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  2. CQM-6054

Clarification of morbidity diagnoses

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    • Hannah Bontrager
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      Thank you for your question about CMS1028v1 Severe Obstetric Complications. The PC07 specifications state that the risk variables must be present on admission (POA) or exempt (from POA reporting). There are over 37,000 codes that are designated as exempt from POA reporting. The list can be found here: https://www.cdc.gov/nchs/icd/comprehensive-listing-of-icd-10-cm-files.htm; specifically the “List of Codes and Descriptions” https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/April-1-2023-Update/POAexemptCodesApr23.zip . The codes and categories on this exempt list correspond to circumstances regarding the healthcare encounter or factors influencing health status that do not represent a current disease or injury or that describe conditions that are always present on admission. Therefore, we include "exempt" codes when identifying risk variable as by definition they are present on admission.

      An example is Z79.4 (long term use of insulin), which is a code on the Preexisting Diabetes value set. Another example is Q21.0 (ventricular septal defect), which is a code on the Cardiac Disease value set. As there are approximately 100 of the risk variable diagnoses that are POA exempt we would hope exploring the POAexemptCodes found in the Comprehensive Listing ICD-10-CM Files provides you the resources relevant to a more specific use case.
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      Thank you for your question about CMS1028v1 Severe Obstetric Complications. The PC07 specifications state that the risk variables must be present on admission (POA) or exempt (from POA reporting). There are over 37,000 codes that are designated as exempt from POA reporting. The list can be found here: https://www.cdc.gov/nchs/icd/comprehensive-listing-of-icd-10-cm-files.htm; specifically the “List of Codes and Descriptions” https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/April-1-2023-Update/POAexemptCodesApr23.zip . The codes and categories on this exempt list correspond to circumstances regarding the healthcare encounter or factors influencing health status that do not represent a current disease or injury or that describe conditions that are always present on admission. Therefore, we include "exempt" codes when identifying risk variable as by definition they are present on admission. An example is Z79.4 (long term use of insulin), which is a code on the Preexisting Diabetes value set. Another example is Q21.0 (ventricular septal defect), which is a code on the Cardiac Disease value set. As there are approximately 100 of the risk variable diagnoses that are POA exempt we would hope exploring the POAexemptCodes found in the Comprehensive Listing ICD-10-CM Files provides you the resources relevant to a more specific use case.
    • CMS1028v2
    • CMS1028v1

      What would be an appropriate diagnosis for "exempt from POA reporting" as suggested on the value set for Present on Admission for ePC-07?

            JLeflore Mathematica EH eCQM Team
            hannah.pierce@dchsystem.com Hannah Pierce (Inactive)
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