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  1. QRDA Issue Tracker
  2. QRDA-184

Conflicting measure specs can lead to incorrect statuses if QRDA is ran for VTE-5 and VTE-6

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    • Resolution: Delivered
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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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      When submit QRDA-I reports for eCQMs, the reports should contain all data that are needed to perform measure calculation as specified by these eCQMs. The QRDA-I standard does not preclude containing some additional data in the QRDA-I reports, in your scenario, to include Principal attribute in Diagnosis Active though VTE-5 does not specifically require the Principal QDM attribute in its eCQM specification.
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      When submit QRDA-I reports for eCQMs, the reports should contain all data that are needed to perform measure calculation as specified by these eCQMs. The QRDA-I standard does not preclude containing some additional data in the QRDA-I reports, in your scenario, to include Principal attribute in Diagnosis Active though VTE-5 does not specifically require the Principal QDM attribute in its eCQM specification.

      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.

            yanheras Yan Heras
            mbozile Matt Bozile (Inactive)
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