MIPS Denominator Criteria-Patient Encounter- CPT Question

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Referred to External Party for Resolution
    • Priority: Moderate
    • Component/s: None
    • None
    • Hide
      Thank you for your inquiry. Your question appears to be related to the MIPS Clinical Quality Measure version. Unfortunately, this is out of scope for the eCQM Issues Tracker. We have created a ticket with the CCSQ Service Center for you with the following ticket number: CS2467693

      You will be contacted by their team and assigned a customer service representative who will work to resolve your inquiry.
      Show
      Thank you for your inquiry. Your question appears to be related to the MIPS Clinical Quality Measure version. Unfortunately, this is out of scope for the eCQM Issues Tracker. We have created a ticket with the CCSQ Service Center for you with the following ticket number: CS2467693 You will be contacted by their team and assigned a customer service representative who will work to resolve your inquiry.
    • CMS0131v13
    • Hide
      Patient encounter during the performance period (CPT or HCPCS):
      clarification of specificity of codes used.
      Show
      Patient encounter during the performance period (CPT or HCPCS): clarification of specificity of codes used.

      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. 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Karen (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved: