The codes that you listed in your question are present in the patient’s profile to accommodate evaluation of CMS 134 logic (Diabetes: Urine Protein Screening) and are present in the Diabetic Nephropathy value set (2.16.840.1.113883.3.464.1003.109.12.1004). The "Diagnosis, Active: Diabetes" using "Diabetes Grouping Value Set (2.16.840.1.113883.3.464.1003.103.12.1001) value set is constant across CMS 122, CMS 123, and CMS 134. You are correct. All of the ICD9 codes in the Diabetic Nephropathy Grouping value set, along with several of the ICD10 and SNOMED codes in the Diabetic Nephropathy value set are present in the Diabetes Grouping value set. As a result, if a code that crosswalks both value set groupings is present in a patient’s profile they can evaluate positively for both data elements. For instance, the presence of ICD9 250.43 (Diabetes with renal manifestations, type 1, uncontrolled) in a patient profile would evaluate positively as the presence of Diabetes AND Diabetes Nephropathy. Whereas, the presence of ICD10 E09.21 (Drug or chemical induced DM with diabetic nephropathy) would only evaluate positive as Diabetic Nephropathy. In answer to your final question, “if the other diagnosis (from March 25, 2011) had not been not present, should this test patient be included in the IPP based on the 2013 diagnosis alone?”, the answer is yes due to the presence of the ICD9 and ICD10 codes. If they were not present (and only the SNOMED code was present), then the patient would not evaluate positively for the IPP.