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  2. CQM-2921

How to handle code that is applicable to multiple Value Sets

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Referred to External Party for Resolution
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    • CMS113v5/NQF0469

      In CMS113v5 (PC-1), for CY2017, the IPP definition calls for "Procedure, Performed: Delivery Procedures", which is associated with Value Set "2.16.840.1.113762.1.4.1045.59". We received a QRDA-1 file containing a Procedure data element, but the Value Set it referenced was "2.16.840.1.113883.3.117.1.7.1.282" (Cesarean Section). The data element had an ICD10PCS code of "10D00Z1". This particular code exists on BOTH Value Sets. Since this code exists in the IPP-referenced Value Set, is it acceptable that this patient be considered part of the IPP (assuming other criteria is met), even though the data element referenced a different Value Set? (In a perfect world, the QRDA-1 should really contain two Procedure data elements, so that both Value Sets are referenced. But this question is for the "real world" where things like this happen.)
      Thank you.

            JLeflore Joelencia Leflore
            gguidarelli Greg Guidarelli
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