EP 0059 Value Set Discrepancies

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    • Type: Value Sets
    • Resolution: Answered
    • Priority: Minor
    • Component/s: ValueSet
    • None
    • 908-578-8171
    • Azara Healthcare
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      Code 250.40 is for “Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled.” For this measure, we are looking for patients with either type 1 or type 2 diabetes, therefore this code does not meet the intent of the measure. This was a clarification that we made between Stage 1 and Stage 2. Since 250% will return codes for unspecified diabetes, we would not recommend using this search for this measure.
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      Code 250.40 is for “Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled.” For this measure, we are looking for patients with either type 1 or type 2 diabetes, therefore this code does not meet the intent of the measure. This was a clarification that we made between Stage 1 and Stage 2. Since 250% will return codes for unspecified diabetes, we would not recommend using this search for this measure.

      The MU1 EP Measure NQF 0059 specifies that 250.40 is a valid diabetes ICD-9-CM code. The 2014 EP Measure CMS122v1/NQF0059 does not include 250.40 in the ICD-9-CM value set for diabetes - FYI this is the value set defined by the OID 2.16.840.1.113883.3.464.1003.103.12.1001.

      Is there any reason for this discrepancy? Are these changes documented anywhere? We come across these while doing discrepancy analysis between stage 1 and stage 2 CQM results and it would be helpful to know upfront what changes were made.

      As a side note, I've seen a lot of in-house code where folks search for diabetes ICD-9 codes using 250% with the % wildcard. Can anyone comment on the validity of that method?

            Assignee:
            Ramya Tallapragada (Inactive)
            Reporter:
            Eric Gunther (Inactive)
            Cindy Cullen (Inactive), Minet Javellana (Inactive)
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              Created:
              Updated:
              Resolved: