CMS 22 - encounter classification

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Melinda Alba
    • Hide
      Thank you for inquiring about the Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented eCQM. Note that the following response assumes that your scenario language around normal and abnormal aligns with the measure specification definitions:
      “Blood Pressure (BP) Classification:
      BP is defined by four (4) BP reading classifications: Normal, Elevated, First Hypertensive, and Second Hypertensive Readings
      -Normal BP: Systolic BP (SBP) < 120 mmHg AND Diastolic BP (DBP) < 80 mmHg
      -Elevated BP: SBP of 120-129 mmHg AND DBP < 80 mmHg
      -First Hypertensive Reading: SBP of >= 130 mmHg OR DBP of >= 80 mmHg without a previous SBP of >= 130 mmHg OR DBP of >= 80 mmHg during the 12 months prior to the encounter
      -Second Hypertensive Reading: Requires a SBP >= 130 mmHg OR DBP >= 80 mmHg during the current encounter AND a most recent BP reading within the last 12 months SBP >= 130 mmHg OR DBP >= 80 mmHg”
      Scenario 1:
      Jan - March: does not meet exclusion criteria; patient needs to have a recommended follow-up plan on the date of encounter to meet the numerator criteria
      April: does not meet exclusion criteria; patient needs to have a recommended follow-up plan on the date of encounter to meet the numerator criteria
      May - December: DOES meet exclusion, since the hypertensive diagnosis was documented in April
       
      Scenario 2:
      Jan - March: Please clarify if the hypertensive diagnosis was in the medical record prior to the first January encounter. If it were, then it would meet the exclusion criteria for Jan – Mar; if not, then it meets the exclusion criteria for Feb – Mar, but not in January (and January encounter would need to have a recommended follow-up plan on the date of the encounter to meet numerator criteria).
      April: DOES meet exclusion, since hypertensive diagnosis was documented before the April encounter
      May - December: does not meet exclusion criteria; normal BP (encounters should meet the numerator)
       
      You will want to work with your EHR/measure reporting vendor to ensure that the specifications and subsequent encounter outcomes are processed in accordance with the measure’s intent.
      Show
      Thank you for inquiring about the Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented eCQM. Note that the following response assumes that your scenario language around normal and abnormal aligns with the measure specification definitions: “Blood Pressure (BP) Classification: BP is defined by four (4) BP reading classifications: Normal, Elevated, First Hypertensive, and Second Hypertensive Readings -Normal BP: Systolic BP (SBP) < 120 mmHg AND Diastolic BP (DBP) < 80 mmHg -Elevated BP: SBP of 120-129 mmHg AND DBP < 80 mmHg -First Hypertensive Reading: SBP of >= 130 mmHg OR DBP of >= 80 mmHg without a previous SBP of >= 130 mmHg OR DBP of >= 80 mmHg during the 12 months prior to the encounter -Second Hypertensive Reading: Requires a SBP >= 130 mmHg OR DBP >= 80 mmHg during the current encounter AND a most recent BP reading within the last 12 months SBP >= 130 mmHg OR DBP >= 80 mmHg” Scenario 1: Jan - March: does not meet exclusion criteria; patient needs to have a recommended follow-up plan on the date of encounter to meet the numerator criteria April: does not meet exclusion criteria; patient needs to have a recommended follow-up plan on the date of encounter to meet the numerator criteria May - December: DOES meet exclusion, since the hypertensive diagnosis was documented in April   Scenario 2: Jan - March: Please clarify if the hypertensive diagnosis was in the medical record prior to the first January encounter. If it were, then it would meet the exclusion criteria for Jan – Mar; if not, then it meets the exclusion criteria for Feb – Mar, but not in January (and January encounter would need to have a recommended follow-up plan on the date of the encounter to meet numerator criteria). April: DOES meet exclusion, since hypertensive diagnosis was documented before the April encounter May - December: does not meet exclusion criteria; normal BP (encounters should meet the numerator)   You will want to work with your EHR/measure reporting vendor to ensure that the specifications and subsequent encounter outcomes are processed in accordance with the measure’s intent.
    • CMS0022v13
    • Incorrectly classification of encounter

      For CMS 22, an eligible encounter is excluded if the patient has a diagnosis of hypertension prior to the eligible encounter.  Could you please help clarify how the following outcomes should be classified based on that criterion?

       

      Scenario 1 and 2:  Considering all visits to be eligible encounters and BP taken at each visit once.  The patient visits with PCP every 28 -30 days.  

       

      Scenario 1:

      Patient is non hypertensive with variable blood pressures, not normal blood pressure in Jan, Feb and March

      In April, the patient is diagnosed with Hypertension at the end of the visit. 

      Patient continues to have diagnosis of HTN from May through December.

      Could you confirm the interpretation of the following information is correct?

       

      Month: Classification of Encounter/ Rationale

      Jan - March:  met or unmet / not hypertensive prior to visit

      April:  met or unmet / not hypertensive prior to the start of this visit

      May - December:  Exclusion / hypertensive diagnosis

       

      Scenario 2:  is the converse of Scenario 1:  (gastric bypass, ozempic use, etc..)

      Patient is hypertensive, Jan, Feb and March

      In April, the patient is diagnosed with stable normal blood pressure and Hypertension diagnosis is removed from problem list at the end of the visit.  

      Patient continues to have normal BP, non hypertensive, from May through December.

      Could you confirm the interpretation of the following information is correct?

       

      Month: Classification of Encounter/ Rationale

      Jan - March:  EXCLUSION / hypertensive prior to visit

      April:  EXCLUSION / hypertensive prior to the start of this visit

      May - December:  Met - controlled  / non hypertensive diagnosis

       

      Currently the EHR will classify

      Scenario 1 :  All Exclusion

      Scenario 2:  All non-exclusion 

        1. Flow Sheet CMS22.png
          Flow Sheet CMS22.png
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            Assignee:
            AIR EC eCQM Team
            Reporter:
            Melinda L Alba
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              Updated:
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