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  2. CQM-1541

Value set for "Diagnosis, Active: Diabetes" is inconsistent across code sets

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      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.
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      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.

      In CMS122v3 and CMS123v3, the SNOMED and ICD codes appear to be inconsistent. For the attached Cypress Certification Patient Test Record, see the diagnoses section. It includes a "Diagnosis, Active of SNOMED-CT: 127013003
      ICD-9-CM: 250.42
      ICD-10-CM: E11.21"

      Both of the ICDs listed there are included in Value Set 2.16.840.1.113883.3.464.1003.103.12.1001 (Version: 20140701). But the SNOMED listed there is not. Is that an error? Should SNOMED-CT 127013003 be included in the Value Set?

      In other words, 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?

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          Sarah D

          [CQM-1541] Value set for "Diagnosis, Active: Diabetes" is inconsistent across code sets

          Sharon Sebastian (Inactive) added a comment -

          Sarah,
          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.

          Please feel free to reach out if you have additional questions or concerns.
          Sharon

          Sharon Sebastian (Inactive) added a comment - Sarah, 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. Please feel free to reach out if you have additional questions or concerns. Sharon

            julia.skapik Julia Skapik (Inactive)
            SarahDATG Sarah D (Inactive)
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