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  2. CQM-7326

CMS142v12 - Numerator Concern

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Elisabeth
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      Thanks for your inquiry. According to the measure steward, the American Academy of Ophthalmology (AAO), there aren’t codes that describe the specific communications that are relevant for this measure. The communication performed is currently verified by the value set codes connoting the diagnosis of the severity of diabetic retinopathy and presence or absence of diabetic retinopathy and the measure logic, which requires there to be documentation of a letter sent to the physician primarily responsible for the management of the patient’s diabetes. These types of correspondences are important to inform the physicians so that they are aware of the patient’s vision and eye health and can reinforce the need for strict blood glucose control but are not like the type of reports in eCQM374 which are formal consultations, in which the patient is actually referred by another physician, and formal reports are coded as such. Even if codes for consult reports were included in the value sets, these would not be used for reporting back to the primary care physician or endocrinologist.
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      Thanks for your inquiry. According to the measure steward, the American Academy of Ophthalmology (AAO), there aren’t codes that describe the specific communications that are relevant for this measure. The communication performed is currently verified by the value set codes connoting the diagnosis of the severity of diabetic retinopathy and presence or absence of diabetic retinopathy and the measure logic, which requires there to be documentation of a letter sent to the physician primarily responsible for the management of the patient’s diabetes. These types of correspondences are important to inform the physicians so that they are aware of the patient’s vision and eye health and can reinforce the need for strict blood glucose control but are not like the type of reports in eCQM374 which are formal consultations, in which the patient is actually referred by another physician, and formal reports are coded as such. Even if codes for consult reports were included in the value sets, these would not be used for reporting back to the primary care physician or endocrinologist.
    • CMS0142v13
    • CMS0142v12
    • The current value sets for eCQM 19 does not confirm if communication was sent to the provider who manages the patient's diabetes care. Only confirms that findings are documented.

      The value sets related to the QDM Category- Communication of eCQM 19 (CMS142), is not verifying that a report has been communicated to another provider but is pertaining to disorders and that findings are present in the exam (level of severity of retinopathy and macular edema). 

      If the communication performed in the measure logic is supposed to represent the transmission, receipt, or acknowledgement of information sent from one clinician to another, but none of the current value sets confirm this was performed, how does this measure's value set determine if communication was or wasn't performed during the performance year? This relates to using this measure by mapping to only SNOMED codes for the numerator that have populated in the exams using QRDA 1 files to report on the measure. 

      In comparison, eCQM 374 (CMS50) uses consult report types for the confirmation of receiving communication. But eCQM 19 does not reference any report or letter types being sent to another clinician. It seems that the current structure of the measure can cause unreliable numerator reporting if only being reported using the populated codes based on the current value sets for 2024 quality reporting. Is only using the value set codes for the communication QDM category appropriate for this measure to indicate if communication was performed?

            AIR EC eCQM Team AIR EC eCQM Team
            Torres Elisabeth
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