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Type:
Hosp Inpt eCQMs - Hospital Inpatient eCQMs
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Resolution: Answered
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Priority:
Moderate
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Component/s: None
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None
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CMS1218v2
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The new eCQM for CY2026 - CMS1218 (HH-Respiratory Failure) has a new value set called - Elective Inpatient Encounter (2.16.840.1.113762.1.4.1248.85). We understand that this was created to capture all scheduled hospitalizations and excludes emergency, urgent, and unplanned admissions. The codes in it are the following -
| Value Set Name | Value Set OID | Code | Description |
| Elective Inpatient Encounter | 2.16.840.1.113762.1.4.1248.85 | 112689000 | Hospital admission, elective, with complete pre-admission work-up (procedure) |
| Elective Inpatient Encounter | 2.16.840.1.113762.1.4.1248.85 | 15584006 | Hospital admission, elective, with partial pre-admission work-up (procedure) |
| Elective Inpatient Encounter | 2.16.840.1.113762.1.4.1248.85 | 81672003 | Hospital admission, elective, without pre-admission work-up (procedure) |
| Elective Inpatient Encounter | 2.16.840.1.113762.1.4.1248.85 | 8715000 | Hospital admission, elective (procedure) |
The existing value set "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)" which is used in all inpatient eCQMs (except STK eCQMs) has the following codes -
| Value Set Name | Value Set OID | Code | Description |
| Encounter Inpatient | 2.16.840.1.113883.3.666.5.307 | 183452005 | Emergency hospital admission (procedure) |
| Encounter Inpatient | 2.16.840.1.113883.3.666.5.307 | 32485007 | Hospital admission (procedure) |
| Encounter Inpatient | 2.16.840.1.113883.3.666.5.307 | 8715000 | Hospital admission, elective (procedure) |
As you can see from above, the "Encounter Inpatient" value set does include one code for elective inpatient admissions which overlaps with the same code in the new value set Elective Inpatient Encounter (2.16.840.1.113762.1.4.1248.85). If this overlapping code is used for an encounter, then the encounter will be eligible to be in population for other eCQMs (e.g. VTE-1, VTE-2, MCS etc.) which use the "Encounter Inpatient" valueset.
However, if the other 3 codes (112689000, 15584006, 81672003) from the new "Elective Inpatient Encounter" which are not in the "Encounter Inpatient" value set are used for an elective encounter, the encounter will not be eligible for calculation (they will be not in population) for the other eCQMs (like VTE-1, VTE-2, etc.). This seems odd.
Since the "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)" value set has one code for the elective hospital admissions, should this valueset not have been updated to include the 3 new codes (112689000, 15584006, 81672003) from the new "Elective Inpatient Encounter" valueset? That way encounters with these codes will also be eligible for calculation of other eCQMs like VTE-1, VTE-2 etc. which use the Encounter Inpatient (2.16.840.1.113883.3.666.5.307) valueset.
