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  2. CQM-6757

CMS 108 /VTE-1: SCIP VTE Selected Surgery Value Set for Hip Fracture Surgery

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      Thank you for your question on CMS108, Venous Thromboembolism Prophylaxis. The Procedure, Performed: Hip Fracture Surgery [Value set OID: 2.16.840.1.113883.3.117.1.7.1.258] was modeled after the SCIP procedure value set which only included the repair concepts noted within the value set. The ICD-9 and the ICD-10 codes on the original SCIP table do not map to open reduction of fracture. We will review all the SCIP value sets and update the value sets accordingly in the next AU process (2025AU). For those 2 codes 0QSB06Z, 0QS806Z, we recommend mapping to a procedure code 239500004 |Interposition arthroplasty of the hip (procedure) within the SNOMED hip fracture surgery value set.
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      Thank you for your question on CMS108, Venous Thromboembolism Prophylaxis. The Procedure, Performed: Hip Fracture Surgery [Value set OID: 2.16.840.1.113883.3.117.1.7.1.258] was modeled after the SCIP procedure value set which only included the repair concepts noted within the value set. The ICD-9 and the ICD-10 codes on the original SCIP table do not map to open reduction of fracture. We will review all the SCIP value sets and update the value sets accordingly in the next AU process (2025AU). For those 2 codes 0QSB06Z, 0QS806Z, we recommend mapping to a procedure code 239500004 |Interposition arthroplasty of the hip (procedure) within the SNOMED hip fracture surgery value set.
    • CMS0108v11
    • Patient falls out of eCQM measure even though they had a hip fracture surgery.

      We are reviewing our data for eCQM VTE-1 and noticed patients will have 'hip fracture surgery' yet their coded procedure is not included in the value set Procedure, Performed: Hip Fracture Surgery [Value set OID: 2.16.840.1.113883.3.117.1.7.1.258]. 

      The value set include 4 ICD10PCS codes: 

      0SQ90ZZ    Repair Right Hip Joint, Open Approach    
      0SQ9XZZ    Repair Right Hip Joint, External Approach
      0SQB0ZZ    Repair Left Hip Joint, Open Approach    
      0SQBXZZ    Repair Left Hip Joint, External Approach

      The value set does not include more granular codes that our coding staff use. Therefore, our patients are not qualifying for the denominator exclusion as we would expect. For example, we had patients with these codes instead.  

      0QSB06Z  Reposition Right Lower Femur with Intramedullary Internal Fixation Device, Open Approach

      0QS806Z - Reposition Right Femoral Shaft with Intramedullary Internal Fixation Device, Open Approach

      Is CMS or TJC giving any consideration to expanding this value set to include more codes? Any guidance about this is greatly appreciated as we do not think asking our coders to code at a less granular level for the purpose of quality reporting would in our best interest. 

            JLeflore Joelencia Leflore
            u18320 Kourtney Kouns
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