Hypo Numerator Logic

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Kelley Karney
    • 4438121287
    • Press Ganey
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      Thank you for your inquiry related to CMS816v4 and CMS816v5: Hospital Harm – Severe Hypoglycemia. The measure’s numerator identifies inpatient encounters where a qualifying severe hypoglycemic event occurred. A severe hypoglycemic event is defined as:

      1. A glucose test with a result < 40 mg/dL, AND
      2. A hypoglycemic medication administered within 24 hours before that glucose result, AND
      3. No repeat glucose test with a result > 80 mg/dL within five minutes or less from the time of that <40 mg/dL result.

      The logic does not specify using the first occurrence of glucose < 40 mg/dL. Each low glucose value is evaluated individually, and the encounter is counted in the numerator if any one of those low values meets all three conditions noted above.

      Based on your results:
      The glucose test at 12:45 AM (38 mg/dL) does not qualify because the patient had a repeat glucose >80 mg/dL within 2 minutes, which disqualifies that event.

      The glucose test at 12:48 AM (32 mg/dL) does qualify because:

       - It is <40 mg/dL,
       - Hypoglycemic medication was administered within the previous 24 hours, and
       - There is no subsequent glucose test >80 mg/dL within 5 minutes.
      Show
      Thank you for your inquiry related to CMS816v4 and CMS816v5: Hospital Harm – Severe Hypoglycemia. The measure’s numerator identifies inpatient encounters where a qualifying severe hypoglycemic event occurred. A severe hypoglycemic event is defined as: 1. A glucose test with a result < 40 mg/dL, AND 2. A hypoglycemic medication administered within 24 hours before that glucose result, AND 3. No repeat glucose test with a result > 80 mg/dL within five minutes or less from the time of that <40 mg/dL result. The logic does not specify using the first occurrence of glucose < 40 mg/dL. Each low glucose value is evaluated individually, and the encounter is counted in the numerator if any one of those low values meets all three conditions noted above. Based on your results: The glucose test at 12:45 AM (38 mg/dL) does not qualify because the patient had a repeat glucose >80 mg/dL within 2 minutes, which disqualifies that event. The glucose test at 12:48 AM (32 mg/dL) does qualify because:  - It is <40 mg/dL,  - Hypoglycemic medication was administered within the previous 24 hours, and  - There is no subsequent glucose test >80 mg/dL within 5 minutes.
    • CMS0816v5
    • CMS0816v4

      If there are multiple glucose tests done on a patient, how do we know which one should be the 'one qualifying severe hypoglycemic event that is counted in the numerator'? We have a patient who has 3 glucose tests. Please see the info for each below:

      Glucose Lab Test with Relevant Date Time 9/30/2025 12:45am and result value of 38 mg/dL
      Glucose Lab Test with Relevant Date Time 9/30/2025 12:47am and result value of 314 mg/dL
      Glucose Lab Test with Relevant Date Time 9/30/2025 12:48am and result value of 32 mg/dL

      So the 1st one is less than 40 (and there is a hypo medication administered within 24 hrs as well) and then the next one is 2 min later with a result > 80. Then the last one is 1 minute later and less than 40. Would this case NOT be in the Numerator because of the 1st and 2nd glucose results? Or would it be IN the numerator because the 3rd glucose that is less than 40 does not have a subsequent repeat test with result > 80? The logic does not say to use the 'First' glucose result so we are confused on how to determine which severe hypoglycemic event would be the 'qualifying one'. Numerator logic is below for reference. Thank you.

      Numerator logic -
      Inpatient hospitalizations where a severe hypoglycemic event occurred during the encounter. A severe hypoglycemic
      event is:

      • A glucose test with a result less than 40 mg/dL
        AND
      • A hypoglycemic medication was administered within 24 hours before the start of the severe hypoglycemic event
        (i .e., the glucose test with a result less than 40 mg/dL)
        AND
      • There was no subsequent repeat test for glucose with a result greater than 80 mg/dL within five minutes or less
        from the start of the initial glucose test with a result less than 40 mg/dL

      Only one qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event
      is counted per encounter.

      The 24-hour and 5-minute timeframes are based on the time the glucose was drawn, as this reflects the time the
      patient was experiencing that specific glucose level.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Kelley Karney
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              Created:
              Updated:
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