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  1. eCQM Issue Tracker
  2. CQM-7042

PC-07 risk adjustment by category or individual code?

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
    • Icon: Moderate Moderate
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    • Thank you for your question about CMS1028v2 Severe Obstetric Complications. You are correct, multiple conditions within a condition category do not more heavily weigh the risk adjustment. We hope this helps.
    • CMS1028v2
    • Risk adjustment may be inaccurate if we are doing it incorrectly.

      When looking at codes for risk variables on ePC-07, we sometimes have codes that both pull into the same category risk factor.  For example, the patient has multiple mental health diagnoses, or multiple substances used, or the patient has both transportation issues and homelessness (housing instability category).  Our vendor is only pulling in one code per category, as once the patient has a diagnosis in the preexisting condition valueset, that's all that's counted.  Is this a correct interpretation, or do multiple conditions within a condition category more heavily weight the risk adjustment?  Thank you.

            JLeflore Joelencia Leflore
            jlharlos Jennifer Harlos (Inactive)
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