Thank you for your thoughtful feedback on the value set codes used in the Preventive Care and Screening measures to represent when a patient declines a procedure or treatment. Please note that SNOMED-CT code 105480006 was only removed because it became inactive with the broader SNOMED-CT terminology updates published in March, immediately before the current annual update release. We understand the mapping burden resulting from code changes; however, some are outside of the developer’s control when the underlying terminologies are revised. There is an alternative SNOMED-CT code (31021000119100) “Screening declines (situation)”) that we will consult with the value set steward about adding for the upcoming annual update, which will better align with the intent of the prior code.

Value set Patient Declined [ 2.16.840.1.113883.3.526.3.1582] This value set is used across many eCQM measure for both inpatient and outpatient in the MIPS, PI and IQR programs we participate in for CMS. The latest version of the value set no longer includes SNOMED code 105480006 [Procedure declined by patient (situation)]. Why was this removed? This code is currently mapped to many records in our system for 'patient declined'. In the latest version of the value set published 2024-05-02, this code was removed. Only 3 codes remain, non of which are appropriate to use for our mapping.       183945002 Procedure declined for religious reason (situation       413311005 Patient non-compliant - declined intervention / support (situation)       895451009 Referral to service declined by subject (situation)  It's not ideal to document that a patient is 'non-compliant'. Most clinical staff do not want to document that a patient intentionally refused to follow doctor's orders or treatment recommendation, which is what 'non-compliant' means. It's not ideal to label patients this way if we avoid it and document in a less offensive manner such as just saying 'patient refused'. Can you please reconsider and add back a code to the value set a code that simply means patient refused please? Such as the one we have used for many years, 105480006 [Procedure declined by patient (situation)]. In addition, by removing codes like this you are increasing our mapping burden and re-work placed on our hospital to report eCQMs to CMS. Add back SNOMED code "105480006 [Procedure declined by patient (situation)]" to value set "Patient Declined [ 2.16.840.1.113883.3.526.3.1582]". This was removed from the most recently published value set in May 2024.