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Type:
EC eCQMs - Eligible Clinicians
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Resolution: Referred to External Party for Resolution
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Priority:
Moderate
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Component/s: None
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None
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CMS0131v13
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I would like some clarification on the role of 'Patient Encounter During the Performance Period', as it relates to the specific CPT codes listed. Our EHR may be improperly calculating data that is affecting our performance scores.
For example: Diabetes: Eye Exam (eCQM 131/ CMS 117)
DENOMINATOR:
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Denominator Criteria (Eligible Cases):
Patients 18-75 years of age on date of the encounter
AND
Diagnosis for diabetes (Many are listed....)
AND
Patient encounter during the performance period (CPT or HCPCS): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, G0438, G0439
AND NOT
DENOMINATOR EXCLUSIONS:
Many are listed.....
Am I to understand that if the patient is 45 years old with a diagnosis of Type 2 diabetes, no exclusions, and has a patient encounter that represents a CPT code from the above list only, that the patient will meet the denominator?
What happens in this scenario if the only difference is that the CPT code used for the encounter is NOT one of the ones that is listed above. Does the patient NOT get pulled into the denominator?
Please break this down for me.
Thank you in advance for your help.