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  2. CQM-6193

Hypoglycemic medication - Insulin slide scale qualification

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      ​Thank you for your inquiry specific to CMS816v3 (Hospital Harm – Severe Hypoglycemia). We appreciate your explanation of using RxNorm code 86009 for ‘insulin lispro sliding scale’ medication orders, but we will not be considering it for inclusion in the 2.16.840.1.113762.1.4.1196.393 Hypoglycemics Severe Hypoglycemia value set because the TTY for that code is IN (ingredient). Per CMS’ recommendation in their Supplemental Blueprint Material “Code Systems, Vocabularies, and Terminologies” (https://mmshub.cms.gov/measure-lifecycle/measure-specification/specify-code/code-systems-vocabularies-terminologies), medication value sets, when used to represent administered, ordered, or recommended substances, must draw from RxNorm and include RxNorm concepts having TTY SCD or GPCK. The expectation is for implementers to map content found in the electronic health records to the most appropriate concept in the value set with either a SCD or GPCK TTY. We refer you to your implementation team to address why mapping 86009 to another RxNorm in the value set is not an option.
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      ​Thank you for your inquiry specific to CMS816v3 (Hospital Harm – Severe Hypoglycemia). We appreciate your explanation of using RxNorm code 86009 for ‘insulin lispro sliding scale’ medication orders, but we will not be considering it for inclusion in the 2.16.840.1.113762.1.4.1196.393 Hypoglycemics Severe Hypoglycemia value set because the TTY for that code is IN (ingredient). Per CMS’ recommendation in their Supplemental Blueprint Material “Code Systems, Vocabularies, and Terminologies” ( https://mmshub.cms.gov/measure-lifecycle/measure-specification/specify-code/code-systems-vocabularies-terminologies), medication value sets, when used to represent administered, ordered, or recommended substances, must draw from RxNorm and include RxNorm concepts having TTY SCD or GPCK. The expectation is for implementers to map content found in the electronic health records to the most appropriate concept in the value set with either a SCD or GPCK TTY. We refer you to your implementation team to address why mapping 86009 to another RxNorm in the value set is not an option.
    • CMS0816v3
    • CMS0816v2

      We seek guidance on qualifying Hypoglycemic medication (for HH-01) when the medication order in the EHR is the 'Insulin slide scale' (insulin lispro sliding scale). Clinicians administer the insulin based on the glucose level. The RXNORM associated with this orderable is '86009' which is not included in the valueset 2.16.840.1.113762.1.4.1196.393, so it fails to qualify. I know previous guidance regarding valuesets only including SCD codes and recommending 'local medication codes need to be mapped to the SCD RxNorm codes found in the value set'. What is the recommendation in this case? Clinically it makes sense for the 'insulin lispro' (RXNORM 86006) to be the order used as the dosage to administer will depend on the glucose level. It is not an option to 'map' it to other SCD RXNORM. Please provide guidance on how to qualify for this hypoglycemic medication. Should you consider adding the RXNORM to the valueset?

        1. Example of Order -slide scale.JPG
          Example of Order -slide scale.JPG
          32 kB
        2. RXNORM.JPG
          RXNORM.JPG
          261 kB

            JLeflore Mathematica EH eCQM Team
            isbelia Isbelia Briceno
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