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  2. CQM-6821

CMS165: Frailty/Advance illness SNOMED codes being used for v11 specification, project year 2023.

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      Thank you for your inquiry about the Advanced Illness and Frailty exclusion for CMS122, CMS130, and CMS165. Those patients who meet the frailty criteria also need to meet the advanced illness criteria, if they are aged 66 to 80. It is the combination of age, frailty, and advanced illness that qualify patients for the exclusion. If the patient is age 81 or older, then they only need to meet frailty criteria to be excluded from the measure. SNOMED code 84229001 (Fatigue) is used in the valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075) for the 2022-05-05 release to meet frailty criteria. A patient with a diagnosis of advanced illness with two outpatient encounters on different dates of services during the measurement period or the year prior, using of any of the SNOMED codes listed in the value sets below may qualify for the advanced illness criteria. You may refer to the measure specifications to review additional requirements for the denominator exclusion.

      valueset "Outpatient" (2.16.840.1.113883.3.464.1003.101.12.1087)
      valueset "Emergency Department Visit" (2.16.840.1.113883.3.464.1003.101.12.1010)
      valueset "Nonacute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1084)
      valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082)
      valueset "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086)
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      Thank you for your inquiry about the Advanced Illness and Frailty exclusion for CMS122, CMS130, and CMS165. Those patients who meet the frailty criteria also need to meet the advanced illness criteria, if they are aged 66 to 80. It is the combination of age, frailty, and advanced illness that qualify patients for the exclusion. If the patient is age 81 or older, then they only need to meet frailty criteria to be excluded from the measure. SNOMED code 84229001 (Fatigue) is used in the valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075) for the 2022-05-05 release to meet frailty criteria. A patient with a diagnosis of advanced illness with two outpatient encounters on different dates of services during the measurement period or the year prior, using of any of the SNOMED codes listed in the value sets below may qualify for the advanced illness criteria. You may refer to the measure specifications to review additional requirements for the denominator exclusion. valueset "Outpatient" (2.16.840.1.113883.3.464.1003.101.12.1087) valueset "Emergency Department Visit" (2.16.840.1.113883.3.464.1003.101.12.1010) valueset "Nonacute Inpatient" (2.16.840.1.113883.3.464.1003.101.12.1084) valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082) valueset "Observation" (2.16.840.1.113883.3.464.1003.101.12.1086)
    • CMS0165v11
    • Large impact with the number of qualifying denominator exclusions patients for Frailty and advance illness for measures CMS165, CMS130 & CMS122.

      We have patients for each one of these measures listed above that are qualifying as a Denominator exclusion for meeting the logic for Frailty and Advance illness for project year 2023. Example: patient has Frailty SNOMED code 84229001(Fatigue) active for measurement period in 2023 and has 2 or more qualifying outpatient encounters with active SNOMED code 42343007(congestive heart failure) in measurement period and year prior. Would this patient qualify for denominator exclusions under the frailty and advance illness logic?   Our vendor is saying to us that "SNOMED codes no longer count for Advance illness". 

      We believe they do still qualify and we used correct value set registry of (eCQM Update 2022-05-05) for measurement period of 2023 during our validations. 

      We are looking for clarification from CMS if SNOMED codes are still acceptable for Frailty and Advance illness for measures CMS165v.11, CMS130v11 & CMS122v11? 

      Thank you.

            edave Mathematica EC eCQM Team
            Tallred Tara Allred
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