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  2. CQM-5411

CMS 154 URI Diagnoses from Problem List

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      Thank you for your question about CMS154v10 (2022 Performance Period). The intent of the measure is to look for an active diagnosis during a visit during the measurement period. In your example, there is an old but active diagnosis of URI. Although the initial diagnosis occurred outside of the measurement period, it meets the criteria of URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod because the diagnosis is still active during a visit during the measurement period. Hope this helps.

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      Thank you for your question about CMS154v10 (2022 Performance Period). The intent of the measure is to look for an active diagnosis during a visit during the measurement period. In your example, there is an old but active diagnosis of URI. Although the initial diagnosis occurred outside of the measurement period, it meets the criteria of URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod because the diagnosis is still active during a visit during the measurement period. Hope this helps.
    • For CMS 154 Appropriate Treatment of URI diagnosis of URI is being used if it is active on the problem list even if the diagnosis happened outside of the measurement period.

      URI diagnosis was placed on the problem list in 1999 and remains active.  Encounters from 2022 are being included in the measure utilizing this diagnosis since the measure logic states that the URI.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod. I understand that the problem list needs to be cleaned up in this scenario, but is it the intent of this measure to utilize a diagnosis that was historically given and just active on the problem list?

            edave Mathematica EC eCQM Team
            jklesmith Jill (Inactive)
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