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  1. eCQM Issue Tracker
  2. CQM-6785

PC-02 eCQM Denominator Exclusions Abnormal Presentation during Qualifying Encounter

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
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    • Emily Solomon
    • Adventist Healthcare
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      Thank you for your question regarding CMS344v5/PC-02 Cesarean Birth.

      The Qualifying Encounter is the hospitalization that includes the prior ED visit if the ED encounter ends 1 hour or less than the OB Triage (or L&D triage in your example) encounter begins, and the OB Triage visit ends 1 hour or less than the inpatient encounter begins. You may also note the comment in the measure specifications (CMS334v5.html) within the Functions section under PCMaternal.HospitalizationWithEDOBTriageObservation(Encounter “Encounter, Performed”).

      To count towards the denominator exclusion, an ICD-10 or SNOMED code in the abnormal presentation value set or placenta previa, accreta, or vasa previa value set must be documented during the qualifying encounter. You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/.
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      Thank you for your question regarding CMS344v5/PC-02 Cesarean Birth. The Qualifying Encounter is the hospitalization that includes the prior ED visit if the ED encounter ends 1 hour or less than the OB Triage (or L&D triage in your example) encounter begins, and the OB Triage visit ends 1 hour or less than the inpatient encounter begins. You may also note the comment in the measure specifications (CMS334v5.html) within the Functions section under PCMaternal.HospitalizationWithEDOBTriageObservation(Encounter “Encounter, Performed”). To count towards the denominator exclusion, an ICD-10 or SNOMED code in the abnormal presentation value set or placenta previa, accreta, or vasa previa value set must be documented during the qualifying encounter. You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) at https://vsac.nlm.nih.gov/ .
    • CMS0334v5
    • Our organization submits ePC-02 measure to the state and federal level to meet regulatory requirements.

      PC-02 eCQM Denominator Exclusions Abnormal Presentation during Qualifying Encounter

      We are asking for clarification on the term "Qualifying Encounter" for encounter with abnormal presentation. 

      Example of possible workflow for maternal patients can start in the ED as an ED encounter then moves to L&D triage as outpatient encounter then delivers newborn which encounter types changes to inpatient status.

      When is the timing for Qualifying encounter for the abnormal presentation diagnosis code ICD-10 or SNOMEDCT to count the patient as a denominator exclusion . 

            JLeflore Mathematica EH eCQM Team
            esolomon Emily Solomon
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