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  2. CQM-7318

Statin Therapy for the Prevention & Tx CV Dx CMS347 [clarify active diagnosis]

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Stacey Arens-Wilson
    • 573-882-2908
    • MUHC
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      Thank you for your inquiry.
      To answer Question 1: No, if the patient does not have a diagnosis of DM (E11.9) within their electronic medical record, then they are not considered to have an active diagnosis of diabetes.

      If the diagnosis of E11.9 is found in the medical record, the measure logic will pick it up as an active diagnosis since it does not know it is “erroneous”. The electronic measure logic determines if the diagnosis is active by the following method:
       - Has the patient ever had a diagnosis of diabetes by a documented diabetes diagnosis code in the medical record? Yes/No
       - If Yes, is there an abatement date/time associated with the diagnosis? Yes/No. If No (i.e., no abatement date/time), condition is active.

      To answer Question 2:
      (Regarding using a claim/ICD10 to identify the diagnosis/denominator): The CQL logic looks back in the medical record to determine if a patient has ever had a diagnosis (ICD10CM or SNOMEDCT), and it does not require an additional diagnosis to be documented during the measurement period to be considered active.
      (Regarding Problem List/SNOMED to identify the denominator): You are correct. The SNOMEDCT is considered active until a documented abatement date/time is documented.

      We hope this helps.
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      Thank you for your inquiry. To answer Question 1: No, if the patient does not have a diagnosis of DM (E11.9) within their electronic medical record, then they are not considered to have an active diagnosis of diabetes. If the diagnosis of E11.9 is found in the medical record, the measure logic will pick it up as an active diagnosis since it does not know it is “erroneous”. The electronic measure logic determines if the diagnosis is active by the following method:  - Has the patient ever had a diagnosis of diabetes by a documented diabetes diagnosis code in the medical record? Yes/No  - If Yes, is there an abatement date/time associated with the diagnosis? Yes/No. If No (i.e., no abatement date/time), condition is active. To answer Question 2: (Regarding using a claim/ICD10 to identify the diagnosis/denominator): The CQL logic looks back in the medical record to determine if a patient has ever had a diagnosis (ICD10CM or SNOMEDCT), and it does not require an additional diagnosis to be documented during the measurement period to be considered active. (Regarding Problem List/SNOMED to identify the denominator): You are correct. The SNOMEDCT is considered active until a documented abatement date/time is documented. We hope this helps.
    • CMS0347v8
    • CMS0347v7
    • overreporting for population 3 if interpreted incorrectly

      Regarding: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

      Collection Type - 2024 eCQMs

      https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS347v7.html

      Population 3: Patients aged 40 to 75 years of age at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.

      Please see previous JIRA CQM-7198 & CQM-7196

      Our initial question 8/21/2024: Will a patient age 55 with a diagnosis of E11.9 on 6/25/2019 claim qualify for Population 3 denominator for 2024 calendar year reporting?

      Our Clarified question 8/27/2024: As in my original example of 55 year old with E11.9 on 6/25/2019 claim, review of medical record shows provider documented “Special Screening Examination for Diabetes Mellitus.”  However, no diagnosis of DM.  This claim was coded incorrectly.  According to this measure, if a patient was coded in correctly 5 years ago for DM they will still fall in the denominator.    

      The Solution Response contradicts the Activity Comments noted on 10/8/2024

      The Solution Response 10/8/2024: Specific to your example, if a patient has an active diagnosis of E11.9 (Type 2 diabetes mellitus without complications), AND was between 40 and 75 years of age, during the measurement period, the patient would qualify for the ‘Population 3’ ‘risk category’ for the ‘Initial Population’ for the 2024 calendar year reporting.
      The Type 2 diabetes mellitus without complications diagnosis is considered active in the EHR if there is no documentation that the diagnosis became inactive, abated, or was resolved prior to the start of the measurement period and not followed by documentation that it became active again during the measurement period.

      Activity Comments 10/8/2024:

      The data element allows for the use of ICD-10 diabetes diagnoses (claims) but also provides SNOMED-CT codes which would pull from problem list documentation. For the purposes of this measure, in order for diabetes to be considered active, it must be documented in the medical record and still current during the measurement period (no documentation of abatement during or prior to the measurement period).

      As you correctly noted, abatement dateTime information is not available for coded/claims data, therefore it is presumed ongoing as long as the provider continues to document it. If a site were using problem list data, then one would expect to see a date added to the problem list and a date ended (if relevant

      Therefore, you would interpret that to mean that the diabetes diagnosis starts when it was first documented in the medical record (onset), and the abatement would be not present and therefore diagnosis ongoing if continued to be tracked which is the intent of terminology “active”).   We agree that if the patient has a diagnosis that is still present, one should see that diagnosis recurring in the record.

      Regarding the example of the 55 year-old with an erroneous diagnosis of diabetes: if that E11.9 diagnosis is still documented in the record and thus deemed a condition still present, then the patient should fall into the denominator.

      We understand the limitations of abatement date/times when using claims data to populate these types of elements. Using SNOMED-CT codes can provide reliable data for active diagnoses and the use of abatement date/times.

      Question 1:

      As in my original example of 55 year old with E11.9 on 6/25/2019 claim, review of medical record from 6/25/2019 provider documented “Special Screening Examination for Diabetes Mellitus.”  No diagnosis of DM.  This claim was incorrectly coded.  No notation of DM ever on patient problem list.  No notation of DM diagnosis ever in EMR Clinician Notes.  We do not believe this meets the definition of active diagnosis of DM.  Do you agree?  yes/no

      Question 2:

      We believe this to be the definition of active diagnosis.  Do you agree?  yes/no

      For diabetes to be considered active, it must be documented in the medical record and still active during the measurement period (no documentation of abatement during or prior to the measurement period).

      Claims/ICD-10:  if using a Claim/ICD-10 to identify the Diagnosis/Denominator, the expectation is the diagnosis is ONLY active if coded during the current measurement period. 

      Problem List/SNOMED: If using a SNOMED from the Patient’s Problem list to identify the Denominator, the expectation is the problem is active from the date it is added to the problem list until an end date is recorded in the EHR. 

       

            AIR EC eCQM Team AIR EC eCQM Team
            Srwilson123 Stacey Arens-Wilson
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