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  2. CQM-6465

ePC-07 Denominator Exclusion for COVID clarification

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      Thanks for your question about CMS1028v1.3(PC-07) Severe Obstetric Complications. The patient would not be excluded for COVID diagnosis alone. They would also need the COVID-related respiratory condition or procedure.

      Because there is significant variation in the severity of COVID-19 illness, only COVID diagnosis with additional respiratory 'conditions' or 'procedures' will exclude the patient from the denominator population.

      The measure specifications for the denominator exclusion are found below:

      Denominator Exclusion

      "Delivery Encounters with COVID and Respiratory Condition or Procedure"
      Delivery Encounters with COVID and Respiratory Condition or Procedure
      "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "COVID 19 Confirmed"
        )
      *** and ( exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
                where EncounterDiagnoses.code in "Respiratory Conditions Related to COVID 19"
                  or exists ( ["Procedure, Performed": "Respiratory Support Procedures Related to COVID 19"] EncounterProcedures
                      where Global."NormalizeInterval" ( EncounterProcedures.relevantDatetime, EncounterProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )
                  )
            )
          )
      The logic prior to the *** require a COVID diagnosis from the "COVID 19 Confirmed" value set (OID 2.16.840.1.113762.1.4.1029.373) which you reference in your question. Please note the measure logic after the ***. In addition to a COVID diagnosis you must have a diagnosis in the "Respiratory Conditions Related to COVID 19" value set or a procedure from the "Respiratory Support Procedures Related to COVID 19" value set that starts during the encounter.
      Show
      Thanks for your question about CMS1028v1.3(PC-07) Severe Obstetric Complications. The patient would not be excluded for COVID diagnosis alone. They would also need the COVID-related respiratory condition or procedure. Because there is significant variation in the severity of COVID-19 illness, only COVID diagnosis with additional respiratory 'conditions' or 'procedures' will exclude the patient from the denominator population. The measure specifications for the denominator exclusion are found below: Denominator Exclusion "Delivery Encounters with COVID and Respiratory Condition or Procedure" Delivery Encounters with COVID and Respiratory Condition or Procedure "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter   where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses       where EncounterDiagnoses.code in "COVID 19 Confirmed"   ) *** and ( exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses           where EncounterDiagnoses.code in "Respiratory Conditions Related to COVID 19"             or exists ( ["Procedure, Performed": "Respiratory Support Procedures Related to COVID 19"] EncounterProcedures                 where Global."NormalizeInterval" ( EncounterProcedures.relevantDatetime, EncounterProcedures.relevantPeriod ) starts during day of PCMaternal."HospitalizationWithEDOBTriageObservation" ( TwentyWeeksPlusEncounter )             )       )     ) The logic prior to the *** require a COVID diagnosis from the "COVID 19 Confirmed" value set (OID 2.16.840.1.113762.1.4.1029.373) which you reference in your question. Please note the measure logic after the ***. In addition to a COVID diagnosis you must have a diagnosis in the "Respiratory Conditions Related to COVID 19" value set or a procedure from the "Respiratory Support Procedures Related to COVID 19" value set that starts during the encounter.
    • CMS1028v1
    • Could have patients not excluded or include patients that should not be in the measure.

      the ePC-07 specifications document states the following as a Denominator Exclusion: "Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure". We are seeking clarification that a diagnosis of COVID is not enough to get excluded but the diagnosis needs to also include a COVID-related respiratory condition or procedure. We have a patient who has a diagnosis of COVID (U07.1 which is included in value set 2.16.840.1.113762.1.4.1029.373) but is not showing as an exclusion. I do not see any additional documentation for any COVID-related respiratory conditions or procedures so am assuming that is why the patient is included.

            JLeflore Mathematica EH eCQM Team
            adunn Amanda Dunn
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