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  2. CQM-7399

Need explanation of the new SOCDx logic for PC-07

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    • Karen McLaughlin
    • 443-241-0156
    • Medisolv, Inc.
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      Thank you for your question about CMS1028v3 Severe Obstetric Complications.

       

      The first few lines of logic for Numerator Exclusion 1 (SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC) evaluates Numerator 1 for cases that have a diagnosis of placenta increta or placenta percreta with a blood transfusion or hysterectomy during the delivery encounter. If yes, the case only qualifies for the numerator exclusion if there are no "Additional SOC" which the second half of the definition addresses (by saying except…):

      SMM diagnosis which must not be present on admission or unable to determine,
      SMM procedure other than blood transfusion or hysterectomy (meaning a cardiac conversion, tracheostomy, or ventilation procedure), or
      Delivery encounter with expiration.
       

      The "SDE SOC Diagnoses Detail" logic identifies which diagnoses put the case in the numerator, uses the function "SOCDxCategory(Dx Code)" to identify which diagnosis code(s) from which value set(s) were present for each patient. "Complication C" and "procedure P" are variables in the logic to identify when complications or procedures are present in the numerator, and to return the specific condition/diagnosis codes and procedure codes. As supplemental data elements, implementers do not need to do anything with it. The receiving system will compute it.
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      Thank you for your question about CMS1028v3 Severe Obstetric Complications.   The first few lines of logic for Numerator Exclusion 1 (SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC) evaluates Numerator 1 for cases that have a diagnosis of placenta increta or placenta percreta with a blood transfusion or hysterectomy during the delivery encounter. If yes, the case only qualifies for the numerator exclusion if there are no "Additional SOC" which the second half of the definition addresses (by saying except…): SMM diagnosis which must not be present on admission or unable to determine, SMM procedure other than blood transfusion or hysterectomy (meaning a cardiac conversion, tracheostomy, or ventilation procedure), or Delivery encounter with expiration.   The "SDE SOC Diagnoses Detail" logic identifies which diagnoses put the case in the numerator, uses the function "SOCDxCategory(Dx Code)" to identify which diagnosis code(s) from which value set(s) were present for each patient. "Complication C" and "procedure P" are variables in the logic to identify when complications or procedures are present in the numerator, and to return the specific condition/diagnosis codes and procedure codes. As supplemental data elements, implementers do not need to do anything with it. The receiving system will compute it.
    • CMS1028v3
    • Not understanding how the new logic works for the Numerator Exclusions for PC-07

      PC-07 now has Numerator Exclusions. I understand the verbiage, but I don't understand the logic behind the verbiage. For example, Numerator Exclusion 1 the logic reads:

      Is this saying that any diagnosis in the Severe Maternal Morbidity Diagnoses value set stops the process OR are there specific diagnoses within that value set such as are listed under functions listed as SOCDxCategory(DxCodes). Where do these diagnoses come into the logic - Numerator, Numerator Exclusions, etc.? 

        

      In other words, is the logic using the value set for Severe Maternal Morbidity Diagnoses or for each of the SOCDx codes which have separate value sets?

      Could you also explain what the new "complication C" and "procedure P" mean in the logic?

       

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          Karen McLaughlin
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          Karen McLaughlin

            aweber Mathematica EH eCQM Team
            kmclaughlin@medisolv.com Karen McLaughlin
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