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  2. CQM-6537

CMS816v2 : qualifying severe hypoglycemic event Query

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      Thank you for your inquiry specific to CMS816v2 Hospital Harm – Severe Hypoglycemia. Based on your scenario, the encounter does not qualify for the numerator. The criteria to meet the numerator is an inpatient hospitalization with a severe hypoglycemic event which is defined as:

      A blood glucose result less than 40 mg/dL

      AND

      A hypoglycemic medication is administered within 24 hours prior to the start of the severe hypoglycemic event (i.e., the glucose result less than 40 mg/dL)

      AND

      There is no subsequent repeat test for blood glucose with a result greater than 80 mg/dL within five minutes of the start of the initial blood glucose test with result less than 40mg/dL

      Although your scenario encounter includes multiple glucose tests with results less than 40mg/dL, none of them have a hypoglycemic medication administered within 24 hours prior to the low glucose result.

      To answer your second question, the measure intent is not to necessarily capture the first qualifying event in the case of multiple qualifying events. Rather, it only needs to capture one qualifying event during the encounter to meet the numerator. The numerator statement in CMS816v3 was revised to clarify this intent, and states that “Only one qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter”.

      We hope this helps.
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      Thank you for your inquiry specific to CMS816v2 Hospital Harm – Severe Hypoglycemia. Based on your scenario, the encounter does not qualify for the numerator. The criteria to meet the numerator is an inpatient hospitalization with a severe hypoglycemic event which is defined as: A blood glucose result less than 40 mg/dL AND A hypoglycemic medication is administered within 24 hours prior to the start of the severe hypoglycemic event (i.e., the glucose result less than 40 mg/dL) AND There is no subsequent repeat test for blood glucose with a result greater than 80 mg/dL within five minutes of the start of the initial blood glucose test with result less than 40mg/dL Although your scenario encounter includes multiple glucose tests with results less than 40mg/dL, none of them have a hypoglycemic medication administered within 24 hours prior to the low glucose result. To answer your second question, the measure intent is not to necessarily capture the first qualifying event in the case of multiple qualifying events. Rather, it only needs to capture one qualifying event during the encounter to meet the numerator. The numerator statement in CMS816v3 was revised to clarify this intent, and states that “Only one qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter”. We hope this helps.
    • CMS0816v2

      Hi Team,

      Consider statements below from CMS816v2:

      A hypoglycemic medication administered within 24 hours prior to the start of the severe hypoglycemic event (i.e., the glucose result less than 40 mg/dL)

      Encounter With Severe Hypoglycemic Harm Event :
      "Encounter With Hypoglycemic Medication Administration" QualifyingEncounter
        where exists ( ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] BloodGlucoseLab1
            with ["Medication, Administered": "Hypoglycemics Severe Hypoglycemia"] HypoglycemicMed
              such that Global."NormalizeInterval" ( HypoglycemicMed.relevantDatetime, HypoglycemicMed.relevantPeriod ) starts 24 hours or less before or on BloodGlucoseLab1.relevantDatetime
                and Global."NormalizeInterval" ( HypoglycemicMed.relevantDatetime, HypoglycemicMed.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( QualifyingEncounter )
            without ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] BloodGlucoseLab2
              such that BloodGlucoseLab2.relevantDatetime during Global."HospitalizationWithObservation" ( QualifyingEncounter )
                and BloodGlucoseLab2.relevantDatetime 5 minutes or less after BloodGlucoseLab1.relevantDatetime
                and BloodGlucoseLab2.result > 80 'mg/dL'
            where BloodGlucoseLab1.relevantDatetime during Global."HospitalizationWithObservation" ( QualifyingEncounter )
              and BloodGlucoseLab1.result < 40 'mg/dL'
        )

      Scenario1 :

      Patient A aged 21 years with

      Start of EDencounter.relevantPeriod = 01/01/2023 18:28:00

      End of EDencounter.relevantPeriod = 05/01/2023 10:51:00

      Start of Inpatientencounter.relevantPeriod = 05/01/2023 10:51:00

      End of Inpatient.relevantPeriod = 10/01/2023 11:28:00

      having Glucose Lab Test Mass Per Volume documented on 01/01/2023 20:09 with value 0 mg/dL Also on 05/01/2023 9:51 with value 2 mg/dL and with Hypoglycemics Severe Hypoglycemia medication administered on 05/01/2023 10:22:00 and Glucose Lab Test Mass Per Volume documented on 01/01/2023 20:13 with value 142 mg/dL. Also, on 05/01/2023 10:05 with value 85 mg/dL 

      #Query : 

      Will the above patient qualify for the numerator? Do we consider only first qualifying hypoglycemic event for numerator determination in case of multiple qualifying hypoglycemic events.

       

       

            JLeflore Joelencia Leflore
            GayatriK4 gayatri kulkarni (Inactive)
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