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Reporting/Attestation
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Resolution: Delivered
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Minor
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None
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None
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Conflicting measure specifications can lead to incorrect measure statuses when QRDA-I is generated for one of the VTE measures that requires a non-principal or principal diagnosis (VTE 3-5) and VTE-6 (which requires a principal diagnosis).
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VTE-5 (CMS-100) requires a patient to have any VTE diagnosis in order to qualify for the IPP. This can be principal or non-principal VTE. VTE-6 (CMS-114) requires a patient to have a non-principal diagnosis of VTE in order to qualify for the IPP.
Let's look at the following scenario, both encounters are in the same reporting period:
Encounter #1: Patient has a principal VTE diagnosis
Encounter #2: Patient has a non-principal VTE diagnosis
If a QRDA-I document is generated for VTE-5, hospital encounters 1 and 2 will both populate in the document. For encounter 1, can we include the attribute for Principal Diagnosis even though it is not listed as a QDM data element?
If we cannot include the attribute for Principal Diagnosis if were are testing VTE-5 by itself, this presents a larger issue if we generate a QRDA-I document for VTE-5 and VTE-6. The document generated would contain data from hospital encounter 1 with no principal diagnosis documented for VTE and data from hospital encounter 2 with a principal diagnosis for VTE. Upon processing of this document, it would now appear that hospital encounter 1 incorrectly qualifies for VTE-6 IPP due to the omission of the Principal Diagnosis attribute.