CMS 122v7 standard workflow for documentation of resolved or erroneous diagnosis is to move the diagnosis from the active problem list to past medical history. Pertinent negatives are also documented in past medical history.

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
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    • 612-262-2219
    • Allina Health
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      Thank you for your question. The initial population and denominator for CMS122v7 requires a diabetes diagnosis, as noted in the initial population statement “Patients 18-75 years of age with diabetes with a visit during the measurement period.” The initial population logic for the measure requires that the diabetes diagnosis overlaps the measurement period. The overlaps function means the diagnosis must be present in the EHR prior to the start of the measurement period and also present in the EHR during the measurement period. If the patient did not have a diabetes diagnosis prior to the measurement period but did during the measurement period, they would not meet the initial population criteria. Conversely, if the patient had a diabetes diagnosis prior to the measurement period but did not during the measurement period they also would not meet the initial population criteria. For purposes of the measure, the treatment or lack of treatment for diabetes does not factor in when determining the presence of a diabetes diagnosis. Presence of a diabetes diagnosis code from the Diabetes value set (2.16.840.1.113883.3.464.1003.103.12.1001), in the patient’s EHR as a prior to the measurement period diagnosis and current diagnosis are what determine whether the patient meets criteria for being in the initial population and denominator. We hope this answers your question.
      Show
      Thank you for your question. The initial population and denominator for CMS122v7 requires a diabetes diagnosis, as noted in the initial population statement “Patients 18-75 years of age with diabetes with a visit during the measurement period.” The initial population logic for the measure requires that the diabetes diagnosis overlaps the measurement period. The overlaps function means the diagnosis must be present in the EHR prior to the start of the measurement period and also present in the EHR during the measurement period. If the patient did not have a diabetes diagnosis prior to the measurement period but did during the measurement period, they would not meet the initial population criteria. Conversely, if the patient had a diabetes diagnosis prior to the measurement period but did not during the measurement period they also would not meet the initial population criteria. For purposes of the measure, the treatment or lack of treatment for diabetes does not factor in when determining the presence of a diabetes diagnosis. Presence of a diabetes diagnosis code from the Diabetes value set (2.16.840.1.113883.3.464.1003.103.12.1001), in the patient’s EHR as a prior to the measurement period diagnosis and current diagnosis are what determine whether the patient meets criteria for being in the initial population and denominator. We hope this answers your question.
    • CMS122v7/NQF59
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      Patients with no diagnosis of diabetes on the active problem list, no diabetes medications prescribed and no diabetes coded visits, labs or medications during the measurement period or year preceding the measurement period appear in submissions as well as decision support advisories. Should the CMS definition of "active diagnosis" include these patients?
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      Patients with no diagnosis of diabetes on the active problem list, no diabetes medications prescribed and no diabetes coded visits, labs or medications during the measurement period or year preceding the measurement period appear in submissions as well as decision support advisories. Should the CMS definition of "active diagnosis" include these patients?

      Examples include

      Case #1: added to the 2019 denominator based on a diagnosis code in past medical history as a "pertinent negative

      Case # 2: added to the 2019 denominator based on an earlier diagnosis noted on the active problem list in 2009 and resolved as erroneous diagnosis and moved to the past medical history in 2015

      Case#3: added to the 2019 denominator based on an encounter diagnosis in 2016

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Theresa Murray (Inactive)
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