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Question on CMS832 Numerator calculation (1.5X and 2X)

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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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      ***Revised Response 10/31/2024***

      Thank you for your question about CMS832v2 (Hospital Harm – Acute Kidney Injury).

      The numerator for the measure is “Inpatient hospitalizations for patients who develop AKI (stage 2 or greater) during the encounter”, as evidenced by either an increase in serum creatinine, or initiation of kidney dialysis.
      An AKI stage 2 or greater is defined as a “subsequent increase in serum creatine value at least 2 times higher than the lowest serum creatinine value, and the increased value is greater than the highest sex-specific normal value for serum creatinine.” The corresponding CQL definition is ‘Encounter with 2 Times Serum Creatinine Increase’.

      The first step to determine if this criterion for AKI is met is to identify an AKI by evaluating if any serum creatinine value obtained between 48 hours after the start of the encounter and either 30 days after the start of the encounter or discharge, whichever is sooner, is at least 1.5 times higher than the lowest value obtained within the prior 7 days (CQL ‘Encounter with 1.5 Times Serum Creatinine Increase’ definition).

      If a 1.5 times increase in serum creatinine is identified, the logic then determines whether the increased serum creatinine value is greater than the highest sex-specific normal value for serum creatinine. If the value is higher, the logic then evaluates serum creatinine for a 2 times increase during the qualifying encounter. If the increase is at least 2 times, the logic again determines whether the increased serum creatinine is greater than the highest sex-specific normal value.

      In your scenario, the highest serum creatinine test result (either 30 days after the start of the encounter or discharge, whichever is sooner) is 2.0 mg/dL (10/8 10:00). The lowest value is 0.9 mg/dL (9/20 7:13). While this represents a 1.5 and 2 times increase in serum creatinine and is greater than the highest sex-specific normal value, the lowest value does not fall within 7 days prior to the highest value, and therefore this patient would not meet the numerator.
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      ***Revised Response 10/31/2024*** Thank you for your question about CMS832v2 (Hospital Harm – Acute Kidney Injury). The numerator for the measure is “Inpatient hospitalizations for patients who develop AKI (stage 2 or greater) during the encounter”, as evidenced by either an increase in serum creatinine, or initiation of kidney dialysis. An AKI stage 2 or greater is defined as a “subsequent increase in serum creatine value at least 2 times higher than the lowest serum creatinine value, and the increased value is greater than the highest sex-specific normal value for serum creatinine.” The corresponding CQL definition is ‘Encounter with 2 Times Serum Creatinine Increase’. The first step to determine if this criterion for AKI is met is to identify an AKI by evaluating if any serum creatinine value obtained between 48 hours after the start of the encounter and either 30 days after the start of the encounter or discharge, whichever is sooner, is at least 1.5 times higher than the lowest value obtained within the prior 7 days (CQL ‘Encounter with 1.5 Times Serum Creatinine Increase’ definition). If a 1.5 times increase in serum creatinine is identified, the logic then determines whether the increased serum creatinine value is greater than the highest sex-specific normal value for serum creatinine. If the value is higher, the logic then evaluates serum creatinine for a 2 times increase during the qualifying encounter. If the increase is at least 2 times, the logic again determines whether the increased serum creatinine is greater than the highest sex-specific normal value. In your scenario, the highest serum creatinine test result (either 30 days after the start of the encounter or discharge, whichever is sooner) is 2.0 mg/dL (10/8 10:00). The lowest value is 0.9 mg/dL (9/20 7:13). While this represents a 1.5 and 2 times increase in serum creatinine and is greater than the highest sex-specific normal value, the lowest value does not fall within 7 days prior to the highest value, and therefore this patient would not meet the numerator.
    • CMS0832v2

      Given these creatinine values for a Male patient during an Inpatient encounter admitted on 9/20/2025 at 6:00 am (note all times are am except 9/22):

      Datetime Value
      9/20/25 7:13 0.9
      9/21/25 7:13 1
      9/22/25 13:06 1.13
      9/23/25 10:01 1.19
      9/29/25 7:01 1.7
      10/2/25 10:00 1.5
      10/6/25 10:00 1.7
      10/7/25 9:00 1.8
      10/8/25 10:00 2
      1. Does the patient meet the Numerator for the measure?
      2. If yes in the numerator: 
        1. which creatinine values are used to identify the 1.5X increase and
        2. which creatinine values are used to identify the 2X increase?

            aweber Mathematica EH eCQM Team
            robin.holder@allscripts.com Robin Holder
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