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  2. CQM-1000

Need understanding for denominator exclusion and numerator criteria in CMS2

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      The guidance should be followed and the depression screening should occur on the same day as the encounter. However QDM limitations made it difficult to express this in the logic. The intent of the measure is to screen once during the year even if there are multiple qualifying encounters. For this reason the logic for numerator criteria and exclusions were set around the risk category assessment rather than the encounter (of which there could be more than one).
       Ideally the logic would more closely follow the guidance. This will be reviewed and possibly updated at the next available opportunity.
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      The guidance should be followed and the depression screening should occur on the same day as the encounter. However QDM limitations made it difficult to express this in the logic. The intent of the measure is to screen once during the year even if there are multiple qualifying encounters. For this reason the logic for numerator criteria and exclusions were set around the risk category assessment rather than the encounter (of which there could be more than one).  Ideally the logic would more closely follow the guidance. This will be reviewed and possibly updated at the next available opportunity.
    • CMS2v1/NQF0418

      The guidance says for denominator exclusion 'patients with an active diagnosis for Depression or a diagnosis of Bipolar Disorder' should be excluded,but it does not specify whether the diagnosis is to be checked on the date of encounter or on the day when risk category assessment was done.
      Whereas as per the population criteria,
      AND NOT: "Occurrence A of Diagnosis, Active: Depression diagnosis" ends before start of "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')"
      AND: "Occurrence A of Diagnosis, Active: Depression diagnosis" starts before start of "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')"
      which clearly states that the diagnosis should start before the risk category assessment and end after it.
      Also as per the guidance the numerator criteria says that 'Patients screened for clinical depression on the date of the encounter using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screen',which means that the patient should have the risk category assessment codes on the date of encounter and if the result is positive then the patient should have the codes for follow-up plan on the same day.
      Wheras the population criteria states that,
      AND: MOST RECENT:"Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')" during "Measurement Period"
      AND: "Patient Characteristic Birthdate: birth date" < 18 year(s) starts before start of "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')"
      AND:
      OR: "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Negative Depression Screening')" during "Measurement Period"
      OR:
      AND: "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Positive Depression Screening')" during "Measurement Period"
      AND:
      OR: "Intervention, Performed: Additional evaluation for depression - adolescent"
      OR: "Intervention, Order: Referral for Depression Adolescent"
      OR: "Medication, Order: Depression medications - adolescent"
      OR: "Intervention, Performed: Follow-up for depression - adolescent"
      OR: "Procedure, Performed: Suicide Risk Assessment"
      <= 1 day(s) starts after start of "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Positive Depression Screening')"
      So as per these conditions,the patient can get the risk assessment codes on any other day other than the encounter date during the measurement period which contraindicates the statement given in the guidance.
      Hence,would kindly request you to help us in understanding the same.

            rtallapragada Ramya Tallapragada (Inactive)
            doha.hatodkar Doha Hatodkar (Inactive)
            Doha Hatodkar (Inactive)
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