providing fundamental prevention and treatment of those patients at risk for or that have had a stroke. One of the Quality Measures (QM) that may be reported for MVP G0054 is QM 187, which is titled “Stroke and Stroke Rehabilitation: Thrombolytic Therapy.”
Measure QM 187 is to be submitted for each episode of acute ischemic stroke for patients (aged 18 years and older) who arrive at the hospital within 3.5 hours of time last known well and for whom intravenous (IV) thrombolytic therapy was initiated within 4.5 hours of time last known well. It is anticipated that MIPS eligible clinicians providing care for patients with acute ischemic stroke in the hospital setting will submit this measure.
The denominator options included in the QM 187 specification are used to submit the quality actions allowed by the measure, and the eligible denominator criteria include the following stroke ICD-10-CM diagnosis codes:
Code | Description |
I63.00 | Cerebral infarction due to thrombosis of unspecified precerebral artery |
I63.011 | Cerebral infarction due to thrombosis of right vertebral artery |
I63.012 | Cerebral infarction due to thrombosis of left vertebral artery |
I63.013 | Cerebral infarction due to thrombosis of bilateral vertebral arteries |
I63.019 | Cerebral infarction due to thrombosis of unspecified vertebral artery |
I63.02 | Cerebral infarction due to thrombosis of basilar artery |
I63.031 | Cerebral infarction due to thrombosis of right carotid artery |
I63.032 | Cerebral infarction due to thrombosis of left carotid artery |
I63.033 | Cerebral infarction due to thrombosis of bilateral carotid arteries |
I63.039 | Cerebral infarction due to thrombosis of unspecified carotid artery |
I63.09 | Cerebral infarction due to thrombosis of other precerebral artery |
I63.10 | Cerebral infarction due to embolism of unspecified precerebral artery |
I63.111 | Cerebral infarction due to embolism of right vertebral artery |
I63.112 | Cerebral infarction due to embolism of left vertebral artery |
I63.113 | Cerebral infarction due to embolism of bilateral vertebral arteries |
I63.119 | Cerebral infarction due to embolism of unspecified vertebral artery |
I63.12 | Cerebral infarction due to embolism of basilar artery |
I63.131 | Cerebral infarction due to embolism of right carotid artery |
I63.132 | Cerebral infarction due to embolism of left carotid artery |
I63.133 | Cerebral infarction due to embolism of bilateral carotid arteries |
I63.139 | Cerebral infarction due to embolism of unspecified carotid artery |
I63.19 | Cerebral infarction due to embolism of other precerebral artery |
I63.20 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries |
I63.211 | Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery |
I63.212 | Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery |
I63.213 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries |
I63.219 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery |
I63.22 | Cerebral infarction due to unspecified occlusion or stenosis of basilar artery |
I63.231 | Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries |
I63.232 | Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries |
I63.233 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries |
I63.239 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery |
I63.29 | Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries |
I63.30 | Cerebral infarction due to thrombosis of unspecified cerebral artery |
I63.311 | Cerebral infarction due to thrombosis of right middle cerebral artery |
I63.312 | Cerebral infarction due to thrombosis of left middle cerebral artery |
I63.313 | Cerebral infarction due to thrombosis of bilateral middle cerebral arteries |
I63.319 | Cerebral infarction due to thrombosis of unspecified middle cerebral artery |
I63.321 | Cerebral infarction due to thrombosis of right anterior cerebral artery |
I63.322 | Cerebral infarction due to thrombosis of left anterior cerebral artery |
I63.323 | Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries |
I63.329 | Cerebral infarction due to thrombosis of unspecified anterior cerebral artery |
I63.331 | Cerebral infarction due to thrombosis of right posterior cerebral artery |
I63.332 | Cerebral infarction due to thrombosis of left posterior cerebral artery |
I63.333 | Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries |
I63.339 | Cerebral infarction due to thrombosis of unspecified posterior cerebral artery |
I63.341 | Cerebral infarction due to thrombosis of right cerebellar artery |
I63.342 | Cerebral infarction due to thrombosis of left cerebellar artery |
I63.343 | Cerebral infarction due to thrombosis of bilateral cerebellar arteries |
I63.349 | Cerebral infarction due to thrombosis of unspecified cerebellar artery |
I63.39 | Cerebral infarction due to thrombosis of other cerebral artery |
I63.40 | Cerebral infarction due to embolism of unspecified cerebral artery |
I63.411 | Cerebral infarction due to embolism of right middle cerebral artery |
I63.412 | Cerebral infarction due to embolism of left middle cerebral artery |
I63.413 | Cerebral infarction due to embolism of bilateral middle cerebral arteries |
I63.419 | Cerebral infarction due to embolism of unspecified middle cerebral artery |
I63.421 | Cerebral infarction due to embolism of right anterior cerebral artery |
I63.422 | Cerebral infarction due to embolism of left anterior cerebral artery |
I63.423 | Cerebral infarction due to embolism of bilateral anterior cerebral arteries |
I63.429 | Cerebral infarction due to embolism of unspecified anterior cerebral artery |
I63.431 | Cerebral infarction due to embolism of right posterior cerebral artery |
I63.432 | Cerebral infarction due to embolism of left posterior cerebral artery |
I63.433 | Cerebral infarction due to embolism of bilateral posterior cerebral arteries |
I63.439 | Cerebral infarction due to embolism of unspecified posterior cerebral artery |
I63.441 | Cerebral infarction due to embolism of right cerebellar artery |
I63.442 | Cerebral infarction due to embolism of left cerebellar artery |
I63.443 | Cerebral infarction due to embolism of bilateral cerebellar arteries |
I63.449 | Cerebral infarction due to embolism of unspecified cerebellar artery |
I63.49 | Cerebral infarction due to embolism of other cerebral artery |
I63.50 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery |
I63.511 | Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery |
I63.512 | Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery |
I63.513 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries |
I63.519 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery |
I63.521 | Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery |
I63.522 | Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery |
I63.523 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries |
I63.529 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery |
I63.531 | Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery |
I63.532 | Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery |
I63.533 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries |
I63.539 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery |
I63.541 | Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery |
I63.542 | Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery |
I63.543 | Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries |
I63.549 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery |
I63.59 | Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery |
I63.6 | Cerebral infarction due to cerebral venous thrombosis, nonpyogenic |
I63.81 | Other cerebral infarction due to occlusion or stenosis of small artery |
I63.89 | Other cerebral infarction |
I63.9 | Cerebral infarction, unspecified |
DOCUMENTATION GUIDELINES:
The clinical documentation for patients diagnosed with a non-traumatic cerebral infarction should include the following:
- Timeline of the infarction
- Tissue Plasminogen Activator (tPa) Administration:
- Facility where administered (local or referring)
- Time started
- Etiology of the infarction:
- Embolism
- Occlusion
- Stenosis
- Thrombosis – arterial
- Thrombosis – central venous, nonpyogenic
- Surgical Intervention
- Specific name/title of surgical intervention
- Cause-and-effect relationship between surgery and infarction
- Intraoperative or Postoperative infarction
- Site(s) of infarction:
- Anterior cerebral artery
- Basilar artery
- Carotid artery
- Cerebellar artery
- Lacunar
- Middle cerebral artery
- Posterior cerebral artery
- Vertebral artery
- Other artery: specify
- Laterality of infarction site(s)
- Left
- Right
- Bilateral
- Hand Preference:
- Ambidextrous
- Left-hand dominant
- Right-hand dominant
- National Institutes of Health Stroke Scale (NIHSS) Score, which is based on:
- Level of consciousness
- Best gaze with horizontal eye movement
- Extinction/inattention
- Face symmetry
- If patient knows the month and own age
- Language dysarthria
- Limb ataxia
- Motor function of each extremity
- Sensory to skin prick
- Visual field testing
- Whether patient can respond to commands to open and close eyes.
- Manifestations of current infarction:
- Alteration in sensation
- Apraxia
- Ataxia
- Cognitive deficits
- Attention/concentration
- Cognitive social/emotional
- Frontal lobe/executive function
- Memory
- Psychomotor
- Visuospatial/spatial neglect
- Other: specify
- Disturbance of vision: specify
- Dysphagia
- Facial Droop/Weakness
- Hemiplegia/hemiparesis
- Laterality
- Dominant Side
- Non-Dominant Side
- Monoplegia/monoparesis
- Lower limb
- Upper limb
- Laterality
- Dominant Side
- Non-Dominant Side
- Other Paralytic Syndrome: specify
- Laterality
- Dominant Side
- Non-Dominant Side
- Quadriparesis (for patients who have had multiple strokes) 1
- Speech/language deficits
- Aphasia
- Dysarthria
- Dysphasia
- Fluency disorder
- Other: specify
- Other Deficit(s): specify
CODING GUIDELINES:
- “Aborted” cerebrovascular infarction is coded as a cerebrovascular infarction in ICD-10-CM.
- NIHSS scores may be compliantly reported with ICD-10-CM codes (R29.700 – R29.742) based on nonphysician documentation, such as emergency medical technicians (EMTs) or nurses.
For more information download the MVP G0054, the QM187 MIPS CQM Specification, the ICD-10-CM Official Guidelines for Coding and Reporting, and/or contact LolitaMJ@iQueryData.com.
1BERNARD, S. P. (2020). Risk adjustment documentation & coding (2nd ed.). AMER MEDICAL Association.