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  2. CQM-6136

CMS122 Diabetes A1C Poor Control Lives in Nursing Home finding

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      Thank you for your inquiry about the exclusion in CMS122v11, Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%). To clarify, the exclusion criteria "Is Age 66 or Older Living Long Term in a Nursing Home" requires patients 66 or older at the end of the measurement period where the last housing status assessment performed (LOINC code 71802-3) has a result of "lives in a nursing home (finding)" (SNOMED code 160734000). The intent of this exclusion is to identify individuals who are likely to be living in a nursing home any time on or before the end of the measurement period and receiving institutionalized long-term care services. Clinically equivalent services can be mapped to the codes; if mapping is done, you should maintain documentation in case of a CMS audit.
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      Thank you for your inquiry about the exclusion in CMS122v11, Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%). To clarify, the exclusion criteria "Is Age 66 or Older Living Long Term in a Nursing Home" requires patients 66 or older at the end of the measurement period where the last housing status assessment performed (LOINC code 71802-3) has a result of "lives in a nursing home (finding)" (SNOMED code 160734000). The intent of this exclusion is to identify individuals who are likely to be living in a nursing home any time on or before the end of the measurement period and receiving institutionalized long-term care services. Clinically equivalent services can be mapped to the codes; if mapping is done, you should maintain documentation in case of a CMS audit.
    • CMS0122v11
    • Assessing ability to capture nursing home patient exclusions

      We've determined that we cannot use CPT codes to capture patients for the nursing home exclusion for the CMS 122 Diabetes Poor Control measure and other measures that use the "Lives in a nursing home (finding) because swing beds utilize the same CPT codes within our system. The organization does not have documentation at this time to identify nursing home patients. However, we do utilize a nursing home encounter type and would like to map this encounter type to the "Lives in nursing home (finding) snomed code. Is this an appropriate solution?

            edave Mathematica EC eCQM Team
            jklesmith Jill
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