CMS117 all versions: NUM

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Minor
    • Component/s: Measure
    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare
    • Hide
      We looked through the examples that you provided. You are describing a scenario in which the patient has two instances of immunization vaccines administered on two separate dates (Immunization, administered: Pneumococcal Conjugate Vaccine), and two instances of a procedure performed on different dates (Procedure, performed: Pneumococcal Conjugate Vaccine Administered).

      As the measure is currently written, the patient in your example does not satisfy the Numerator requirement for PCV. The patient has to have either four PCV’s administered on four separate dates (documented with CVX codes), or four separate immunization procedures (documented with CPT codes) on different dates of service.
       
      The measure logic that can accommodate the examples you described would be highly complex. We decided not to include the additional lines of logic because we believed the scenario you described to be rare. However, we do welcome feedback on the frequency of such cases.
       
      We hope this answers your question.
      Show
      We looked through the examples that you provided. You are describing a scenario in which the patient has two instances of immunization vaccines administered on two separate dates (Immunization, administered: Pneumococcal Conjugate Vaccine), and two instances of a procedure performed on different dates (Procedure, performed: Pneumococcal Conjugate Vaccine Administered). As the measure is currently written, the patient in your example does not satisfy the Numerator requirement for PCV. The patient has to have either four PCV’s administered on four separate dates (documented with CVX codes), or four separate immunization procedures (documented with CPT codes) on different dates of service.   The measure logic that can accommodate the examples you described would be highly complex. We decided not to include the additional lines of logic because we believed the scenario you described to be rare. However, we do welcome feedback on the frequency of such cases.   We hope this answers your question.
    • CMS117v5/NQF0038
    • CMS117 all versions
    • Urgent impacts multiple vendors
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      Measure Description:

      Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday

      JIRA Issue:

      CQM2223 describes a scenario in which the patient has two instances of immunization vaccines administered on two separate dates (Immunization, administered: Pneumococcal Conjugate Vaccine), and two instances of a procedure performed on different dates (Procedure, performed: Pneumococcal Conjugate Vaccine Administered).

      The current logic is written as follows:

      ◦AND: Union of:
      ◾"Immunization, Administered: Pneumococcal Conjugate Vaccine" satisfies all:
      ◾>= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ) ) )
      ◾<= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate"
      ◾"Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" satisfies all:
      ◾>= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ) ) )
      ◾<= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate"
      ◾"Diagnosis: Anaphylactic Reaction to Pneumococcal Conjugate Vaccine" <= 730 day(s) starts after start of "Birthdate : Patient Characteristic Birthdate"
       

      As the measure is currently written, the patient does not satisfy the Numerator requirement for PCV. The patient has to have either four PCV’s administered on four separate dates (documented with CVX codes), or four separate immunization procedures (documented with CPT codes) on different dates of service.

      https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/childhood-immunization-status
      Show
      Measure Description: Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday JIRA Issue: CQM2223 describes a scenario in which the patient has two instances of immunization vaccines administered on two separate dates (Immunization, administered: Pneumococcal Conjugate Vaccine), and two instances of a procedure performed on different dates (Procedure, performed: Pneumococcal Conjugate Vaccine Administered). The current logic is written as follows: ◦AND: Union of: ◾"Immunization, Administered: Pneumococcal Conjugate Vaccine" satisfies all: ◾>= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 1 day(s) starts after end of ("Immunization, Administered: Pneumococcal Conjugate Vaccine" >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ) ) ) ◾<= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ◾"Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" satisfies all: ◾>= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 1 day(s) starts after end of ("Procedure, Performed: Pneumococcal Conjugate Vaccine Administered" >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ) ) ) ◾<= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" ◾"Diagnosis: Anaphylactic Reaction to Pneumococcal Conjugate Vaccine" <= 730 day(s) starts after start of "Birthdate : Patient Characteristic Birthdate"   As the measure is currently written, the patient does not satisfy the Numerator requirement for PCV. The patient has to have either four PCV’s administered on four separate dates (documented with CVX codes), or four separate immunization procedures (documented with CPT codes) on different dates of service. https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/childhood-immunization-status
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      We will update the logic for all vaccines to make sure providers get credit for documenting a combination of CPT and CVX codes. The logic for Pneumococcal Conjugate Vaccine will be updated as follows:

       $PneumococcalConjugateVaccine >= 1 day(s) starts after end of ($PneumococcalConjugateVaccine >= 1 day(s) starts after end of ($PneumococcalConjugateVaccine >= 1 day(s) starts after end of $PneumococcalConjugateVaccine))

       

      QDM Data Variable:
      $PneumococcalConjugateVaccine =
      · Union of:
      · "Immunization, Administered: Pneumococcal Conjugate Vaccine" satisfies all:
      o >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate"
      o <= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate
      · "Procedure, Performed: Pneumococcal Conjugate Vaccine" satisfies all:
      o >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate"
      o <= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate
      Show
      We will update the logic for all vaccines to make sure providers get credit for documenting a combination of CPT and CVX codes. The logic for Pneumococcal Conjugate Vaccine will be updated as follows:  $PneumococcalConjugateVaccine >= 1 day(s) starts after end of ($PneumococcalConjugateVaccine >= 1 day(s) starts after end of ($PneumococcalConjugateVaccine >= 1 day(s) starts after end of $PneumococcalConjugateVaccine))   QDM Data Variable: $PneumococcalConjugateVaccine = · Union of: · "Immunization, Administered: Pneumococcal Conjugate Vaccine" satisfies all: o >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" o <= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate · "Procedure, Performed: Pneumococcal Conjugate Vaccine" satisfies all: o >= 42 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate" o <= 730 day(s) ends after start of "Birthdate : Patient Characteristic Birthdate

      CMS117 all versions
      We need to know for this measure Numerator when a total counts of a specific vaccine is require does all 4 counts of the vaccine have to come from a single value set code system?

      It appears from the specification that this measure does not require 4 Medication, administered: Pneumococcal Conjugate Vaccine, OR 4 Procedure, performed: Pneumococcal Conjugate Vaccine Administered exclusively. It just requires a total count of 4 ‘Pneumococcal Conjugate Vaccines’ components so any combination from the qualifying value set for this on 4 different dates would qualify for the 4 counts. There is no documentation from CMS that indicates it must be 4 unique counts of the same component (same coding system) for a specific value set to count towards numerator.

      See example below:

      Four pneumococcal
      For CMS117, the measure requires Four pneumococcal vaccines for a patient and allowable value sets for pneumococcal conjugate vaccines are CVX and CPT codes as provided via value set spreadsheet. As result we would like confirmation if it would be acceptable to count any 4 combination of whether CVX or CPT from the qualifying value set documented on 4 different dates to meet the criteria of Four pneumococcal vaccines? Or does the patient have to have 4 PCV from the same value set coding system for example 4 CVX for PCV to meet numerator OR 4 CPT for PCV to meet numerator?

      Which patient would meet the 4 PCV criterion?

      Patient 1#- Has 4 PVC vaccines documented on 4 different visit with two qualifying CVX and 2 qualifying CPT. Would this patient meet the criterion for 4 counts of PCV?
      • Enc 1: pneumococcal vaccine on 1/1/2015 with qualifying CVX
      • Enc 2: pneumococcal vaccine on 5/1/2015 with qualifying CVX
      • Enc 3: pneumococcal vaccine on 6/1/2016 with qualifying CPT
      • Enc 4: pneumococcal vaccine on 10/1/2016 with qualifying CPT

      Patient 2#- Has 4 PVC vaccines documented on 4 different visit with four qualifying CVX. Would this patient meet the criterion for 4 counts of PCV?
      • Enc 1: pneumococcal vaccine on 1/1/2015 with qualifying CVX
      • Enc 2: pneumococcal vaccine on 5/1/2015 with qualifying CVX
      • Enc 3: pneumococcal vaccine on 6/1/2016 with qualifying CVX
      • Enc 4: pneumococcal vaccine on 10/1/2016 with qualifying CVX

      Patient 3#- Has 4 PVC vaccines documented on 4 different visit with four qualifying CPT. Would this patient meet the criterion for 4 counts of PCV?
      • Enc 1: pneumococcal vaccine on 1/1/2015 with qualifying CPT
      • Enc 2: pneumococcal vaccine on 5/1/2015 with qualifying CPT
      • Enc 3: pneumococcal vaccine on 6/1/2016 with qualifying CPT

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Elissa Chandler (Inactive)
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            1 Vote for this issue
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