CMS 832 (HH-AKI)

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry regarding CMS832v2, Hospital Harm – Acute Kidney Injury. For denominator exclusion definition ‘Encounter with Index eGFR Less Than 60 within First 48 Hours’, the logic only evaluates the index serum creatinine, which is defined in the ‘Definition’ header section as the lowest serum creatinine value within the first 24 hours of encounter start. If there are no serum creatinine values within the first 24 hours, then the index is the first serum creatinine value within the first 48 hours of encounter start.

      Specific to your scenario, the patient was admitted on 6/30 at 0513. The first serum creatinine value, 67 mg/dL, taken on 6/30 at 0615, is measured within 24 hours of encounter start. However, the second serum creatinine, 54.2 mg/dL, taken on 7/1 at 0028, is also measured within 24 hours of encounter start. Therefore, the index serum creatinine value in this scenario is 54.2 mg/dL, because this value represents the lowest serum creatinine taken within 24 hours of encounter start. As a result, this scenario would meet the denominator exclusion criteria for ‘Encounter with Index eGFR Less Than 60 within First 48 Hours’.

      However, if the second index serum creatinine value of 54.2 mg/dL was obtained after the first 24 hours (though prior to 48 hours) of encounter start, for example, on 7/2 at 0028, then the index serum creatinine value would be 67 mg/dL and the patient would not meet the denominator exclusion.
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      Thank you for your inquiry regarding CMS832v2, Hospital Harm – Acute Kidney Injury. For denominator exclusion definition ‘Encounter with Index eGFR Less Than 60 within First 48 Hours’, the logic only evaluates the index serum creatinine, which is defined in the ‘Definition’ header section as the lowest serum creatinine value within the first 24 hours of encounter start. If there are no serum creatinine values within the first 24 hours, then the index is the first serum creatinine value within the first 48 hours of encounter start. Specific to your scenario, the patient was admitted on 6/30 at 0513. The first serum creatinine value, 67 mg/dL, taken on 6/30 at 0615, is measured within 24 hours of encounter start. However, the second serum creatinine, 54.2 mg/dL, taken on 7/1 at 0028, is also measured within 24 hours of encounter start. Therefore, the index serum creatinine value in this scenario is 54.2 mg/dL, because this value represents the lowest serum creatinine taken within 24 hours of encounter start. As a result, this scenario would meet the denominator exclusion criteria for ‘Encounter with Index eGFR Less Than 60 within First 48 Hours’. However, if the second index serum creatinine value of 54.2 mg/dL was obtained after the first 24 hours (though prior to 48 hours) of encounter start, for example, on 7/2 at 0028, then the index serum creatinine value would be 67 mg/dL and the patient would not meet the denominator exclusion.
    • CMS0832v2

      A denominator exclusion for this measure: Inpatient hospitalizations for patients with the index eGFR value of <60 mL/min within 48 hours of the encounter start.

       

      If a patient has multiple eGFR values resulted within the 48 hour timeframe, does this measure look just to the initial one for exclusion? For example, a patient was admitted on 6/30 at 0513 and her first eGFR was 67 on 6/30 at 0615. Then, she had another one result within the 48 time frame on 7/1 at 0028 that was 54.2. Should the patient be excluded?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Jennifer Mull
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