CMS 165 Question

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Teladoc
    • Hide
      Thank you for your inquiry regarding CMS165v14 (2026 Performance Period). A patient will be eligible for the measure if there is documented evidence of an active essential hypertension diagnosis, using a code from the "Essential Hypertension" value set (2.16.840.1.113883.3.464.1003.104.12.1011) within the first six months of the measurement period. The measure logic specifies that diagnoses such as essential hypertension (e.g., I10) remain active within the first six months of the measurement period to qualify for initial population, as expressed in the CQL logic below. Since the patient referenced in your inquiry has a qualifying diagnosis (I10) with an "active" status, they would qualify for inclusion in the denominator. However, a diagnosis that is resolved before the start of the measurement period does not meet the criteria.

      Essential Hypertension Diagnosis
      ["Diagnosis": "Essential Hypertension"] Hypertension
      where Hypertension.prevalencePeriod overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )

      Please review the measure specification for further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS165-v14.0.000-QDM.html. If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs.
      Show
      Thank you for your inquiry regarding CMS165v14 (2026 Performance Period). A patient will be eligible for the measure if there is documented evidence of an active essential hypertension diagnosis, using a code from the "Essential Hypertension" value set (2.16.840.1.113883.3.464.1003.104.12.1011) within the first six months of the measurement period. The measure logic specifies that diagnoses such as essential hypertension (e.g., I10) remain active within the first six months of the measurement period to qualify for initial population, as expressed in the CQL logic below. Since the patient referenced in your inquiry has a qualifying diagnosis (I10) with an "active" status, they would qualify for inclusion in the denominator. However, a diagnosis that is resolved before the start of the measurement period does not meet the criteria. Essential Hypertension Diagnosis ["Diagnosis": "Essential Hypertension"] Hypertension where Hypertension.prevalencePeriod overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months ) Please review the measure specification for further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS165-v14.0.000-QDM.html . If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .
    • CMS0165v14
    • CMS1206v3

      My organization has a disagreement with our EMR vendor over what we believe should be inclusion criteria for Controlling High Blood Pressure. The example that I provided was a patient had a visit on 1/16/2026 and had the encounter codes documented properly. They had a diagnosis of I10 in their problem list, entered on 7/18/2025 and flagged as 'Active'. My understanding of the denominator criteria was that we needed a visit in the measurement period and a diagnosis during the measurement period or leading into the measurement period. I thought our patient met the later criteria with their diagnosis being in the prior year, leading into this measurement period. The support staff indicated the following: "Also, we observed that "hypertensive disorder" documented in the problems section as an active problem. However, it is not a valid SNOMED as per specifications. Also, please note the I10 Essential (Primary) Hypertension is not a valid one to be documented in the problems section as discussed above." My understanding was that if we documented the ICD10 diagnosis code of I10, that would satisfy the denominator criteria. Can you help me clarify this? 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Bob Brassil
            Votes:
            0 Vote for this issue
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: