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  1. eCQM Issue Tracker
  2. CQM-5571

Frailty Symptom valueset includes 'living in nursing home' snomed code

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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    • Roy Soltoff
    • 7038017844
    • Medicomp Systems, Inc
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      Thank you for your recommendation for the Advanced Illness and Frailty Exclusion ECQM library for 2023 performance period, which we will consider for future revision. To clarify, a patient can meet the "living long term in a nursing home" exclusion using SNOMED code 160734000 (in addition to LOINC code 71802-3). They may also use the same SNOMED code to meet the frailty criteria, however, in order for a patient aged 66-80 to meet the entire "advanced illness and frailty" exclusion, they would also need to meet the advanced illness criteria in addition to the frailty criteria. It is the combination of age, frailty and advanced illness that qualify them for the denominator exclusion. The exception is patients aged 81 and older in CMS165 where they can meet exclusion with only one indication of frailty. The measures will exclude the patient if one of any denominator exclusions is met.
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      Thank you for your recommendation for the Advanced Illness and Frailty Exclusion ECQM library for 2023 performance period, which we will consider for future revision. To clarify, a patient can meet the "living long term in a nursing home" exclusion using SNOMED code 160734000 (in addition to LOINC code 71802-3). They may also use the same SNOMED code to meet the frailty criteria, however, in order for a patient aged 66-80 to meet the entire "advanced illness and frailty" exclusion, they would also need to meet the advanced illness criteria in addition to the frailty criteria. It is the combination of age, frailty and advanced illness that qualify them for the denominator exclusion. The exception is patients aged 81 and older in CMS165 where they can meet exclusion with only one indication of frailty. The measures will exclude the patient if one of any denominator exclusions is met.
    • CMS0122v11, CMS0125v11, CMS0130v11, CMS0131v11, CMS0165v11
    • Measures using the Advanced Illness and Frailty Exclusion ECQM library get credit for two denominator exclusion bullets for the same SNOMED code.

      CMS measures 165, 134, 122, 131, 125, and 130 all use the advanced illness library. But there is a value set duplication. The denominator exclusions are:

      • Hospice."Has Hospice Services"
      •   or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
      •   or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
      •   or PalliativeCare."Palliative Care in the Measurement Period"

      The value set "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075) used in the 2nd exclusion contains SNOMED code 160734000. This code is also used as the Direct Reference Code (DRC) for the 3rd bullet when assessing housing status,

      I believe that the frailty symptom value set should not include that code.

            edave Mathematica EC eCQM Team
            RoSoltoff4889 Roy Soltoff
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