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  2. CQM-1001

CMS166 question regarding order of events

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Measure
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    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare Information Systems
    • measure criteria - Initial population and DENOMINATOR question - see below
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      The measure statements should be evaluated in order. You would look for the first diagnosis of low back pain during the measurement period and that would become Occurrence A. You would then check if that diagnosis occurred in the first 337 days of the measurement period on a qualifying encounter. In your example, the 1/3/13 diagnosis could be considered Occurrence A and it would not meet the criteria of being documented during a qualifying visit, so would not be in the IPP.
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      The measure statements should be evaluated in order. You would look for the first diagnosis of low back pain during the measurement period and that would become Occurrence A. You would then check if that diagnosis occurred in the first 337 days of the measurement period on a qualifying encounter. In your example, the 1/3/13 diagnosis could be considered Occurrence A and it would not meet the criteria of being documented during a qualifying visit, so would not be in the IPP.
    • CMS166v1/NQF0052
    • Critical to measures team development!!

      CMS 166:

      Initial Patient Population:

      Question 1#: Is the measure looking for the very ‘FIRST’ OCCURRENCE A Diagnosis, Active: Low Back Pain to occur during the measurement period? Or are we looking for the ‘FIRST’ Diagnosis, Diagnosis, Active: Low Back Pain that occur during the first 337 days of the measurement period on a qualifying encounter for Office Visit , Emergency Department Visit, or Face-to-Face Interaction during the measurement period?

      As per the spec ‘OCCURRENCE A of Diagnosis, Active: Low Back Pain’ MUST also meet the criterion below. Thus, if a patient has more than one diagnosis documented for Low Back Pain see example below, which would be considered ‘FIRST’ ‘OCCURRENCE A Low Back Pain? (see example below)

      The example below, which is considered the FIRST: "Occurrence A of Diagnosis, Active: Low Back Pain?
      Would Encounter on 1/3/13 be considered the ‘FIRST’ OCCURRENCE A of Diagnosis, Active: Low Back Pain even thought this occurrence fails to be documented on a qualifying encounter?
      OR Would encounter#2 on 12/3/13 be considered ‘FIRST’ OCCURRENCE A of Diagnosis, Active: Low Back Pain as this was on a qualifying encounter? Please clarify

      • Encounter#1: 1/3/13: Documentation of Low Back Pain Diagnosis
      • Encounter#2: 12/3/13: Documentation of Low Back Pain Diagnosis AND 99201 documented for qualifying office visit encounter

      Thank you

        1. CQM_1001_CMS_166_attachment.docx
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            rtallapragada Ramya Tallapragada (Inactive)
            elissa Elissa Chandler (Inactive)
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