CMS 506v7 - Hospice Care and Palliative Care Referrals to Outpatient clinicians

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Bethany A. Castagna
    • Cheshire Medical Center
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      Thank you for your question regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. Codes related to "Intervention, Order: Palliative or Hospice Care" can be found in value set "Palliative or Hospice Care (OID 2.16.840.1.113883.3.600.1.1579)."

      Value sets can be accessed online at the Value Set Authority Center; however, users may need to create a free account to view the codes contained within a value set.

      Clinically equivalent services may be mapped to the codes used in the measure’s value sets to satisfy the measure requirements. Unfortunately, we are unable to provide more specific guidance related to the mapping of codes, we recommend that you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
      Show
      Thank you for your question regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. Codes related to "Intervention, Order: Palliative or Hospice Care" can be found in value set "Palliative or Hospice Care (OID 2.16.840.1.113883.3.600.1.1579)." Value sets can be accessed online at the Value Set Authority Center; however, users may need to create a free account to view the codes contained within a value set. Clinically equivalent services may be mapped to the codes used in the measure’s value sets to satisfy the measure requirements. Unfortunately, we are unable to provide more specific guidance related to the mapping of codes, we recommend that you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
    • CMS0506v8
    • CMS0506v7
    • CMS0506v6
    • Patients qualifying for measure Numerator, potentially inflating rate.

      It's important for us to recognize that this measure won’t reach a zero rate, which brings up a key question: should inpatients discharged with an "Outpatient" referral to Palliative Care or Hospice be excluded from the denominator? Additionally, accurately mapping these outpatient orders to the relevant SNOMED CT codes is crucial for effectively tracking patient care pathways. Your insights on this will play a significant role in enhancing our practices and ensuring we achieve the best possible patient outcomes. Thank you for your engagement on this important topic! 

      These are the codes we are questioning should be mapped to the corresponding outpatient referral.  

      • "Referral to palliative care service (procedure) 306237005 SNOMEDCT [2.16.840.1.113883.6.96]"
      • "Referral to hospice (procedure) 306205009 SNOMEDCT [2.16.840.1.113883.6.96]"

      Thank you!  

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Bethany Castagna
            Votes:
            1 Vote for this issue
            Watchers:
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              Created:
              Updated:
              Resolved:
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