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  1. eCQM Issue Tracker
  2. CQM-5946

2023 eCQM Observation codes

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    • Resolution: Answered
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      ​Thank you for your inquiry. ​Organizations should use the value sets and codes as they exist and not make adjustments in reporting based on the changes to code definitions or code status (e.g., obsolete). If a measure that uses the Observation value set only looks back at dates of service that occur in 2023 or later then the value set is simply irrelevant to the measure (while it will likely not identify any visits, leaving it in the measure does not cause any harm). If a measure looks back prior to 2023 then those observation visits will be included in reporting.

      That said, effective 1/1/2023 observation visits are combined with hospital care (in CPT codes that are used on claims for billing purposes) and if an organization is mapping data to CPT codes observation visits should be mapped to the codes for "initial hospital care or observation care."
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      ​Thank you for your inquiry. ​Organizations should use the value sets and codes as they exist and not make adjustments in reporting based on the changes to code definitions or code status (e.g., obsolete). If a measure that uses the Observation value set only looks back at dates of service that occur in 2023 or later then the value set is simply irrelevant to the measure (while it will likely not identify any visits, leaving it in the measure does not cause any harm). If a measure looks back prior to 2023 then those observation visits will be included in reporting. That said, effective 1/1/2023 observation visits are combined with hospital care (in CPT codes that are used on claims for billing purposes) and if an organization is mapping data to CPT codes observation visits should be mapped to the codes for "initial hospital care or observation care."
    • CMS0122v11, CMS0125v11, CMS0130v11, CMS0131v11, CMS0136v12, CMS0137v11, CMS0146v11, CMS0154v11
    • Observation codes appear to have been retired as of 1/1/23. Health Organizations billing Observation services need to be advised what codes should be used for 2023 reporting.

      We are an EHR vendor looking for guidance on which codes our customers should be using for “Observation” type encounters due to the following two Value Set OIDs containing no codes for the 2023 MIPS performance year:

      1. Initial Hospital Observation Care value set 2.16.840.1.113883.3.464.1003.101.12.1002
      2. Observation value set  2.16.840.1.113883.3.464.1003.101.12.1086

      We reached out to the National Committee for Quality Assurance and received a response stating “CPT code definitions were changed effective 1/1/2023; codes for observation (alone) were retired and codes for “hospital care” were modified to also include Observation (e.g., codes formerly described as “hospital care” changed to “hospital care or observation care”). With this change hospital and observation care become synonymous (as far as coding is concerned).” 

      Per the response from NCQA, can you please advise us on which exact Value Set OIDs and their corresponding codes should be referenced?

      Encounter, Performed: Initial Hospital Observation Care value set 2.16.840.1.113883.3.464.1003.101.12.1002

      eCQMs using this data element:

      CMS137v11 - Initiation and Engagement of Substance Use Disorder Treatment

      CMS136v12 - Follow-Up Care for Children Prescribed ADHD Medication (ADD)

      CMS146v11 - Appropriate Testing for Pharyngitis

      CMS154v11 - Appropriate Treatment for Upper Respiratory Infection (URI)

       

      Encounter, Performed: Observation value set  2.16.840.1.113883.3.464.1003.101.12.1086

      eCQMs using this data element:

      CMS122v11 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

      CMS125v11 - Breast Cancer Screening

      CMS130v11 - Colorectal Cancer Screening

      CMS131v11 - Diabetes: Eye Exam

      CMS165v11 - Controlling High Blood Pressure

      CMS146v11 - Appropriate Testing for Pharyngitis

      CMS154v11 - Appropriate Treatment for Upper Respiratory Infection (URI)

            edave Mathematica EC eCQM Team
            ssousa Stephanie Sousa
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