Measure 23 – Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)

Audit Criteria

When we’re reviewing your clinicians’ data, it may be helpful to know what we are looking for in order for us to verify to CMS that your data is accurate and complete. Measure 23 requires documentation of an order (written, verbal, or standing) for a pharmacologic or manual venous thromboembolism prophylaxis for one of the denominator procedures included in the measure.

This documentation may be found in the operative report, physician’s notes, hospital or practice policies, nurse’s notes, hospital pharmacy orders, etc. The relevant document should be made available to the auditor for the patient requested.


What is a venous thromboembolism (VTE) prophylaxis?

A VTE prophylaxis is a drug or device meant to prevent the development of venous thromboembolism (VTE). The risk of VTE is estimated to be 20% for general surgical patients and 30% for patients undergoing colorectal procedures.[1] Below is a list of devices and pharmacologic interventions that qualify as a VTE prophylaxis and should be listed in the documentation:

  • Mechanical Devices
    • Graduated Compression Stockings
    • Intermittent Pneumatic Compression Devices
      • Graduated Sequential Compression Devices
      • Uniform Compression Devices
    • Pharmacologic Interventions
      • Low-Dose Unfractionated Heparin
      • Low-Molecular-Weight Heparin
        • Enoxaparin
        • Dalteparin
        • Tinzaparin
      • Fondaparinux


[1] McLeod R S, Geerts W H, Sniderman K W. et al.Canadian Colorectal Surgery DVT Prophylaxis Trial investigators . Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg. 2001;233(3):438–444.