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CLONE - NQF 69: Diagnosis of URI and exclusion diagnosis are documented on same encounter

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      Thank you for your inquiry. In the example you provide, where URI and an exclusion diagnosis are documented on the same encounter, the patient would qualify as an exclusion, as the competing diagnosis can occur anytime on the same day.
      This is due to timing of the diagnosis, specifically the “day of” timing, which under definition ‘Has Competing Diagnosis for Upper Respiratory Infection’ states that “…competing condition starts 3 days or less after day of start of EncounterWithURI.ValidEncounter.relevantPeriod”.
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      Thank you for your inquiry. In the example you provide, where URI and an exclusion diagnosis are documented on the same encounter, the patient would qualify as an exclusion, as the competing diagnosis can occur anytime on the same day. This is due to timing of the diagnosis, specifically the “day of” timing, which under definition ‘Has Competing Diagnosis for Upper Respiratory Infection’ states that “…competing condition starts 3 days or less after day of start of EncounterWithURI.ValidEncounter.relevantPeriod”.
    • CMS154v1/NQF0069
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      NQF 0069: If the diagnosis of URI and exclusion diagnosis (Competing Condition for Respiratory Condtions) are documented on same encounter, should the patient quality as an exclusion? The text in the measure leads one to beleive it should be a different encounter than the URI encounter. Please advise.

            edave Mathematica EC eCQM Team
            Aniek Aniek Valentine (Inactive)
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