CMS 143 Denominator Encounter requirements

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Major
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      ​​Thank you for your inquiry on CMS143v10: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation.

      Per the measure specification, the following value sets include codes that identify qualifying encounters that would meet denominator criteria.

      "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001),
      "Ophthalmological Services" (2.16.840.1.113883.3.526.3.1285),
      "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008),
      "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012), and
      "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
      In addition to a qualifying encounter during the measurement period, patients must have a diagnosis of primary open-angle glaucoma (POAG) to be included in the denominator. Acceptable POAG diagnosis codes are included in the "Primary Open-Angle Glaucoma" (2.16.840.1.113883.3.526.3.326) value set.

      You can review codes included in each value set on the Value Set Authority Center (VSAC) website at https://vsac.nlm.nih.gov.
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      ​​Thank you for your inquiry on CMS143v10: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation. Per the measure specification, the following value sets include codes that identify qualifying encounters that would meet denominator criteria. "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001), "Ophthalmological Services" (2.16.840.1.113883.3.526.3.1285), "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008), "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012), and "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014) In addition to a qualifying encounter during the measurement period, patients must have a diagnosis of primary open-angle glaucoma (POAG) to be included in the denominator. Acceptable POAG diagnosis codes are included in the "Primary Open-Angle Glaucoma" (2.16.840.1.113883.3.526.3.326) value set. You can review codes included in each value set on the Value Set Authority Center (VSAC) website at https://vsac.nlm.nih.gov .

      Numerator includes Optic Disc Exam Performed Result and this is done in Ophthalmology office.

      Looking at the 2022 CQL for Initial Population and Qualifying  Encounter During Measurement Period definitions as below, would you please help me interpret the requirements to be in the Denominator? It looks to me for a patient to be in the IP / Denominator of a provider that there needs to be an Opthalmological Services Encounter performed during the Performance Year, not just a general office visit code. 

      Is this correct? See measure 143 CQL below.

      Initial Population
      exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 18)

      and exists "Primary Open Angle Glaucoma Encounter"

       

      Qualifying Encounter During Measurement Period
      ( ["Encounter, Performed": "Office Visit"]

      union ["Encounter, Performed": "Ophthalmological Services"] union ["Encounter, Performed": "Outpatient Consultation"] union ["Encounter, Performed": "Nursing Facility Visit"] union ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] ) QualifyingEncounter where QualifyingEncounter.relevantPeriod during "Measurement Period"

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            cynthia richesin (Inactive)
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