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  1. eCQM Issue Tracker
  2. CQM-6939

Use of High-Risk Medications in the Elderly

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    • Icon: OQR eCQMs - Outpatient Quality Reporting OQR eCQMs - Outpatient Quality Reporting
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
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    • Buffalo Medical Group, PC
    • 7166564481
    • Buffalo Medical Group
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      Thank you for your inquiry for CMS156v12: Use of High-Risk Medications in Older Adults. Depending on which Hospice or Palliative Care data criteria is used, there may be a CPT code within their respective value sets that will show the exclusion. Our value sets also contain SNOMED CT or LOINC codes that will represent the exclusion if they are used. To appropriately determine whether a service is for hospice or palliative care, please see below the list of value sets and direct reference codes for hospice and palliative care:

      Hospice:
      "Encounter Inpatient": '2.16.840.1.113883.3.666.5.307'
      "Hospice Care Ambulatory": '2.16.840.1.113883.3.526.3.1584'
      "Hospice Diagnosis": '2.16.840.1.113883.3.464.1003.1165'
      "Hospice Encounter": '2.16.840.1.113883.3.464.1003.1003'
      "Discharge to healthcare facility for hospice care (procedure)": '428371000124100'
      "Discharge to home for hospice care (procedure)": '428361000124107'
      "Hospice care [Minimum Data Set]": '45755-6'

      Palliative Care:
      "Palliative Care Diagnosis": '2.16.840.1.113883.3.464.1003.1167'
      "Palliative Care Encounter": '2.16.840.1.113883.3.464.1003.101.12.1090'
      "Palliative Care Intervention": '2.16.840.1.113883.3.464.1003.198.12.1135'
      "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)": '71007-9'

      Value sets are lists of unique coded identifiers with names (called descriptors) for groupings of clinical and administrative concepts selected from standard vocabularies. They serve to define a set of concepts (for example, diabetes or clinical visit) identifying selected populations and satisfy measure criteria in eCQMs. Value sets can be found at the Value Set Authority Center (https://vsac.nlm.nih.gov/ ), which is maintained by the National Library of Medicine in collaboration with CMS. The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications. Access to value set details in VSAC requires a free Unified Medical Language System® Metathesaurus LicenseMetathesaurus License (https://www.nlm.nih.gov/research/umls/index.html?_gl=1%2am7sdtq%2a_ga%2aNjg0MjMxNDk2LjE2NDE1ODg2NDk.%2a_ga_7147EPK006%2aMTY0NzM2Njg3MC4xLjEuMTY0NzM2NzU2Ny4w).
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      Thank you for your inquiry for CMS156v12: Use of High-Risk Medications in Older Adults. Depending on which Hospice or Palliative Care data criteria is used, there may be a CPT code within their respective value sets that will show the exclusion. Our value sets also contain SNOMED CT or LOINC codes that will represent the exclusion if they are used. To appropriately determine whether a service is for hospice or palliative care, please see below the list of value sets and direct reference codes for hospice and palliative care: Hospice: "Encounter Inpatient": '2.16.840.1.113883.3.666.5.307' "Hospice Care Ambulatory": '2.16.840.1.113883.3.526.3.1584' "Hospice Diagnosis": '2.16.840.1.113883.3.464.1003.1165' "Hospice Encounter": '2.16.840.1.113883.3.464.1003.1003' "Discharge to healthcare facility for hospice care (procedure)": '428371000124100' "Discharge to home for hospice care (procedure)": '428361000124107' "Hospice care [Minimum Data Set]": '45755-6' Palliative Care: "Palliative Care Diagnosis": '2.16.840.1.113883.3.464.1003.1167' "Palliative Care Encounter": '2.16.840.1.113883.3.464.1003.101.12.1090' "Palliative Care Intervention": '2.16.840.1.113883.3.464.1003.198.12.1135' "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)": '71007-9' Value sets are lists of unique coded identifiers with names (called descriptors) for groupings of clinical and administrative concepts selected from standard vocabularies. They serve to define a set of concepts (for example, diabetes or clinical visit) identifying selected populations and satisfy measure criteria in eCQMs. Value sets can be found at the Value Set Authority Center ( https://vsac.nlm.nih.gov/ ), which is maintained by the National Library of Medicine in collaboration with CMS. The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications. Access to value set details in VSAC requires a free Unified Medical Language System® Metathesaurus LicenseMetathesaurus License ( https://www.nlm.nih.gov/research/umls/index.html?_gl=1%2am7sdtq%2a_ga%2aNjg0MjMxNDk2LjE2NDE1ODg2NDk.%2a_ga_7147EPK006%2aMTY0NzM2Njg3MC4xLjEuMTY0NzM2NzU2Ny4w ).
    • Not measure related
    • Not measure related
    • Not measure related
    • Not measure related
    • CMS0156v12
    • Not measure related
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    • Not measure related

      For patients who would be excluded from this measure for Hospice or Palliative Care, how would that be confirmed? Are there CPT codes used in billing that shows exclusion?

            edave Mathematica EC eCQM Team
            cmach99 Christine Mach (Inactive)
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