CMS130v13 not counting more specific G20.A1 code

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Sherry Willis
    • 765-599-3471
    • Henry Community Health
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      Thank you for your inquiry about the advanced illness and frailty exclusion criteria for CMS130v13 (performance period 2025). Value sets once published cannot be updated, please note that ICD10CM code G20.A1 is included in the "Advanced Illness (2.16.840.1.113883.3.464.1003.110.12.1082)" value set for 2026 reporting. You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) https://vsac.nlm.nih.gov/ or you can find the value set using the 2025-05-08 expansion file in the link below: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion/eCQM%20Update%202025-05-08. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit.
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      Thank you for your inquiry about the advanced illness and frailty exclusion criteria for CMS130v13 (performance period 2025). Value sets once published cannot be updated, please note that ICD10CM code G20.A1 is included in the "Advanced Illness (2.16.840.1.113883.3.464.1003.110.12.1082)" value set for 2026 reporting. You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) https://vsac.nlm.nih.gov/ or you can find the value set using the 2025-05-08 expansion file in the link below: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion/eCQM%20Update%202025-05-08 . Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit.
    • CMS0130v13
    • Using new dx codes per CMS requirements for HCC coding and other programs, but the codes are not all counting for exclusion criteria per codesets

      As we've continued to adopt the newer, more specific diagnosis codes as required per CMS, we find that the value sets tied to our quality measures do not keep up with these new codes. As an example, the newer Parkinson's disease code G20.A1 is not on the code set for CMS130v13; only the more generic code G20 is listed. Therefore, we cannot get our EMR to add the new G20.A1 code to count as an advanced illness code for CMS130v13 reporting. Since the G20.A1 is simply a more specific code under the primary G20 code, can we use G20.A1 as an advanced illness code for CMS130v13?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Sherry Willis
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              Created:
              Updated:
              Resolved:
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