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  2. CQM-4623

CMS9v10 Newborn TPN Med Administered Data Element Clarification

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
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    • Nicholas Howe
    • 7817744026
    • MEDITECH
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      Thank you for your questions on CMS9, Exclusive Breast Milk Feeding.​

      Question, Part 1: Is the value set for Medication, Administered: Total Parenteral Nutrition using "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)" the only value set for capturing dextrose or glucose 40% gel being administered? There is only 1 generic SNOMED code for Total Parenteral Nutrition Agent. Is this enough to validate the substance was administered as a medication?

      Answer: The "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)" value set is NOT intended to capture dextrose or glucose 40% gel, as they are 2 different substances. Total parenteral nutrition (TPN) is intravenous administration of nutrition, with many components mixed together in a bag. SNOMED code 789708003 | Total Parenteral Nutrition Agent is a high level SNOMED code for TPN in the medicinal product hierarchy, as no higher level concepts are found at RxNorm.

      Question, Part 2: There is an additional glucose(substance) SNOMED value within the "Substance, Administered: Dietary Intake Other than Breast Milk" using "Dietary Intake Other than Breast Milk (2.16.840.1.113883.3.117.1.7.1.27)". Is this intended to be used in modifying the Total Parenteral Nutrition Value set to clarify the substance was glucose, or does this SNOMED otherwise still qualify to be used as an exclusion for PC-05?

      The code "Glucose (substance)" is contained within the Dietary Intake Other than Breast Milk value set (2.16.840.1.113883.3.117.1.7.1.27). 'Glucose (substance)" is applicable when, for example, the baby if given glucose water for feeding. The Rxnorm code for the Sweet Ease 198683 ​(glucose 0.4 MG/MG Oral Gel) is considered a medication and excluded from the value set of "Dietary Intake Other than Breast Milk”, which focuses on nutritional intake.

      In summary, 40% or greater glucose would be considered a medication, and the glucose water would be an example of dietary intake.​ Again dextrose or glucose 40% gel is different from TPN so a baby given dextrose or glucose 40% gel is NOT considered “the Dietary Intake Other than Breast Milk” or “Parenteral Nutrition”.
      Show
      Thank you for your questions on CMS9, Exclusive Breast Milk Feeding.​ Question, Part 1: Is the value set for Medication, Administered: Total Parenteral Nutrition using "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)" the only value set for capturing dextrose or glucose 40% gel being administered? There is only 1 generic SNOMED code for Total Parenteral Nutrition Agent. Is this enough to validate the substance was administered as a medication? Answer: The "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)" value set is NOT intended to capture dextrose or glucose 40% gel, as they are 2 different substances. Total parenteral nutrition (TPN) is intravenous administration of nutrition, with many components mixed together in a bag. SNOMED code 789708003 | Total Parenteral Nutrition Agent is a high level SNOMED code for TPN in the medicinal product hierarchy, as no higher level concepts are found at RxNorm. Question, Part 2: There is an additional glucose(substance) SNOMED value within the "Substance, Administered: Dietary Intake Other than Breast Milk" using "Dietary Intake Other than Breast Milk (2.16.840.1.113883.3.117.1.7.1.27)". Is this intended to be used in modifying the Total Parenteral Nutrition Value set to clarify the substance was glucose, or does this SNOMED otherwise still qualify to be used as an exclusion for PC-05? The code "Glucose (substance)" is contained within the Dietary Intake Other than Breast Milk value set (2.16.840.1.113883.3.117.1.7.1.27). 'Glucose (substance)" is applicable when, for example, the baby if given glucose water for feeding. The Rxnorm code for the Sweet Ease 198683 ​(glucose 0.4 MG/MG Oral Gel) is considered a medication and excluded from the value set of "Dietary Intake Other than Breast Milk”, which focuses on nutritional intake. In summary, 40% or greater glucose would be considered a medication, and the glucose water would be an example of dietary intake.​ Again dextrose or glucose 40% gel is different from TPN so a baby given dextrose or glucose 40% gel is NOT considered “the Dietary Intake Other than Breast Milk” or “Parenteral Nutrition”.
    • EH
    • CMS0009v10
    • Curious as to how we are to account for TPN Med Administered for Glucose without an RXNorm and with how to handle existing Glucose Snomed within Dietary Intake Other Than Milk value set

      In reviewing the 2022 RY eCQM specification release, we are requesting additional clarification on the PC-05 eCQM for capturing Exclusive Breastmilk Feeding for Newborns. Below we have listed the referenced information from the specification along with our questions for CMS:

      Given:

      1. Guidance Section: If dextrose or glucose 40% gel is given, it is considered a medication not a feeding. This should be reflected as such in the newborn's EHR documentation.
      2. Data Criteria (new value set): "Medication, Administered: Total Parenteral Nutrition" using "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)"

      Questions:

      1. Is the value set for Medication, Administered: Total Parenteral Nutrition using "Total Parenteral Nutrition (2.16.840.1.113762.1.4.1110.54)" the only value set for capturing dextrose or glucose 40% gel being administered? There is only 1 generic SNOMED code for Total Parenteral Nutrition Agent. Is this enough to validate the substance was administered as a medication? Normally a Medication that is administered would have an RXNorm code associated.
      2. There is an additional glucose(substance) SNOMED value within the "Substance, Administered: Dietary Intake Other than Breast Milk" using "Dietary Intake Other than Breast Milk (2.16.840.1.113883.3.117.1.7.1.27)". Is this intended to be used in modifying the Total Parenteral Nutrition Value set to clarify the substance was glucose, or does this SNOMED otherwise still qualify to be used as an exclusion for PC-05?

      Thank you for your time.

            JLeflore Mathematica EH eCQM Team
            nhowe@meditech.com Nicholas Howe (Inactive)
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