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  2. CQM-1007

Clarification of intent on opthalmologic examination for CMS142

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Minor Minor
    • Measure
    • None
    • CMS 142
    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare Information Systems
    • Measure critera
    • Hide
      1. Can you please confirm the following for satisfactory reporting of the Denominator?
      a. 32451-7 ie, ‘Physical findings of Macula’ should be used ONLY
      b. 32451-7 ie, ‘Physical findings of Macula’ should be used WITH ‘Level of Severity of Retinopathy Findings’ AND ‘Macular Edema Findings Present/Absent’

      RESPONSE: For the purpose of meeting the Denominator for CMS 142, code 32451-7 should be used, but a result should be present in the EHR. The code(s) for the result of the diagnostic study do not make a patient eligible or ineligible for the denominator criteria.

      2. Can you please confirm the following for satisfactory reporting of the Numerator?
      a. Documentation of Communication from Provider to Provider ONLY
      b. Documentation of Communication from Provider to Provider WITH ‘Level of Severity of Retinopathy Findings’ AND ‘Macular Edema Findings Present/Absent’

      RESPONSE: For the purpose of meeting the Numerator for CMS 142, the communication from provider to provider would need to include BOTH the level of severity of retinopathy AND either the presence or absence of macular edema findings. A code from the value set ‘Level of Severity or Retinopathy Findings’ AND a code from either ‘Macular Edema Findings Present’ OR ‘Macular Edema Findings Absent’ should be recorded in the EHR and communicated with the physician managing the patient’s ongoing care.

      3. If “b” is true for the above, should all of them be documented on the same encounter?

      RESPONSE: ‘Level of Severity of Retinopathy’ and ‘Macular Edema Findings Present’ or ‘Macular Edema Findings Absent’ would be the results of the diagnostic study (macular exam). Therefore, they would most definitely result from the same encounter, specifically, to meet the denominator, ‘Occurrence A’ of any of the appropriate encounters included in the measure.
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      1. Can you please confirm the following for satisfactory reporting of the Denominator? a. 32451-7 ie, ‘Physical findings of Macula’ should be used ONLY b. 32451-7 ie, ‘Physical findings of Macula’ should be used WITH ‘Level of Severity of Retinopathy Findings’ AND ‘Macular Edema Findings Present/Absent’ RESPONSE: For the purpose of meeting the Denominator for CMS 142, code 32451-7 should be used, but a result should be present in the EHR. The code(s) for the result of the diagnostic study do not make a patient eligible or ineligible for the denominator criteria. 2. Can you please confirm the following for satisfactory reporting of the Numerator? a. Documentation of Communication from Provider to Provider ONLY b. Documentation of Communication from Provider to Provider WITH ‘Level of Severity of Retinopathy Findings’ AND ‘Macular Edema Findings Present/Absent’ RESPONSE: For the purpose of meeting the Numerator for CMS 142, the communication from provider to provider would need to include BOTH the level of severity of retinopathy AND either the presence or absence of macular edema findings. A code from the value set ‘Level of Severity or Retinopathy Findings’ AND a code from either ‘Macular Edema Findings Present’ OR ‘Macular Edema Findings Absent’ should be recorded in the EHR and communicated with the physician managing the patient’s ongoing care. 3. If “b” is true for the above, should all of them be documented on the same encounter? RESPONSE: ‘Level of Severity of Retinopathy’ and ‘Macular Edema Findings Present’ or ‘Macular Edema Findings Absent’ would be the results of the diagnostic study (macular exam). Therefore, they would most definitely result from the same encounter, specifically, to meet the denominator, ‘Occurrence A’ of any of the appropriate encounters included in the measure.
    • CMS142v1/NQF0089
    • Critical: impedes development for certification!

      The following has been specified in the government specification of the CMS 142:

      DENOMINATOR:
      o AND: "Diagnostic Study, Result: Macular Exam (result)" during
       OR: "Occurrence A of Encounter, Performed: Ophthalmological Services"
       OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
       OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      NUMERATOR:
      o AND:
       AND: "Communication: From Provider to Provider: Level of Severity of Retinopathy Findings"
       AND:
       OR: "Communication: From Provider to Provider: Macular Edema Findings Present"
       OR: "Communication: From Provider to Provider: Macular Edema Findings Absent"
       starts after start of
       OR: "Occurrence A of Encounter, Performed: Ophthalmological Services"
       OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
       OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      Questions:
      1. Can you please confirm the following for satisfactory reporting of the Denominator?
      a. 32451-7 i.e. Physical findings of Macula should be used ONLY
      b. 32451-7 i.e. Physical findings of Macula should be used with Level of Severity of Retinopathy Findings AND Macular Edema Findings Present/ Macular Edema Findings Absent. If this is true, should all of them be documented on the same encounter
      2. Can you please confirm the following for satisfactory reporting of the Numerator?
      a. Documentation of Communication from Provider to Provider ONLY
      b. Documentation of Communication from Provider to Provider with Level of Severity of Retinopathy Findings AND Macular Edema Findings Present/ Macular Edema Findings Absent. If this is true, should all of them be documented on the same encounter
      3. Please provide details of satisfactory reporting of the Denominator and Numerator if it is other than mentioned in the above two questions

      of Encounter, Performed: Outpatient Consultation"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      NUMERATOR:
      o AND:
       AND: "Communication: From Provider to Provider: Level of Severity of Retinopathy Findings"
       AND:
       OR: "Communication: From Provider to Provider: Macular Edema Findings Present"
       OR: "Communication: From Provider to Provider: Macular Edema Findings Absent"
       starts after start of
       OR: "Occurrence A of Encounter, Performed: Ophthalmological Services"
       OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
       OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      Questions:
      1. Can you please confirm the following for satisfactory reporting of the Denominator?
      a. 32451-7 i.e. Physical findings of Macula should be used ONLY
      b. 32451-7 i.e. Physical findings of Macula should be used with Level of Severity of Retinopathy Findings AND Macular Edema Findings Present/ Macular Edema Findings Absent
      2. Can you please confirm the following for satisfactory reporting of the Numerator?
      a. Documentation of Communication from Provider to Provider ONLY
      b. Documentation of Communication from Provider to Provider with Level of Severity of Retinopathy Findings AND Macular Edema Findings Present/ Macular Edema Findings Absent
      3. Please provide details of satisfactory reporting of the Denominator and Numerator if it is other than mentioned in the above two questions

            rtallapragada Ramya Tallapragada (Inactive)
            elissa Elissa Chandler (Inactive)
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