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  2. CQM-5336

Patients with encounters started in december 2022 and discharged in first quarter of 2023

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    • Infomedika
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      ​The answer for STK-5 is correct. Ticagrelor was moved from valueset "Pharmacological Contraindications for Antithrombotic Therapy" (oid: 2.16.840.1.113762.1.4.1110.52) to valueset "Antithrombotic Therapy" (oid: 2.16.840.1.113762.1.4.1110.62) per the new FDA-indication for its use in ischemic stroke, for reporting year 2023. Therefore if Ticagrelor is administered it will qualify the patient for the Numerator rather than a Denominator Exception.
      For VTE-1 measure, 2 SNOMED CT codes (195394007, 266267005) are deleted from the value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279) because those 2 codes are obsoleted due to Terminology updates. Therefore, patient with those 2 codes will meet IPP in 2023 reporting year. Our suggestion is to map to other appropriate active codes so that the patient will be excluded from IPP aligned with 2022 reporting year.

      For 506v5, only medication at discharge is included in the measure. Since the patient discharge occurs on Jan. 7th, 2023, the medication 1655058 - Meperidine Hydrochloride 150 MG Oral tablet, would not be counted in the measure, as per the 2023 version of Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165).
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      ​The answer for STK-5 is correct. Ticagrelor was moved from valueset "Pharmacological Contraindications for Antithrombotic Therapy" (oid: 2.16.840.1.113762.1.4.1110.52) to valueset "Antithrombotic Therapy" (oid: 2.16.840.1.113762.1.4.1110.62) per the new FDA-indication for its use in ischemic stroke, for reporting year 2023. Therefore if Ticagrelor is administered it will qualify the patient for the Numerator rather than a Denominator Exception. For VTE-1 measure, 2 SNOMED CT codes (195394007, 266267005) are deleted from the value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279) because those 2 codes are obsoleted due to Terminology updates. Therefore, patient with those 2 codes will meet IPP in 2023 reporting year. Our suggestion is to map to other appropriate active codes so that the patient will be excluded from IPP aligned with 2022 reporting year. For 506v5, only medication at discharge is included in the measure. Since the patient discharge occurs on Jan. 7th, 2023, the medication 1655058 - Meperidine Hydrochloride 150 MG Oral tablet, would not be counted in the measure, as per the 2023 version of Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165).
    • EH
    • CMS0072v11
    • How would this patients should be evaluated without penalizing the hospitals?

      Based on the CQL this patient is suppose to be evaluated on the 2023 reporting period. But what happens if the majority of the codes are from December 2022 and those codes have been removed from 2023 measures.

       

      Example with Measure 72:

      • A patient is admitted on December 29, 2022 and discharged on January 7, 2023.
      • On December 29, 2022 the patient received the medication 1116635 - Ticagrelor 90 MG Oral Tablet but in the new Technical Release Notes 2023 the code have been removed.
      • This patient would not be counted as a denominator exception.

       

      Additional examples with my real question added 5/18/22:

      1. eCQM 108v11
       

      • A patient is admitted on December 29, 2022 and discharged on January 7, 2023.
      • This patient is admitted with the diagnosis 195394007 - Phlebitis and thrombophlebitis (disorder) but in the new Technical Release Notes 2023 the code have been removed and is not added to another VS.
      • On 2023 the patient will meet the IPP criteria although it was admitted on 2022 where this code existed.

      CQL:
      Initial Population

      • VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions"{}

      Reference TRN 2023:

      • Value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279): Deleted 2 SNOMED CT codes (195394007, 266267005) based on terminology update.

       

      2. eCQM 506v5

      • A patient is admitted on December 29, 2022 and discharged on January 7, 2023.
      • On December 29, 2022 the patient received the medication 1655058 - Meperidine Hydrochloride 150 MG Oral tablet but in the new Technical Release Notes 2023 the code have been removed and is not added to another VS.
      • This patient would not be included in the IPP for 2023.

      CQL:

      Initial Population

      • "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge"

      Reference TRN 2023:

      • Value set Schedule II & III Opioid Medications (2.16.840.1.113762.1.4.1111.165): Added 3 RxNorm codes (2539186, 2539191, 857121) based on terminology update. Deleted 15 RxNorm codes based on review by technical experts, SMEs, and/or public feedback and updated extensional set . Deleted 5 RxNorm codes (1655058, 1655060, 1731530, 977935, 993763) based on terminology update.

      I made a new comment on June 20, 2022.

            JLeflore Mathematica EH eCQM Team
            ldejesus Lisenid De Jesus
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