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  2. CQM-6288

CMS 122v11 - Denominator bringing in patients seen by provider not licensed to treat diabetes

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      Thank you for your inquiry for CMS122v11: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%). The intent of "Qualifying Encounter" is to allocate patients to clinicians who have an ongoing relationship with the patient. Clinicians who have patients with a documentation of a qualifying encounter and an active diabetes diagnosis during the measurement period can report this measure.
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      Thank you for your inquiry for CMS122v11: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%). The intent of "Qualifying Encounter" is to allocate patients to clinicians who have an ongoing relationship with the patient. Clinicians who have patients with a documentation of a qualifying encounter and an active diabetes diagnosis during the measurement period can report this measure.
    • CMS0122v11
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      In a multidiscipline clinic patients only seen by chiropractors are getting pulled into the diabetes measure even though it may be outside of their scope of practice to treat diabetes.
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      In a multidiscipline clinic patients only seen by chiropractors are getting pulled into the diabetes measure even though it may be outside of their scope of practice to treat diabetes.

      The eCQM CMS 122V11, Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) defines the denominator as the "Initial Population", the definition for the "Initial Population" includes people with a "Qualifying Encounter" and then "Qualifying Encounter" includes the "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001) value set. This value set contains the CPT code 99212. 

      This code 99212 is used by provider types that are not licensed to treat diabetes such as chiropractors. Is the intent of the measure to include patients seen by providers that are not licensed to treat diabetes? 

            edave Mathematica EC eCQM Team
            akladnitsky Aleksandr Kladnitsky
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