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  2. CQM-6632

CMS 506 Safe Use of Opioids - Denominator exclusion related to cancer diagnosis.

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
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    • Peggy Lutz
    • 715-305-7805
    • Ascension WI
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      Thank you for your question regarding CMS506v5 Safe Use of Opioids - Concurrent Prescribing. Please see below for answers to your questions:

      What determines if the cancer diagnosis overlaps the encounter?
      A cancer diagnosis overlaps the encounter if it is an active diagnosis at any time during the encounter.

      Does the cancer diagnosis have to be a coded diagnosis for the encounter to be considered an exclusion?
      The cancer diagnosis must have a code from the All Primary and Secondary Cancer value set (2.16.840.1.113762.1.4.1111.161) to be considered an exclusion. You can review codes in the value set on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov

      If the cancer diagnosis is on the non-hospital problem list, is it considered an exclusion?
      If the cancer diagnosis is coded on the non-hospital problem list and it is available in the patient’s hospital EHR, it can be considered an exclusion as long as it is an active diagnosis during the inpatient encounter.

      Is there a timeframe from the date of IP encounter where cancer diagnosis would qualify as overlapping and be an exclusion?
      While there is not a specific timeframe from the date of the IP encounter that the cancer diagnosis must be present to be considered overlapping, the cancer diagnosis must be active at some point during the IP encounter to qualify as overlapping.

      Does familial cancer overlapping the encounter qualify for denominator exclusion?
      The All Primary and Secondary Cancer value set (2.16.840.1.113762.1.4.1111.161) contains four SNOMEDCT codes for familial cancer. If the cancer associated with any of these codes overlaps the encounter it would qualify for the denominator exclusion. You can review codes in the value set on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov
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      Thank you for your question regarding CMS506v5 Safe Use of Opioids - Concurrent Prescribing. Please see below for answers to your questions: What determines if the cancer diagnosis overlaps the encounter? A cancer diagnosis overlaps the encounter if it is an active diagnosis at any time during the encounter. Does the cancer diagnosis have to be a coded diagnosis for the encounter to be considered an exclusion? The cancer diagnosis must have a code from the All Primary and Secondary Cancer value set (2.16.840.1.113762.1.4.1111.161) to be considered an exclusion. You can review codes in the value set on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov If the cancer diagnosis is on the non-hospital problem list, is it considered an exclusion? If the cancer diagnosis is coded on the non-hospital problem list and it is available in the patient’s hospital EHR, it can be considered an exclusion as long as it is an active diagnosis during the inpatient encounter. Is there a timeframe from the date of IP encounter where cancer diagnosis would qualify as overlapping and be an exclusion? While there is not a specific timeframe from the date of the IP encounter that the cancer diagnosis must be present to be considered overlapping, the cancer diagnosis must be active at some point during the IP encounter to qualify as overlapping. Does familial cancer overlapping the encounter qualify for denominator exclusion? The All Primary and Secondary Cancer value set (2.16.840.1.113762.1.4.1111.161) contains four SNOMEDCT codes for familial cancer. If the cancer associated with any of these codes overlaps the encounter it would qualify for the denominator exclusion. You can review codes in the value set on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov
    • CMS0506v5

      We are seeking clarification on CMS 506 Safe Use of Opioids, Concurrent Prescribing, particularly the denominator exclusion related to cancer diagnosis.  
       
      According to Epic's Green Book (April 28, 2023) measure specifications for the 2023 reporting year, it is a denominator exclusion for inpatient hospitalization where patients have cancer that overlaps the encounter. 
       

       
      What determines if the cancer diagnosis overlaps the encounter? 

      • Does the cancer diagnosis have to be a coded diagnosis for the encounter to be considered an exclusion? 
      • If the cancer diagnosis is on the non-hospital problem list, is it considered an exclusion? 
      • Is there a timeframe from the date of IP encounter where cancer diagnosis would qualify as overlapping and be an exclusion? 
        Here is an example of an encounter where I questioned if the cancer diagnosis should be considered a denominator exclusion. 
         


         
         

         

      Here is another example where this time cancer is listed as a denominator exclusion where I cannot find evidence of a cancer diagnosis.  
       
      Admit date 10/6/2023 Discharge date 10/30/2023

      CMS-506 - denominator exclusion 

      Chart review:  Intra-abdominal abscess (HCC)  is the only hospital problem listed.  I do not see a diagnosis of cancer on the non-hospital problem list. The only thing I found in the chart is familial cancer of breast listed on the hospital non-problem list. Coding does not show a diagnosis code for cancer for the inpatient encounter.

      • Does familial cancer overlapping the encounter qualify for denominator exclusion? 

      Below are copies of the problem list and Epic mapping related to this metric. 
       

       

       
      In Epic's Green Book for Measure Logic (2022 Reporting Year), it is a denominator exclusion when the patient has a diagnosis of cancer (all primary and secondary cancer) at any time during the hospitalization. This was easy to identify from the hospital problem list and coding.

            JLeflore Mathematica EH eCQM Team
            trampull Tom Rampulla (Inactive)
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