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  2. CQM-6752

CMS 154v12 Competing Conditions Value Set Clarification

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Mina Humphrey
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      Thank you for your questions for CMS154v12: Appropriate Treatment for Upper Respiratory Infection (URI). The responses are listed below in the order received.
      Thank you for your feedback; we will review the competing conditions value set. Any necessary changes will be included in a future release.
      For 2024 performance period, please use the current measure/value set publications for CMS154v12 for reporting. CQM-6413 is referencing a potential update for a future publication to account for pharyngitis/tonsillitis.
      ICD-10-CM code J20.9 (Acute bronchitis, unspecified) is not included in the 'Competing Conditions for Respiratory Conditions' or 'Comorbid Conditions for Respiratory Conditions' value sets as antibiotics. It should not be given for this condition and thus does not meet measure intent.
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      Thank you for your questions for CMS154v12: Appropriate Treatment for Upper Respiratory Infection (URI). The responses are listed below in the order received. Thank you for your feedback; we will review the competing conditions value set. Any necessary changes will be included in a future release. For 2024 performance period, please use the current measure/value set publications for CMS154v12 for reporting. CQM-6413 is referencing a potential update for a future publication to account for pharyngitis/tonsillitis. ICD-10-CM code J20.9 (Acute bronchitis, unspecified) is not included in the 'Competing Conditions for Respiratory Conditions' or 'Comorbid Conditions for Respiratory Conditions' value sets as antibiotics. It should not be given for this condition and thus does not meet measure intent.
    • CMS0154v12

      1. I would like to inquire about the inclusion of viral codes in the competing conditions value set shared between measures 154v12 and 146v12. I have noticed that there are several viral codes included and I am curious about the rationale behind this decision. Please see attached excel document.

       

      2. Additionally, I am aware that per CQM-6413  the use of the value sets

      • Acute Pharyngitis (OID: 2.16.840.1.113883.3.464.1003.102.12.1011) AND
      • Acute Tonsillitis (OID: 2.16.840.1.113883.3.464.1003.102.12.1012)

      are recommended to include as an exclusion for CMS 154 to include ICD-10-CM code J02.0. There are some codes included in these value sets that are viral or unspecified. Are there specific codes from this value set that you would recommend to include as an exclusion or the entire value set?

       

      3. Would it be appropriate to include ICD-10-CM Diagnosis code J20.9 as a competing diagnosis or comorbid condition? This code is unspecified and does not indicate if viral or bacterial.

        1. CMS154v12 Competing DX Viral Questions.xlsx
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            edave Mathematica EC eCQM Team
            mlhumphrey Mina Humphrey (Inactive)
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