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  1. eCQM Issue Tracker
  2. CQM-6904

Encounter Diagnosis related Query for EH eCQMs

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      Thank you for questions regarding CMS108v12: Venous Thromboembolism Prophylaxis and CMS71v13: Anticoagulation Therapy for Atrial Fibrillation or Flutter.
      Question #1: The diagnosis of each measure can vary depending on the criteria within the logic and how it is stated. For example, a measure with lookback criteria on a diagnosis may refer to "inactive" conditions.

      Question #2:The measure logic for both CMS 71 and 108 in your example provided is looking for a principle diagnosis code of Stroke ("111297002") that occurs during the qualifying encounter.

      The qualifying encounter for both measures include global.hospitalizationwithobservation which includes observation or ed services ending 1 hour or less before start of the encounter so a diagnosis occurring during the observation will apply to the criteria.

      A code with a rank of 1 identifies a principal diagnosis. A principal diagnosis is the primary condition or disease identified by a healthcare provider as the main reason for a patient's encounter or hospitalization. So, a principal diagnosis would not be an inactive condition.

      Show
      Thank you for questions regarding CMS108v12: Venous Thromboembolism Prophylaxis and CMS71v13: Anticoagulation Therapy for Atrial Fibrillation or Flutter. Question #1: The diagnosis of each measure can vary depending on the criteria within the logic and how it is stated. For example, a measure with lookback criteria on a diagnosis may refer to "inactive" conditions. Question #2:The measure logic for both CMS 71 and 108 in your example provided is looking for a principle diagnosis code of Stroke ("111297002") that occurs during the qualifying encounter. The qualifying encounter for both measures include global.hospitalizationwithobservation which includes observation or ed services ending 1 hour or less before start of the encounter so a diagnosis occurring during the observation will apply to the criteria. A code with a rank of 1 identifies a principal diagnosis. A principal diagnosis is the primary condition or disease identified by a healthcare provider as the main reason for a patient's encounter or hospitalization. So, a principal diagnosis would not be an inactive condition.
    • CMS0108v12

      Hi Team,

      This is in reference with our recently raised query for CMS108v12 ( Ticket link- CQM-6828 )

      As per your response,  CMS108v12 is looking for active diagnoses addressed during the encounter.

      Queries:

      1) Is the same criteria applicable for below mentioned EH ecqms for encounter diagnosis.

      CMS71v13, CMS72v13, CMS104v12,CMS190v12,CMS506v6,CMS334v5,CMS996v4 and CMS1028v2

      2) Cypress is expecting Patients with inactive diagnosis to pass the diagnosis criteria.

      Below mentioned are Patients from cypress test deck for CMS108v12 and CMS71v13 having inactive diagnosis code.

      Example 1- CMS108v12

      Patient name- Carol Bell (Diagnosis code- 111297002)

      Expected output on cypress - Should Qualify for Denominator exclusion.

      Example 2- CMS71v13

      Patient name- Edwin Kelley (Diagnosis code- 111297002) 

      Expected output on cypress - Should Qualify for Numerator

      Please find attached, Patient files from cypress test deck and snapshots from Cypress UI.

      Kindly help us understand this. 

      Request you to provide us with the resolution urgently as our client deliverables are dependent on it.

       .9_Carole_Bell.xml2_Edwin_Kelley.xml

       

       

       

       

            JLeflore Mathematica EH eCQM Team
            Prajakta Prajakta Ghadigaonkar
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