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  2. CQM-1397

Counting SNOMED and CPT on same encounter?

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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      The version in question is v2 of CMS143 as noted by the inquirer. The measure logic intends to capture at least two distinct encounters or visits. If an EHR is dual coding encounters, using both SNOMED and CPT, a single encounter could count twice when exported into QRDA I. While we recognize this issue, it is not the intent of our specification or the intent of our measure – the expectation is that to satisfy the requirement of ‘COUNT >= 2’, the patient will have at least two unique encounters/interactions.
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      The version in question is v2 of CMS143 as noted by the inquirer. The measure logic intends to capture at least two distinct encounters or visits. If an EHR is dual coding encounters, using both SNOMED and CPT, a single encounter could count twice when exported into QRDA I. While we recognize this issue, it is not the intent of our specification or the intent of our measure – the expectation is that to satisfy the requirement of ‘COUNT >= 2’, the patient will have at least two unique encounters/interactions.
    • CMS142v3/NQF0089, CMS143v3/NQF0086, CMS167v3/NQF0088
    • high - impacts 3 CQMs

      QUESTION: Pertains to multiple measures: CMS 143, CMS 167, CMS 142

      According to CMS143v2 spec below – initial patient population is count of > = 2 encounters.

      • Must 2 encounter codes be reported on 2 distinct encounters?

      OR

      • Could reporting 1) a CPT code and 2) a snomed code on same date qualify as 2 encounters?

      CMS143v2 Population criteria
      • Initial Patient Population =
      o AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
      o AND: "Diagnosis, Active: Primary Open Angle Glaucoma (POAG)" starts before or 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"
       during "Measurement Period"
      o AND: Count >= 2 of:
       OR: "Encounter, Performed: Ophthalmological Services"
       OR: "Encounter, Performed: Care Services in Long-Term Residential Facility"
       OR: "Encounter, Performed: Nursing Facility Visit"
       OR: "Encounter, Performed: Office Visit"
       OR: "Encounter, Performed: Outpatient Consultation"
       OR: "Encounter, Performed: Patient Provider Interaction"
       during "Measurement Period"

            edave Mathematica EC eCQM Team
            elissa Elissa Chandler (Inactive)
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