Inpatient hospital based Denominator/CPT code issues CERNER MIPS

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    • Type: None
    • Resolution: Answered
    • Priority: Critical
    • Component/s: None
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      Thank you for your inquiry regarding CMS127, 135, 138, 139, 144, 146, and 156. The value sets are "frozen" for the current performance period. Equivalent services can be mapped to the value sets, e.g., see example below for codes/value sets required for CMS127v10 denominator. If mapping is conducted, you should maintain documentation in the event of a CMS audit. The value sets that correspond to the inpatient population/denominator are located in the in the eCQM measure specifications. Please reference the Value Set Authority Center (https://vsac.nlm.nih.gov/) for to view the codes contained in the specified value sets. You can submit codes for measure developers to review for inclusion in future years.

      valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
       valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
       valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
       valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
       valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
       valueset "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
       valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
       valueset "Discharge Services - Nursing Facility" (2.16.840.1.113883.3.464.1003.101.11.1065)
       valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
       valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
       code "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." ("CPT Code (99211)")
      Show
      Thank you for your inquiry regarding CMS127, 135, 138, 139, 144, 146, and 156. The value sets are "frozen" for the current performance period. Equivalent services can be mapped to the value sets, e.g., see example below for codes/value sets required for CMS127v10 denominator. If mapping is conducted, you should maintain documentation in the event of a CMS audit. The value sets that correspond to the inpatient population/denominator are located in the in the eCQM measure specifications. Please reference the Value Set Authority Center ( https://vsac.nlm.nih.gov/ ) for to view the codes contained in the specified value sets. You can submit codes for measure developers to review for inclusion in future years. valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)  valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)  valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)  valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)  valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)  valueset "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)  valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)  valueset "Discharge Services - Nursing Facility" (2.16.840.1.113883.3.464.1003.101.11.1065)  valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)  valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)  code "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." ("CPT Code (99211)")
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      When our EHR company (cerner) is mapping our metrics for MIPs to be submitted through ECQM via QRDAIII file, we are finding that our patients are not pulling into the denominator due to the CPT codes we use to bill in the inpatient setting not being part of the CMS code mapping set.

       
      Show
      When our EHR company (cerner) is mapping our metrics for MIPs to be submitted through ECQM via QRDAIII file, we are finding that our patients are not pulling into the denominator due to the CPT codes we use to bill in the inpatient setting not being part of the CMS code mapping set.  

      We have a hospital based facility that we need to report for, but we are running into some road blocks.

       

      When our EHR team is mapping our metrics so we can report in the QRDA III file, but we are finding that our patients are not pulling into the denominator due to the CPT codes we use to bill in the inpatient setting........ how are other hospitals working around that?

       

      Is there a CPT code for hospital based setting we are missing? If so can you provide some?

       

      For example for most CPT codes for falls risk are for outpatient or home health settings even though we do them on all patients, but we only have 10 patients because the CPT codes aren't for inpatient billing.

       

      This is happening for Multiple metrics including CMS127, CMS138, CMS139 CMS146 CMS156

       CMS144 and CMS135 are pulling patients in the IP_pop but not the denominator. 

       

      Any help would be greatly appreciated. 

      Thank you!

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Dallas Luciotti (Inactive)
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