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  2. CQM-6861

CMS190v12- clarifying DEN Exclusion and DEN Exception

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
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      Thank you for your inquiry on CMS190v12: Intensive Care Unit Venous Thromboembolism Prophylaxis. Please note that the following 2 definitions are looking for different setting of length of stays, where Denominator Exception is checking ICU length of stay < 1 day and Denominator Exclusion is to exclude patient with total of inpatient hospital stay < 2 days.

      DEN EXCEPTION definition is "Encounter with First ICU Location Stay Less Than 1 Day"

      DEN EXCLUSION definition "Encounter with ICU Location And Encounter Less than 2 Days",

      Below are the responses to your questions.

      1. According to the info and explanations above, patient stayed in ICU for 1 day and the case would continue proceed in Numerator. Since this patient has a documentation of a reason to not receive VTE prophylaxis, this patient will satisfy the numerator condition if the documentation time is within a qualifying timeframe.

      2. As explained above, "Encounter with ICU Location And Encounter Less than 2 Days" is evaluating an overall hospital stay/encounter with an ICU encounter.
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      Thank you for your inquiry on CMS190v12: Intensive Care Unit Venous Thromboembolism Prophylaxis. Please note that the following 2 definitions are looking for different setting of length of stays, where Denominator Exception is checking ICU length of stay < 1 day and Denominator Exclusion is to exclude patient with total of inpatient hospital stay < 2 days. DEN EXCEPTION definition is "Encounter with First ICU Location Stay Less Than 1 Day" DEN EXCLUSION definition "Encounter with ICU Location And Encounter Less than 2 Days", Below are the responses to your questions. 1. According to the info and explanations above, patient stayed in ICU for 1 day and the case would continue proceed in Numerator. Since this patient has a documentation of a reason to not receive VTE prophylaxis, this patient will satisfy the numerator condition if the documentation time is within a qualifying timeframe. 2. As explained above, "Encounter with ICU Location And Encounter Less than 2 Days" is evaluating an overall hospital stay/encounter with an ICU encounter.
    • CMS0190v12
    • Need clarification to understand if mapping is correct based on logic/definitions

      a particular patient was in an acute care hospital for a total of 8 days- Jan 12 thru Jan 20.

      On Jan 19 the patient was transferred to the ICU.  The patient was discharged from the ICU on Jan 20.   

      The patient did have documentation of a reason to not receive VTE prophylaxis.

      The patient was in the ICU =1 day, not <1 day. - NOT DEN EXCEPTION

      The patient was in the ICU =1 day, < 2 days- DEN EXCLUSION

      DEN EXCEPTION definition is "Encounter with First ICU Location Stay Less Than 1 Day"

      DEN EXCLUSION definition "Encounter with ICU Location And Encounter Less than 2 Days" 

      QUESTIONS:

      1) The QRDA file for this particular patient is showing the patient to be in the NUM category, but shouldn't it fall into the DEN EXCLUSION population based on the flow for the measure? 

      2) Please clarifying the meaning of DEN Exclusion "Encounter with ICU Location AND Encounter Less Than 2 days"

      Does this mean less than 2 days in the ICU?

      OR

      Does this mean less than 2 days of an overall hospital stay/encounter with an ICU encounter? 

       

       

       

            JLeflore Joelencia Leflore
            shorca Cari Ann Jones
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