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  1. eCQM Issue Tracker
  2. CQM-6334

Missing ICD 10 diagnosis codes for CMS125 and other eCQMs with Frailty and Advanced Illness Exclusion

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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      Thank you for your inquiry about the advanced illness and frailty criteria. Published versions of the measures cannot be changed after publication. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit. We will consider updates to the value set in a future publication. We hope this helps.

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      Thank you for your inquiry about the advanced illness and frailty criteria. Published versions of the measures cannot be changed after publication. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit. We will consider updates to the value set in a future publication. We hope this helps.
    • CMS0125v11
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      Patients with certain qualifying advanced illness diagnoses are not excluded from denominator for eCQMs using this data element:
      CMS125 - Breast Cancer Screening
      CMS165 - Controlling High Blood Pressure
      CMS122 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
      CMS131 - Diabetes: Eye Exam
      CMS130 - Colorectal Cancer Screening
      CMS134 - Diabetes: Medical Attention for Nephropathy
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      Patients with certain qualifying advanced illness diagnoses are not excluded from denominator for eCQMs using this data element: CMS125 - Breast Cancer Screening CMS165 - Controlling High Blood Pressure CMS122 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) CMS131 - Diabetes: Eye Exam CMS130 - Colorectal Cancer Screening CMS134 - Diabetes: Medical Attention for Nephropathy

      Several eCQMs have the frailty and advanced illness exclusion. My question is why the value set for Advanced Illness is composed of both SNOMED and ICD10 diagnosis codes, but there are inconsistencies/omissions when comparing the SNOMED code list to the codes in the ICD10 list. 

      One notable discrepancy is found for Multiple Sclerosis. There are 15 SNOMED codes in the 2023 value set that reference Multiple Sclerosis, yet zero ICD10 diagnosis codes. Why is G35 not included? 

      Since a patient with a diagnosis of any of the ICD10 or SNOMED codes listed, during an inpatient encounter or two outpatient encounters on different days, may qualify for the advanced illness criteria, would it be appropriate for internal mapping to be done in the EHR so that the patients with dx G35 would be flagged with one of the SNOMED codes that are in the value set for this diagnosis and therefore would be appropriately excluded?

      We note that G35 has been added to the value set for 2024, but this will not help our 2023 reporting.

            edave Mathematica EC eCQM Team
            hensonsw@bcm.edu Gail Henson-Swaney
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