CMS832v2-Encounter with Less Than 2 Creatinine Results within First 48 Hours

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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). Based on the ‘Definition’ section of the specification’s header, inpatient hospitalization includes time in the emergency department and observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other. Upon reviewing the example in your inquiry, because the time between ED discharge (12/29/24- 4:34) and Inpatient Admission (12/29/24- 4:34) is less than 1 hour, the emergency department visit counts as part of the inpatient hospitalization. Further, there are two serum creatinine lab tests with results within the first 48 hours from the start of the inpatient hospitalization (12/29/24- 2:32- value 1.00; 12/30/24- 8:17- value 0.80), which meet the Denominator and Initial population criteria. Therefore, the encounter would not meet the denominator exclusion criteria for ‘Encounter With Less Than 2 Creatinine Results Within First 48 Hours’. If the patient does not meet any of the other five denominator exclusions, the encounter should be assessed for numerator compliance.
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      Thank you for your inquiry regarding CMS832v2 (Hospital Harm – Acute Kidney Injury). Based on the ‘Definition’ section of the specification’s header, inpatient hospitalization includes time in the emergency department and observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other. Upon reviewing the example in your inquiry, because the time between ED discharge (12/29/24- 4:34) and Inpatient Admission (12/29/24- 4:34) is less than 1 hour, the emergency department visit counts as part of the inpatient hospitalization. Further, there are two serum creatinine lab tests with results within the first 48 hours from the start of the inpatient hospitalization (12/29/24- 2:32- value 1.00; 12/30/24- 8:17- value 0.80), which meet the Denominator and Initial population criteria. Therefore, the encounter would not meet the denominator exclusion criteria for ‘Encounter With Less Than 2 Creatinine Results Within First 48 Hours’. If the patient does not meet any of the other five denominator exclusions, the encounter should be assessed for numerator compliance.
    • CMS0832v2

      Hi Team,

      Consider the below statement from Denominator Exclusion of CMS832v2:

      Encounter with Less Than 2 Creatinine Results within First 48 Hours
      "Encounter with Creatinine and without Obstetrical Conditions" QualifyingEncounter
      where ( Count("CreatinineLabTestwithResultwithinFirst48Hours"(QualifyingEncounter)) < 2 )

      "CreatinineLabTestwithResultwithinFirst48Hours":

      CreatinineLabTestwithResultwithinFirst48Hours(QualifyingEncounter "Encounter, Performed")
      from
      ["Laboratory Test, Performed": "Creatinine Mass Per Volume"] CreatinineTest
      where CreatinineTest.result is not null
      and Global."EarliestOf" ( CreatinineTest.relevantDatetime, CreatinineTest.relevantPeriod ) during Interval[start of Global."HospitalizationWithObservation" ( QualifyingEncounter ), start of Global."HospitalizationWithObservation" ( QualifyingEncounter ) + 48 hours] and Global."EarliestOf" ( CreatinineTest.relevantDatetime, CreatinineTest.relevantPeriod ) during Global."HospitalizationWithObservation" ( QualifyingEncounter )
      return CreatinineTest

      Query:

      Consider, Female Patient ABC aged 20 years at the start of InpatientEncounter.relevantPeriod. Consider the patient has IPP Qualifying data, Below mentioned Patient has 4 CreatinineTest.result.values.

      Visit 1
      Procedure start date(relevantDatetime) : 2025-01-01 04:41:00.000 and has Numeric value of 0.70
      Procedure start date(relevantDatetime) : 2024-12-31 05:46:00.000 and has Numeric value of 0.80
      Procedure start date(relevantDatetime) : 2024-12-30 08:17:00.000 and has Numeric value of 0.80
      Procedure start date(relevantDatetime) : 2024-12-29 02:32:00.000 and has Numeric value of 1.00

      Encounter (Emergency to Inpatient)

      Codes:

      SNOMEDCT: 32485007 - Hospital admission (procedure)
      SNOMEDCT: 4525004 - Emergency department patient visit (procedure)
      LOINC: 2160-0 - (Creatinine Test)

      ED Admit Date: 2024-12-29 01:53:00.000
      ED Discharge Date: 2024-12-29 04:34:00.000

      Inpatient Admit Date: 2024-12-29 04:34:00.000
      Inpatient Discharge Date: 2025-01-01 15:00:00.000

      For Patient ABC , If we consider ED-IP scenario , here the patient gets 2 CreatinineTest.result.values which is '1.0' with Procedure start date : '2024-12-29 02:32:00.000' and '0.8' with Procedure start date : '2024-12-30 08:17:00.000', as per data and statement mentioned above the patient should not satisfy for Denominator Exclusion and check for Performance Met/ Not Met criteria.

      But if we consider for only IP scenario, here the patient gets 1 CreatinineTest.result.values which is '0.8' and has Procedure start date as: '2024-12-30T08:17', as per data and statement mentioned above the patient should satisfy for Denominator Exclusion.

      For the above scenario what should be the expected clinical status for the patient? Kindly assist us on the above query.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Simran Motwani
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              Created:
              Updated:
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