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  1. eCQM Issue Tracker
  2. CQM-7588

eCQM measure CMS165v12 controlling HBP and QRDA I files

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
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    • Amanda Lord Darbani
    • 3107139895
    • Patient360
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      Thank you for your inquiry regarding CMS165v12 (2024 Performance Period) and CMS165v13 (2025 Performance Period). The intent of the measure is to assess the blood pressure control for patients diagnosed with essential hypertension during the measurement period. The Initial Population identifies patients who are 18-85 years of age, have a visit during the measurement period, and have a diagnosis of essential hypertension that started before or within the first six months of the measurement period. If a code from the "Essential Hypertension" value set (2.16.840.1.113883.3.464.1003.104.12.1011) is not documented, the patient is not considered denominator eligible.
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      Thank you for your inquiry regarding CMS165v12 (2024 Performance Period) and CMS165v13 (2025 Performance Period). The intent of the measure is to assess the blood pressure control for patients diagnosed with essential hypertension during the measurement period. The Initial Population identifies patients who are 18-85 years of age, have a visit during the measurement period, and have a diagnosis of essential hypertension that started before or within the first six months of the measurement period. If a code from the "Essential Hypertension" value set (2.16.840.1.113883.3.464.1003.104.12.1011) is not documented, the patient is not considered denominator eligible.
    • CMS0165v13
    • CMS0165v12
    • The measure we are questioning in our inquiry isn't even listed in any of the options above.

      For an MSSP ACO who is reporting measure 236 as an eCQM(CMS 165v12), consider the following scenario with one of their patients and two of their providers at different participant TINs. Patient sees PCP in June and is denominator eligible for measure 236. Their BP is done and satisfies the Met numerator response "Most recent systolic blood pressure < 140 mmHg (G8752)". The patient then sees a specialist at another TIN in December where the visit does not document the I10 hypertension diagnosis thus the visit is not denominator eligible but they do document a high blood pressure, which if they were denominator eligible would be a performance Not Met. Is the ACO expected to report a Met or a Not Met, given the specialist visit wasn't technically denominator eligible? We're finding that EHRs nationally do not produce QRDAIs if the patient isn't denominator eligibile.

            AIR EC eCQM Team AIR EC eCQM Team
            alord@patient360.com Amanda Lord
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