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  2. CQM-5976

Alignment of Pregnancy Exclusion Value Sets

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    • Resolution: Answered
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    • ​​Thank you for your inquiry. We will consider value set harmonization for a future annual update.
    • CMS0165v11
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      Both the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CQM and the Controlling High Blood Pressure CQM have active diagnosis of pregnancy as an exclusion but use different value sets. This results in pregnant patients being inconsistently excluded between measures.

      CQMs having the same exclusion of pregnancy but using different value sets result in pregnant patients being correctly excluded in one measure and not excluded in another measure. This is both confusing for providers and more importantly decreases the accuracy of both measures.
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      Both the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CQM and the Controlling High Blood Pressure CQM have active diagnosis of pregnancy as an exclusion but use different value sets. This results in pregnant patients being inconsistently excluded between measures. CQMs having the same exclusion of pregnancy but using different value sets result in pregnant patients being correctly excluded in one measure and not excluded in another measure. This is both confusing for providers and more importantly decreases the accuracy of both measures.

      Currently in the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CQM there is an exclusion for pregnancy and the value set associated with that exclusion is "Pregnancy or Other Related Diagnoses" with an OIG of: 2.16.840.1.113883.3.600.1.1623

      In the Controlling High Blood Pressure CQM there is also an exclusion for pregnancy and the value set associated with that exclusion is "Pregnancy" with an OIG of: 2.16.840.1.113883.3.526.3.378. 

      The 2 different value sets do not contain the same codes, with the Controlling High Blood Pressure CQM value set (OIG of: 2.16.840.1.113883.3.526.3.378) contains significantly more codes, despite the exclusion criteria being the same. Why isn't the same value set used to exclude pregnant patients from each measure?

      In the future, can the measure stewards align the value sets, so that 1 value set is used and is inclusive of all the codes currently in both value sets?

       

            edave Mathematica EC eCQM Team
            pgarman@wphca.org Parker Garman (Inactive)
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