Obesity Exclusion patient for CMS771v6 not qualifying

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Beth Copenhaver
    • 7703292368
    • Clinigence Health
    • Hide
      Thank you for your inquiry regarding CMS771v6. If the test patient has a Morbid Obesity diagnosis where the PrevalencePeriod begins prior to the Follow Up USS Assessment and overlaps the Measurement Period, then the patient meets the criteria for the Denominator Exclusion. If the patient has a Morbid Obesity diagnosis that began before the Measurement Period (e.g., 2023) and extends into the Measurement Period or lacks an end date, the patient will still meet the criteria for the Denominator Exclusion. This is based on the definition: “Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts on or Before Follow-Up USS Assessment.”
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      Thank you for your inquiry regarding CMS771v6. If the test patient has a Morbid Obesity diagnosis where the PrevalencePeriod begins prior to the Follow Up USS Assessment and overlaps the Measurement Period, then the patient meets the criteria for the Denominator Exclusion. If the patient has a Morbid Obesity diagnosis that began before the Measurement Period (e.g., 2023) and extends into the Measurement Period or lacks an end date, the patient will still meet the criteria for the Denominator Exclusion. This is based on the definition: “Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts on or Before Follow-Up USS Assessment.”
    • CMS0771v6
    • This measure is required by one of our customers for PY 2025

      The exclusion for Obesity/BMI>40 for CMS771v6 is described in the spec as:

      Morbid Obesity Diagnosis On or Before Follow Up USS Assessment ["Diagnosis": "Morbid Obesity"] MorbidObesity with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment such that MorbidObesity.prevalencePeriod overlaps day of "Measurement Period" and MorbidObesity.prevalencePeriod starts on or before FollowUpUSSAssessment.assessmentDatetime 

      But the Cypress patient CMS771 3 has the obesity diagnosis in 2023, not 2025. Isn't the diagnosis supposed to begin in the measurement period - 2025?

       

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            Assignee:
            AIR EC eCQM Team
            Reporter:
            Beth Copenhaver (Inactive)
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