Sequence 10116, Cardiac Rehab Referral, is indicating if a cardiac rehab referral was provided on discharge. The program may include a traditional cardiac rehab program based on face-to-face interactions and training sessions, or may include other options such as home-based approaches. Cardiac rehab services have been shown to help reduce morbidity and mortality in persons who have experienced a recent coronary event, but these services are used in less than 30% of eligible patients. A key component to outpatient cardiac rehab program utilization is the appropriate and timely referral of patients, and generally the most important time for this referral to take place is while the patient is still hospitalized for a qualifying event or diagnosis. This would be coded when there is documented communication between the healthcare provider and the patient to recommend an outpatient cardiac rehab program, and either an official referral order was sent to the rehab program, all this information required for enrollment should be transmitted to the program and maintain HIPAA compliancy, or if there is documentation of patient refusal to justify why the information was not sent to the cardiac rehab program. So basically, performance would be met and yes would be selected if steps 1 and either 2A or 2B are met. When neither criteria to select yes are evidence to have occurred, and there is no documented medical, patient, or healthcare system reason why such a referral was not made on discharge to satisfy the target value, no reason not documented would be coded. Additionally, reasons cannot be assumed nor correlated. Reasons must be explicitly documented. When a patient has been deemed by a medical professional to have a medically unstable life-threatening condition or has other cognitive or physical impairments that preclude cardiac rehab participation on discharge, no medical reason would be documented. When a patient has been discharged to a nursing care facility or a long-term care facility or the patient lacks medical coverage for cardiac rehab to satisfy the target value, no healthcare system reason would be coded. Keep in mind that reasons cannot be assumed nor correlated. In other words, to code no healthcare system reason documented, there must be explicit documentation making that connection. So as an example, a cardiac rehab referral not provided due to a patient being discharged to a skilled nursing facility on discharge would support coding this. When the patient has no traditional cardiac rehab program available within a 60-minute travel time from their home or the patient does not have access to an alternative model of cardiac rehab delivery that meets all criteria, no patient-oriented reason would be coded. Keep in mind that reasons cannot be assumed nor correlated. So in other words, in order to code no patient-oriented reason, there must be explicit documentation making that connection. So for example, documentation stating cardiac rehab referral not provided due to no traditional cardiac rehab program available to the patient within a 60-minute travel time from their home would support coding this.

cardiac rehab referrals

morbidity and mortality reduction

hospital discharge

timely referral

documentation