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  2. CQM-3215

CMS 132v7 numerator patients have only 1 cataract surgery

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    • Judi Dorsey
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      Thank you for your inquiry and for drawing this to our attention.

      The measure’s ‘Cataract Surgery’ value sets include concepts for all types of cataract procedures. As the cataract is a lens procedure, there is some overlap among coding for the initial population requirement and one of the possible numerator criterion (‘Lens Procedure’ value sets).

      Based on intent of CMS132, the same procedure should not meet both of the measure components (initial population and numerator). The numerator should be satisfied only if the subsequent procedure occurs within 30 days of the day of cataract surgery, and also should not be able to occur on the same day as the cataract surgery which meets the initial population. However, the issue raised highlights that there is a need for additional logic to ensure that the initial population and numerator criteria are not satisfied by the same procedure. We believed that the definition, as written, would have excluded those scenarios, but that appears to not be the case. Therefore, during the next round of annual updates, we will modify the definition logic to incorporate this condition.
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      Thank you for your inquiry and for drawing this to our attention. The measure’s ‘Cataract Surgery’ value sets include concepts for all types of cataract procedures. As the cataract is a lens procedure, there is some overlap among coding for the initial population requirement and one of the possible numerator criterion (‘Lens Procedure’ value sets). Based on intent of CMS132, the same procedure should not meet both of the measure components (initial population and numerator). The numerator should be satisfied only if the subsequent procedure occurs within 30 days of the day of cataract surgery, and also should not be able to occur on the same day as the cataract surgery which meets the initial population. However, the issue raised highlights that there is a need for additional logic to ensure that the initial population and numerator criteria are not satisfied by the same procedure. We believed that the definition, as written, would have excluded those scenarios, but that appears to not be the case. Therefore, during the next round of annual updates, we will modify the definition logic to incorporate this condition.

    Description

      I am testing CMS 132v7 in Cypress V4.0.0 and find 2 of the 3 numerator patients given only have one cataract surgery. This measure requires at least 1 additional surgery within 30 days of the initial surgery to satisfy the numerator requirement. Is this a bug in the test deck?

      I have attached html and xml files for the two patients:

      Z9 Eye (Crystal Williamson)
      Z8 Eye (Deborah Hodges)

      Thanks,

      Judi

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              edave Mathematica EC eCQM Team
              woodstep67 Judi Dorsey
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