General ICD codes mapped for CMS measures, MDs selecting more specific Diagnoses.

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Victoria K Boswell
    • 404-606-3885
    • Piedmont Healthcare
    • Hide
      Thank you for your suggestions related to the value sets used in CMS0144v14 (Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) and CMS0002v14 (Preventive Care and Screening: Screening for Depression and Follow-Up Plan) and other eCQMs. Your suggestions will be taken into consideration as value sets are updated in future years. However, it is important to note that value set authors follow a set of best practice guidelines when determining which codes to include in their value sets. These guidelines include criteria for aligning codes with aspects such as value set intent, clinical validity, and terminological hierarchies. More information on value set best practices can be found at: https://www.nlm.nih.gov/vsac/support/authorguidelines/bestpractices.html. Also, measure implementation and reporting should be done in consultation with your EHR/measure reporting vendor. Some sites use the explicit codes within the measure, whereas others work with their EHR/measure reporting vendor to map their existing codes and record documentation to the codes within the eCQM value sets. You may want to consider working with your vendor to determine the least burdensome process for provider documentation and subsequent eCQM reporting.
      Show
      Thank you for your suggestions related to the value sets used in CMS0144v14 (Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) and CMS0002v14 (Preventive Care and Screening: Screening for Depression and Follow-Up Plan) and other eCQMs. Your suggestions will be taken into consideration as value sets are updated in future years. However, it is important to note that value set authors follow a set of best practice guidelines when determining which codes to include in their value sets. These guidelines include criteria for aligning codes with aspects such as value set intent, clinical validity, and terminological hierarchies. More information on value set best practices can be found at: https://www.nlm.nih.gov/vsac/support/authorguidelines/bestpractices.html . Also, measure implementation and reporting should be done in consultation with your EHR/measure reporting vendor. Some sites use the explicit codes within the measure, whereas others work with their EHR/measure reporting vendor to map their existing codes and record documentation to the codes within the eCQM value sets. You may want to consider working with your vendor to determine the least burdensome process for provider documentation and subsequent eCQM reporting.
    • CMS0144v14
    • CMS0144v13
    • CMS0144v12
    • Large

      With CMS choosing generic ICD codes and providers selecting diagnosis with the highest/greatest specificity (least generic). This difference is extensive and creating a misrepresentation of pass/fails/exceptions. This affects inpatient and outpatient and can potentially affect all measures. 
       
      For instance, regarding CMS 144:
       
      Arrhythmia 


      More specific arrhythmias are not in the OID:


      But further investigation finds this across other measures:
       
      The following code, O10.03, would be missed for dx of HTN, CMS22: 
       

       
      The code P91.829 would not be included in the dx for CMS 347 when it should be. If Epic were set up to include the generic ICD the more specific, associated ICS it is referenced under, then it would be included appropriately:

       
      If the system is able to find the General Concept and list out the More Specific Concepts below. Why cant the system attach the more General ICD10 to all the More Specific Concepts as a secondary code? It does this sort of attachment (secondary code) in most scenarios but not all, which is where we are missing the mark for pass/fail/exclusion? 
       

       
      Daniel Badendbaden@epic.com?subject=SLG%20%2310521162%20-%20CMS%20144%20Support%20Report%20pt%20Fails%20but%20should%20Pass
      Tue, Nov 4, 2025 1:24 PM
       #13
      As mentioned, the measure is using what CMS is providing, who does not clarify that a general ICD10 code would be acceptable - only the specific list in the value set.
      If they should accept a larger list, this should be a JIRA ticket to CMS for review.

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            Assignee:
            AIR EC eCQM Team
            Reporter:
            Victoria Boswell
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              Created:
              Updated:
              Resolved:
              Solution Posted On: