Using CPT-II codes for diagnosis data

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Priority: Moderate
    • Component/s: Guidance, ValueSet
    • None
    • Eric Gunther
    • Azara Healthcare
    • Hide
      The HITSC requires that measure developers use ICD9, ICD10 or SNOMED codes for any diagnosis value sets. CPT is not an eligible terminology for diagnoses and will not be considered for future versions of this value set.

      For further information on the allowable terminologies for each data category, please refer to the Measures Management System Blueprint at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint.html. For Blueprint version 12.0, please refer to Table 17 starting on page 259 for a crosswalk between the concepts and terminologies.

      Please also note that CMS126 has been retired and is no longer maintained by NCQA.
      Show
      The HITSC requires that measure developers use ICD9, ICD10 or SNOMED codes for any diagnosis value sets. CPT is not an eligible terminology for diagnoses and will not be considered for future versions of this value set. For further information on the allowable terminologies for each data category, please refer to the Measures Management System Blueprint at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint.html . For Blueprint version 12.0, please refer to Table 17 starting on page 259 for a crosswalk between the concepts and terminologies. Please also note that CMS126 has been retired and is no longer maintained by NCQA.
    • CMS126v5/NQFna
    • CMS126v4/NQF0036
    • CMS126v3/NQF0036

      The "Persistent Asthma" value set (OID 2.16.840.1.113883.3.464.1003.102.12.1023) only contains ICD-10-CM and SNOMED-CT codes. However, there appears to be a CPT Category II code 1038F for "Persistent asthma (mild, moderate or severe) (Asthma)" that appears to meet the value set intent.

      Is there are any chance CPT Category II codes would ever be included in diagnosis value sets?

      How are the code systems used for each different type of clinical concept chosen? For example, I've noticed that diagnoses are limited to ICD-10-CM/SNOMED-CT codes whereas encounters are limited to CPT/HCPCS/SNOMED-CT codes. Are these associations documented anywhere?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Eric Gunther (Inactive)
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            1 Vote for this issue
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              Created:
              Updated:
              Resolved:
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