OPI-1 V7 Logic calls for OUD diagnosis where start of prevalence period is before day encounter starts, So should all previous OUD diagnosis be included in 2025 patient encounter QRDA I file or not?

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • M. Frankenstein
    • St. Luke's Health System
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      Thank you for your question regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. The measure should be reported as specified for the given reporting periods. OUD Diagnosis should not be submitted for CMS506v6 and earlier. For CMS506v7, the logic evaluates for patients who ever had a diagnosis of OUD (see logic below and known issue- https://oncprojectracking.healthit.gov/support/browse/EKI-31). Therefore, an OUD diagnosis with a prevalence period of 9/26/2023-10/2/2023 would meet the denominator exclusion for an encounter that took place 1/26/2025-1/30/2025. All previous OUD diagnosis should therefore be included in QRDA I file when reporting CMS506v7.
      Show
      Thank you for your question regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. The measure should be reported as specified for the given reporting periods. OUD Diagnosis should not be submitted for CMS506v6 and earlier. For CMS506v7, the logic evaluates for patients who ever had a diagnosis of OUD (see logic below and known issue- https://oncprojectracking.healthit.gov/support/browse/EKI-31) . Therefore, an OUD diagnosis with a prevalence period of 9/26/2023-10/2/2023 would meet the denominator exclusion for an encounter that took place 1/26/2025-1/30/2025. All previous OUD diagnosis should therefore be included in QRDA I file when reporting CMS506v7.
    • CMS0506v7
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      If 2025 encounter data is supposed to include any prior diagnosis for OUD, even if no longer active (as indicated for 2024 encounter in CQM-7018) but validation will be for the encounter not related to that diagnosis, this data will not be captured in the validation file pulled for that encounter
      So should all previous OUD diagnosis be included in QRDA I file or not?
      Show
      If 2025 encounter data is supposed to include any prior diagnosis for OUD, even if no longer active (as indicated for 2024 encounter in CQM-7018 ) but validation will be for the encounter not related to that diagnosis, this data will not be captured in the validation file pulled for that encounter So should all previous OUD diagnosis be included in QRDA I file or not?

      [Requested solution preserved from the Solution field to make room for the EH eCQM Team's response:

      Appears resolved in version 8.2, but we need to submit data for version 7.0 so clarity on whether patients without an active diagnosis for their 2025 encounter, but had a diagnosis in previous encounters (that is no longer "active"/prevalence period ended before 2025 encounter) should be an exclusion]

       

      A patient with a diagnosis of Opioid Dependence with a prevalence period of 9/26/2023-10/2/2023 and encounter being submitted occurred 1/26/2025-1/30/2025 would be a denominator exclusion per spec. However, the diagnosis from 2023 is not active in the 2025 encounter charting and thus would not be pulled in the chart file for validation.

      So should all previous OUD diagnosis be included in QRDA I file or not?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Maya Frankenstein
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