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  2. CQM-6135

Z00.xx code for qualifying encounter

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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      Thank you for your inquiry regarding CMS155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents, CMS69 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan, CMS2 Preventive Care and Screening: Screening for Depression and Follow-Up Plan, CMS177 Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment.

      Your question asked if the use of ICD-10-CM codes Z00.00, Z00.01, Z00.129, Z00.121 can be used to fulfill the initial population and denominator requirement for a qualifying encounter. Although clinically equivalent services can be mapped to the codes specified in the CMS155, CMS69, CMS2, and CMS177 value sets, these codes do not meet the accepted criteria for inclusion. We would encourage you to collaborate with your vendor in this area. If mapping is done, you should maintain documentation in the event of a CMS audit.
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      Thank you for your inquiry regarding CMS155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents, CMS69 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan, CMS2 Preventive Care and Screening: Screening for Depression and Follow-Up Plan, CMS177 Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment. Your question asked if the use of ICD-10-CM codes Z00.00, Z00.01, Z00.129, Z00.121 can be used to fulfill the initial population and denominator requirement for a qualifying encounter. Although clinically equivalent services can be mapped to the codes specified in the CMS155, CMS69, CMS2, and CMS177 value sets, these codes do not meet the accepted criteria for inclusion. We would encourage you to collaborate with your vendor in this area. If mapping is done, you should maintain documentation in the event of a CMS audit.
    • CMS0002v13, CMS0069v12, CMS0155v12, CMS0177v12
    • Patients are not included in any measures due to the code used

      Our of our clients has a practice site that sent the Z00.xxx code in the encounter field. As a result, none of their patients are included in the measures. Some of the specific codes they received include: 

      Z00.00 - !https://www.icd10data.com/images/icd10data_ico.png!2023 ICD-10-CM Diagnosis Code Z00.00: Encounter for general adult medical examination without abnormal findings

      Z00.01 - !https://www.icd10data.com/images/icd10data_ico.png!2023 ICD-10-CM Diagnosis Code Z00.01: Encounter for general adult medical examination with abnormal findings

      Z00.129 - !https://www.icd10data.com/images/icd10data_ico.png!2023 ICD-10-CM Diagnosis Code Z00.129: Encounter for routine child health examination without abnormal findings

      Z00.121 - !https://www.icd10data.com/images/icd10data_ico.png!2023 ICD-10-CM Diagnosis Code Z00.121: Encounter for routine child health examination with abnormal findings

      While these are technically diagnosis codes, we feel they are reasonable to represent outpatient visits and serve as qualifying encounter for a number of measures, such as cms2, cms155, etc. Any reason to think one should not map these to the qualifying encounters?

       

            edave Mathematica EC eCQM Team
            chunli966 Chun Li
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