Brief description of measure: CMS56: Functional Status Assessment for Total Hip Replacement Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery CMS66: Functional Status Assessment for Total Knee Replacement Percentage of patients 19 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery ​CMS90: Functional Status Assessments for Heart Failure Percentage of patients 18 years of age and older with heart failure who completed initial and follow-up patient-reported functional status assessments Description of issue: ​​​The measure steward received feedback to include additional codes to represent severe cognitive impairment for the denominator exclusions. Currently, only code "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " is a denominator exclusion. Goal of review: Obtain clinical and technical feedback

Proposed solution: ​​We propose replacing "Severe dementia (disorder) SNOMEDCT Code 428351000124105 " with the Cognitive Impairment value set (2.16.840.1.113883.3.464.1003.1186) in the logic. CMS90 Logic before: define "Denominator Exclusions": Hospice."Has Hospice"   or exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia       where Dementia.prevalencePeriod overlaps "Measurement Period"  ) CMS90 Logic after: define "Denominator Exclusions": Hospice."Has Hospice"   or exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment       where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period"  ) CMS56 and CMS66 Logic before: define "Has Dementia Diagnosis": exists ( ["Diagnosis": "Severe dementia (disorder)"] Dementia     where Dementia.prevalencePeriod overlaps "Measurement Period") CMS56 and CMS66 Logic after: define "Has Dementia Diagnosis": exists ( ["Diagnosis": "Cognitive Impairment"] SevereCognitiveImpairment     where SevereCognitiveImpairment.prevalencePeriod overlaps "Measurement Period") CMS56, 66, 56 and 90 Terminology before: "Severe dementia (disorder)” SNOMEDCT Code 428351000124105  CMS56, 66, 56 and 90 Terminology After: Cognitive Impairment (2.16.840.1.113883.3.464.1003.1186) Rationale for change: ​​​We propose including additional codes to better represent the denominator exclusion criteria for severe cognitive impairment.