HCC Best Practice: Congestive Heart Failure/Cardiomyopathy

HCC Best Practice Advisory: CHF/Cardiomyopathy

To assist you in identifying patients with a potential CHF/cardiomyopathy (HCC 85) diagnosis, OHN’s Clinical Documentation Excellence(CDE) team, in collaboration with clinical leaders, have created a logic model within the HCC Best Practice Advisory (BPA) tool. The model considers a combination of medications, echo results, EKG results, symptoms, physical exam findings and lab tests to find potential diagnoses and present these within the BPA to providers.

HCC85 CHF/Cardiomyopathy Logic Process Explained

Criteria must include items 1, 2 and 3; at least one in 4 through 7; and 8.

1. Last EF < 45%
2. Cardiomyopathy in the problem list
3. Problem list reviewed last year
4. Abnormal echo in the past three years
5. Abnormal basic metabolic panel in the past three years
6. Abnormal EKG in the past three years
7. Active prescription in the ACE inhibitor or ARB medication class
8. Any of the following symptoms documented in the last three years

• Orthopnea
• Paroxysmal nocturnal dyspnea (PND)
• Dyspnea
• Dyspnea on exertion
• Leg swelling
• Rales/crackles
• Breath sounds normal
• Edema
• Gallop rhythm