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  2. CQM-6691

Is Value set for Present On Admission for PC-07 lacking codes?

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    • Robert Trout
    • 2817850282
    • CHI St. Luke's Health - CommonSpirit
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      Thank you for inquiring about CMS1028/PC-07 Severe Obstetric Complications risk adjustment variables. The value set “Present on Admission = Yes or Exempt” (2.16.840.1.113762.1.4.1110.63) contains two (2) codes from the code system of PresentOnAdmission:

      “1” with the description of “Unreported/Not used. Exempt from POA reporting” and
      “Y” with the description of “Diagnosis was present at the time of inpatient admission.”
       
      For the risk adjustment variables, the logic calls for the diagnosis code (or procedure) to be included in one of risk adjustment variable value sets and that that the identified diagnosis or procedure was present on admission.

      For example, for the Risk Variable Anemia to be applicable, “EncounterDiagnoses.code in “Anemia”” refers to a diagnosis code in the valueset "Anemia" (2.16.840.1.113762.1.4.1029.323) and for that diagnosis code, PresentOnAdmission code would be evaluated to be “Y” for Yes or “1” for Exempt.
      Show
      Thank you for inquiring about CMS1028/PC-07 Severe Obstetric Complications risk adjustment variables. The value set “Present on Admission = Yes or Exempt” (2.16.840.1.113762.1.4.1110.63) contains two (2) codes from the code system of PresentOnAdmission: “1” with the description of “Unreported/Not used. Exempt from POA reporting” and “Y” with the description of “Diagnosis was present at the time of inpatient admission.”   For the risk adjustment variables, the logic calls for the diagnosis code (or procedure) to be included in one of risk adjustment variable value sets and that that the identified diagnosis or procedure was present on admission. For example, for the Risk Variable Anemia to be applicable, “EncounterDiagnoses.code in “Anemia”” refers to a diagnosis code in the valueset "Anemia" (2.16.840.1.113762.1.4.1029.323) and for that diagnosis code, PresentOnAdmission code would be evaluated to be “Y” for Yes or “1” for Exempt.
    • CMS1028v2
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      PC-07 is a risk adjusted measure. The risk adjustment requires that Diagnoses must be Present on Admission. The value set for "Present on Admission=Yes or Exempt" appears to contain no codes (SNOMED or LOINC). As a result, none of the diagnoses are included in the risk adjustment, giving a false value for the adjustment.
      Show
      PC-07 is a risk adjusted measure. The risk adjustment requires that Diagnoses must be Present on Admission. The value set for "Present on Admission=Yes or Exempt" appears to contain no codes (SNOMED or LOINC). As a result, none of the diagnoses are included in the risk adjustment, giving a false value for the adjustment.

      The measure CMS 1028 (PC-07) Severe Obstetric Complications is a risk adjusted measure. Additional variables that are used for risk adjustment are “Pre-existing conditions and variables must be present on admission:” The data that is submitted to CMS for risk adjustment must include both the codes for the diagnosis that qualifies for risk adjustment and a code for “Present on Admission.”

      Is the value set for present on admission empty? The value set “Present on Admission =Yes or Exempt” 2.16.840.1.113762.1.4.1110.63 contains only another value set: 2.16.840.1.113883.6.301.11. This value set appears to be empty.

      The QRDA files that we have generated to submit to hqr.cms.gov don’t include a code for “Present on Admission,” since, as far as I can see, no code exists for this. Consequently, our risk assessment will not include any of the 25+ diagnoses that require that a code for “Present on Admission” also be submitted.

      Include SNOMED or LOINC codes in the value set that represents Present on Admission=Yes or Exempt

            JLeflore Joelencia Leflore
            RobertTrout Robert Trout
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