Mapping Alternate Code Sets Question and Clarification

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Wendy Lynch
    • 5743446183
    • IMAT Solutions
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      Thank you for your inquiry about CMS122v13, CMS125v13, and CMS165v13 (2025 Performance Period). To fulfill the initial population and denominator requirement for a qualifying encounter, clinically equivalent services can be mapped to the codes specified in these measure's value sets; if mapping is done, you should maintain documentation in case of a CMS audit.
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      Thank you for your inquiry about CMS122v13, CMS125v13, and CMS165v13 (2025 Performance Period). To fulfill the initial population and denominator requirement for a qualifying encounter, clinically equivalent services can be mapped to the codes specified in these measure's value sets; if mapping is done, you should maintain documentation in case of a CMS audit.
    • CMS0122v13, CMS0125v13, CMS0165v13
    • Allowing mapping expands denominator capture and improves completeness

      We would like to confirm if encounter data can be standardized through mapping to alternate code sets (e.g., SNOMED, CPT, ICD) for submission, provided that the original source codes are preserved in the record.
      Could CMS clarify:
      Whether mapping of encounter codes for reporting purposes is acceptable, and if so, under what conditions?

      If there are restrictions on transforming or crosswalking encounter codes between code systems when generating files for submission?
      For example:
      Visit Type Codes: if we have from the PHA Adapt TEL with the code with the display of telephone can that be mapped to the corresponding SNOMED code in the VSAC. 

      Some of these offices dont have robust workflows that support the CPT codes in the VSAC but they are seeing the patients and rendering services during an encounter with visit types (that are statically configured) in their system- set documentation standards. This could help contribute to data completeness and denominator capture. 
      Can CMS confirm whether such mappings are acceptable for encounter reporting, and if so, what conditions or documentation are required to remain compliant?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Wendy Lynch
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              Updated:
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