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  1. eCQM Issue Tracker
  2. CQM-4810

Add ICD-10-CM coding for palliative care exclusion and palliative care SNOMED-CT concepts

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Details

    • EP/EC eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None

    Description

      Brief Description of Measure:
      ​CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

      CMS124: Cervical Cancer Screening

      CMS125: Breast Cancer Screening

      CMS130: Colorectal Cancer Screening

      CMS131: Diabetes: Eye Exam

      CMS134: Diabetes: Medical Attention for Nephropathy

      CMS156: Use of High-Risk Medications in Older Adults

      CMS165: Controlling High Blood Pressure

      Description of Issue:

      Implementers (CQM-3065) expressed interest in seeing ICD-10-CM Z-code, Z51.5, included in the exclusion.

      Below is the current specification:

      code system "LOINC": 'urn:oid:2.16.840.1.113883.6.1'

      value set "Palliative Care Encounter": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1090'
      value set "Palliative Care Intervention": 'urn:oid:2.16.840.1.113883.3.464.1003.198.12.1135'

      code "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)": '71007-9' from "LOINC" display 'Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)'

      define "Palliative Care in the Measurement Period":
      exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period" )
      or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
      where PalliativeEncounter.relevantPeriod overlaps "Measurement Period" )
      or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
      where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period" )

      Proposed Solution:

      For the palliative care exclusion specification, we propose adding a new "Diagnosis" data type using ICD-10-CM code Z51.5 ([Z51.5] Encounter for palliative care).

      Below is the proposed specification:

      code system "ICD10CM": 'urn:oid:2.16.840.1.113883.6.90'
      code system "LOINC": 'urn:oid:2.16.840.1.113883.6.1'

      value set "Palliative Care Encounter": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1090'
      value set "Palliative Care Intervention": 'urn:oid:2.16.840.1.113883.3.464.1003.198.12.1135'

      code "Encounter for palliative care": 'Z51.5' from "ICD10CM" display 'Encounter for palliative care'
      code "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)": '71007-9' from "LOINC" display 'Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)'

      define "Palliative Care in the Measurement Period":
      exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where Global."NormalizeInterval"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps "Measurement Period" )
      or exists (["Diagnosis": "Encounter for palliative care"] PalliativeDiagnosis
      where PalliativeDiagnosis.prevalencePeriod overlaps "Measurement Period")
      or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
      where PalliativeEncounter.relevantPeriod overlaps "Measurement Period" )
      or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
      where Global."NormalizeInterval"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps "Measurement Period" )

      We also propose adding 3 SNOMED-CT finding codes to an existing value set, Palliative Care Intervention (Grouping OID: 2.16.840.1.113883.3.464.1003.198.12.1135), which maps to "Intervention, Performed":

      • 305686008, Seen by palliative care physician (finding)
      • 305824005, Seen by palliative care medicine service (finding)
      • 441874000, Seen by palliative care service (finding)

      Rationale for Change:

      ​These changes would reduce implementation burden for eligible clinicians and allow them to identify patients meeting measure criteria using their current documentation workflows.

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            khancock Mathematica EC eCQM Team
            khancock Mathematica EC eCQM Team
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            Dates

              Created:
              Updated: