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  2. CQM-6631

CMS125v11 - ICD-10 code R92.0 acceptable for Numerator section or not for PY 2023

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      Thank you for your inquiry about CMS125v11, Breast Cancer Screening.
      The ICD-10-CM code system is not appropriate to use in the "Mammography" (2.16.840.1.113883.3.464.1003.108.12.1018) value set. The eCQM value set uses LOINC codes, because the data criteria for 'Mammography' follows the CMS Measures Management System Blueprint's requirement of using the LOINC code system for the clinical concept of 'Diagnostic Study'.

      Please find below links to the Blueprint for your reference. Equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit. Supplemental Material to the CMS MMS Blueprint, Codes, Code Systems, and Value Sets, Appendix. QDM Categories with ONC Health Information Technology Standards Committee (HITSC) Recommended Vocabularies: https://www.cms.gov/files/document/blueprint-codes-code-systems-value-sets.pdf#page=25 CMS Measures Management System Blueprint Version 17.0: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint
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      Thank you for your inquiry about CMS125v11, Breast Cancer Screening. The ICD-10-CM code system is not appropriate to use in the "Mammography" (2.16.840.1.113883.3.464.1003.108.12.1018) value set. The eCQM value set uses LOINC codes, because the data criteria for 'Mammography' follows the CMS Measures Management System Blueprint's requirement of using the LOINC code system for the clinical concept of 'Diagnostic Study'. Please find below links to the Blueprint for your reference. Equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit. Supplemental Material to the CMS MMS Blueprint, Codes, Code Systems, and Value Sets, Appendix. QDM Categories with ONC Health Information Technology Standards Committee (HITSC) Recommended Vocabularies: https://www.cms.gov/files/document/blueprint-codes-code-systems-value-sets.pdf#page=25 CMS Measures Management System Blueprint Version 17.0: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint
    • CMS0125v11

      Is ICD-10-CM Diagnosis Code R92.0:  Mammographic microcalcification found on diagnostic imaging of breast, an acceptable code for the numerator criteria for CMS125v11 – Breast Cancer Screening?

       

      The reason I ask is because the measure specification mention that:

      Numerator Instructions: This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening.

       

      Whereas the code description for R92.0 mentions “diagnostic imaging” and not mammogram specifically.

            edave Mathematica EC eCQM Team
            FBaloch Fatima Baloch (Inactive)
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