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  2. CQM-6854

Encounter Diagnosis attribute clarification

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      Thank you for your question on CMS165v12: Controlling High Blood Pressure. The answer is provided in the context of the advanced illness portion of the denominator exclusion for the 2024 performance period measure. The intent is to look for at least 1 inpatient encounter or 2 outpatient encounters with an advanced illness diagnosis as it is specified. According to QDM 5.6 "the QDM datatype “Encounter, Performed” diagnoses attribute now has three components. The first component is diagnosis (code) defining the diagnosis that must be addressed during the encounter to meet the measure criteria."

      The patient scenario given does not meet the logic requirements for "Outpatient Encounters with Advanced Illness".

      Revision to reduce the complexity of the specification is currently under consideration for future publication.
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      Thank you for your question on CMS165v12: Controlling High Blood Pressure. The answer is provided in the context of the advanced illness portion of the denominator exclusion for the 2024 performance period measure. The intent is to look for at least 1 inpatient encounter or 2 outpatient encounters with an advanced illness diagnosis as it is specified. According to QDM 5.6 "the QDM datatype “Encounter, Performed” diagnoses attribute now has three components. The first component is diagnosis (code) defining the diagnosis that must be addressed during the encounter to meet the measure criteria." The patient scenario given does not meet the logic requirements for "Outpatient Encounters with Advanced Illness". Revision to reduce the complexity of the specification is currently under consideration for future publication.
    • CMS0165v12

      Based on the QDM definition, "Encounter, Performed" diagnoses attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.'
       
      Can you please confirm if the intent of this datatype/attribute is to qualify only the conditions that were addressed in a particular encounter? Is it also intended to evaluate the active conditions documented in the patient's problem list (the EHR problem list tracks the patient's conditions) even when some of those conditions were not addressed during a particular visit?
       
      Logic example: 
       

      • ( ["Encounter, Performed": "Outpatient"]
        union ["Encounter, Performed": "Observation"]
        union ["Encounter, Performed": "Emergency Department Visit"]
        union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter
        where exists ( OutpatientEncounter.diagnoses Diagnosis
        where Diagnosis.code in "Advanced Illness"
        )
        and OutpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,
        end of "Measurement Period"]
         
        Scenario: 
        -A patient has documentation of 'Chronic right-sided heart failure (10335000) in the problem list, active since 2019 (this code is included in the advanced illness valueset)
        -Patient has an Outpatient visit on 1/1/2024 - Diagnosis documented for the visit was J45.20 (Mild intermittent asthma - no in the advanced illness valueset)
        -Patient has an Outpatient visit on 3/1/2024 - Diagnosis documented for the visit was D50.9 (Iron deficiency anemia - no in the advanced illness valueset)
         
        Question: Does this scenario meet the 'Outpatient Encounters with Advanced Illness'?
        Thank you for your guidance

            edave Mathematica EC eCQM Team
            isbelia Isbelia Briceno
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