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  2. CQM-6126

Definition of Qualifying Encounter and Relevant Period

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      ​​Thank you for your inquiry on CMS108v11 Venous Thromboembolism Prophylaxis. Patient had a knee surgery (0SRC0J9) on 3/27, but was admit to inpatient on 3/29.

      1. Since knee surgery is not considered as a principal procedure occurring during the inpatient encounter stay, it would not be qualifying the denominator exclusion condition named "Encounter with Principal Procedure of SCIP VTE Selected Surgery"
      2. According to provided info, this patient is stratifying the condition of "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery" where to evaluate a knee surgery started before or on end of QualifyingEncounter.relevantPeriod. The time frame for QualifyingEncounter.relevantPeriod is inpatient admission datetime to discharge datetime. this definition is looking for 'end of relevantPeriod' which is discharge datetime.
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      ​​Thank you for your inquiry on CMS108v11 Venous Thromboembolism Prophylaxis. Patient had a knee surgery (0SRC0J9) on 3/27, but was admit to inpatient on 3/29. 1. Since knee surgery is not considered as a principal procedure occurring during the inpatient encounter stay, it would not be qualifying the denominator exclusion condition named "Encounter with Principal Procedure of SCIP VTE Selected Surgery" 2. According to provided info, this patient is stratifying the condition of "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery" where to evaluate a knee surgery started before or on end of QualifyingEncounter.relevantPeriod. The time frame for QualifyingEncounter.relevantPeriod is inpatient admission datetime to discharge datetime. this definition is looking for 'end of relevantPeriod' which is discharge datetime.
    • CMS0108v11
    • Patient's with SCIP procedures, during encounter but prior to inpatient admission date, are not being excluded from the measure.

      I have a patient who arrived at the hospital on 3/27 @ 0559 for a knee replacement (OSRC0J9).  She was transferred from Day Surgery to Observation Status afterwards.  The patient was transferred to Inpatient status until 3/29.  Would this patient be excluded from the measure as she had her SCIP procedure during the encounter even though it was before she was admitted to inpatient status?  This is the definition I see:

      Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery
      VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
        with ( ["Procedure, Performed": "Hip Replacement Surgery"]
          union ["Procedure, Performed": "Knee Replacement Surgery"] ) HipKneeProcedure
          such that Global."NormalizeInterval" ( HipKneeProcedure.relevantDatetime, HipKneeProcedure.relevantPeriod ) starts on or before 
          end of QualifyingEncounter.relevantPeriod

      I guess the question is, which time frame is considered the Qualifying Encounter during the relevant period?  Would this time period include arrival to discharge?

            JLeflore Mathematica EH eCQM Team
            adani65 Ashley Daniel
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