Thank you for your questions on CMS111, Median Admit Decision Time to ED Departure Time for Admitted Patients; CMS108, Venous Thromboembolism Prophylaxis; and CMS190, Intensive Care Unit Venous Thromboembolism Prophylaxis. The value sets of “Psychiatric/Mental Health Diagnosis” and “Mental Health Diagnoses” serve different purposes according to the intent of each measure. CMS111 uses the "Psychiatric/Mental Health Diagnosis" value set (2.16.840.1.113883.3.117.1.7.1.299) for measure stratification, not for determining the appropriateness of excluding cases from the denominator. The "Mental Health Diagnoses" value set (2.16.840.1.113883.3.464.1003.105.12.1004) is used to identify denominator exclusions for CMS108 and CMS190. A case with Principal Dx of R41.1 (Anterograde amnesia) or R44.1 (Visual hallucinations) will be included in ED-2 because one or both VTE measures may be applicable for these cases. Thus, R41.1 and R44.1 are not contained in the "Mental Health Diagnoses" value set.

There are two separate value sets used for Mental Health Diagnoses for eCQMs. Value Set 2.16.840.1.113883.3.117.1.7.1.299 is used for CMS111 and 2.16.840.1.113883.3.464.1003.105.12.1004 is used for CMS108 and CMS190. Both of these require a "Principal diagnosis". I have a patient with a Principal diagnosis of R44.1 but also has a diagnosis of R41,1. The patient can only be excluded from CMS111 and not CMS108 because the value sets are different. Since a patient can only have 1 Principal diagnosis, why aren't these value sets combined so that the patient can qualify for exclusion from more than one measure? Since these measures are now being publicly reported, we feel that having two value sets misrepresents the mental health exclusion of the eCQMs.