CMS 140 Denominator question

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Minor
    • Component/s: Measure
    • None
    • Elissa Chandler
    • 2677255354
    • NextGen Healthcare Information Systems
    • denominator query
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      For the timing constraint for the following string of logic in question,
      o AND:
       AND NOT: "Occurrence A of Procedure, Result: Clinical Staging Procedure" starts before start of "Occurrence A of Diagnosis, Active: Breast Cancer"
       AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Distant Metastasis Status M0')" starts before or during
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      The timing constraint is that the result of ‘Breast Distant Metastasis Status M0’ should occur any time before or during “Occurrence A of Encounter, Performed: Office Visit” OR “Occurrence A of Encounter, Performed: Face-to-Face Interaction”.
        
      It is important to note that there is an additional logic constraint of "AND NOT" that requires that the procedure result not occur before the diagnosis of breast cancer. Both logic statements need to be true for the patient to be included in the denominator of the measure.

      For Question 2, the two strings of logic outlined below are the key to understanding the denominator of CMS140. These two strings of logic – AND statement & AND NOT statement -- define the constraints for Occurrence A of Clinical Staging Procedure; all instances where Occurrence A of Clinical Staging Procedure is used later in the logic will be bound by these timing constraints. Additional information about the concept of "Occurrencing" is available in section 3.3 of the eMeasure Implementation Guide (version 1.5-June 2013 release), available at: http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

      Two logic phrases in Denominator:
      o AND:
       AND NOT: "Occurrence A of Procedure, Result: Clinical Staging Procedure" starts before start of "Occurrence A of Diagnosis, Active: Breast Cancer"
       AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Distant Metastasis Status M0')" starts before or during
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
      Show
      For the timing constraint for the following string of logic in question, o AND:  AND NOT: "Occurrence A of Procedure, Result: Clinical Staging Procedure" starts before start of "Occurrence A of Diagnosis, Active: Breast Cancer"  AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Distant Metastasis Status M0')" starts before or during  OR: "Occurrence A of Encounter, Performed: Office Visit"  OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" The timing constraint is that the result of ‘Breast Distant Metastasis Status M0’ should occur any time before or during “Occurrence A of Encounter, Performed: Office Visit” OR “Occurrence A of Encounter, Performed: Face-to-Face Interaction”.    It is important to note that there is an additional logic constraint of "AND NOT" that requires that the procedure result not occur before the diagnosis of breast cancer. Both logic statements need to be true for the patient to be included in the denominator of the measure. For Question 2, the two strings of logic outlined below are the key to understanding the denominator of CMS140. These two strings of logic – AND statement & AND NOT statement -- define the constraints for Occurrence A of Clinical Staging Procedure; all instances where Occurrence A of Clinical Staging Procedure is used later in the logic will be bound by these timing constraints. Additional information about the concept of "Occurrencing" is available in section 3.3 of the eMeasure Implementation Guide (version 1.5-June 2013 release), available at: http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html Two logic phrases in Denominator: o AND:  AND NOT: "Occurrence A of Procedure, Result: Clinical Staging Procedure" starts before start of "Occurrence A of Diagnosis, Active: Breast Cancer"  AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Distant Metastasis Status M0')" starts before or during  OR: "Occurrence A of Encounter, Performed: Office Visit"  OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    • CMS140v1/NQF0387
    • critical impacts measure development for certification

      I have the following CMS 140 Denominator query:

      Question 1:

      The following has been specified in the Denominator of the government specification:
      o AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Distant Metastasis Status M0')" starts before or during
       OR: "Occurrence A of Encounter, Performed: Office Visit"
       OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"

      Can you please confirm if for satisfactory reporting of the denominator of this measure, the result: ‘Breast Distant Metastasis Status M0’ should be documented any time before or during Occurrence A of Encounter, Performed: Office Visit OR Occurrence A of Encounter, Performed: Face-to-Face Interaction

      Question 2:

      The following has been specified in the Denominator of the government specification:
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N3')"
       OR:
       AND:
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T0')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1a')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1b')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1c')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1mi')"
       AND:
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N1')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status pN1a')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status pN1b')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status pN1c')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status pN1mi')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N2')"
       OR:
       AND:
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T2')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T3')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T4')"
       AND:
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N0')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N1')"
       OR: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N2')"
       OR:
       AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Primary Tumor Size T1c')"
       AND: "Occurrence A of Procedure, Result: Clinical Staging Procedure (result: 'Breast Cancer Regional Lymph Node Status N0')"

      Can you please confirm if for satisfactory reporting of the denominator of this measure, the below conditions should be documented any time before or during Occurrence A of Encounter, Performed: Office Visit OR Occurrence A of Encounter, Performed: Face-to-Face Interaction?

      1. result: 'Breast Cancer Regional Lymph Node Status N3'
      2. result: 'Breast Cancer Primary Tumor Size T0'
      3. result: 'Breast Cancer Primary Tumor Size T1'
      4. result: 'Breast Cancer Primary Tumor Size T1a'
      5. result: 'Breast Cancer Primary Tumor Size T1b'
      6. result: 'Breast Cancer Primary Tumor Size T1c'
      7. result: 'Breast Cancer Primary Tumor Size T1mi'
      8. result: 'Breast Cancer Regional Lymph Node Status N1'
      9. result: 'Breast Cancer Regional Lymph Node Status pN1a'
      10. result: 'Breast Cancer Regional Lymph Node Status pN1b'
      11. result: 'Breast Cancer Regional Lymph Node Status pN1c'
      12. result: 'Breast Cancer Regional Lymph Node Status pN1mi'
      13. result: 'Breast Cancer Regional Lymph Node Status N2'
      14. result: 'Breast Cancer Primary Tumor Size T2'
      15. result: 'Breast Cancer Primary Tumor Size T3'
      16. result: 'Breast Cancer Primary Tumor Size T4'
      17. result: 'Breast Cancer Regional Lymph Node Status N0'
      18. result: 'Breast Cancer Regional Lymph Node Status N1'
      19. result: 'Breast Cancer Regional Lymph Node Status N2'
      20. result: 'Breast Cancer Primary Tumor Size T1c'
      21. result: 'Breast Cancer Regional Lymph Node Status N0'

            Assignee:
            Ramya Tallapragada (Inactive)
            Reporter:
            Elissa Chandler (Inactive)
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