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CMS 155

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      Thank you for your inquiry about CMS155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents. Since no measure version is specified, the answer will be provided in the context of CMS155v11 (2023 Performance Period). Since the ICD10 code O35.5XX0 is contained in the "Pregnancy" value set for 2023 Performance Period, the patient would meet the denominator exclusion criteria for a diagnosis of this code where the diagnosis is occurring any time during the measurement period. HCC codes that are equivalent and mapped to the ICD10 code O35.5XX0 would satisfy this denominator exclusion requirements. Equivalent services can be mapped to the value set; if mapping is done, you should maintain documentation in case of a CMS audit.
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      Thank you for your inquiry about CMS155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents. Since no measure version is specified, the answer will be provided in the context of CMS155v11 (2023 Performance Period). Since the ICD10 code O35.5XX0 is contained in the "Pregnancy" value set for 2023 Performance Period, the patient would meet the denominator exclusion criteria for a diagnosis of this code where the diagnosis is occurring any time during the measurement period. HCC codes that are equivalent and mapped to the ICD10 code O35.5XX0 would satisfy this denominator exclusion requirements. Equivalent services can be mapped to the value set; if mapping is done, you should maintain documentation in case of a CMS audit.
    • CMS0155v11

       CMS 155 states to exclude Patients who have a diagnosis of pregnancy during the measurement period. Should patient (4 years old) be excluded for a dx of Maternal Care For Suspected Damage To Fetus By Drugs Single Gestation (HCC) code O035.5XX0
      Looking at value set for pregnancy CMS 155 this code is listed. Should patient be excluded? 

            edave Mathematica EC eCQM Team
            hollerich.amber@mayo.edu Amber Hollerich
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