[CQM-6334] Missing ICD 10 diagnosis codes for CMS125 and other eCQMs with Frailty and Advanced Illness Exclusion Created: 08/28/23 Updated: 02/06/24 Resolved: 09/11/23 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Moderate |
| Reporter: | Gail Henson-Swaney | Assignee: | Mathematica EC eCQM Team (Inactive) |
| Resolution: | Answered | Votes: | 0 |
| Labels: | None | ||
| Solution: | Thank you for your inquiry about the advanced illness and frailty criteria. Published versions of the measures cannot be changed after publication. Clinically equivalent services can be mapped to the measure's value set. If mapping is done, please maintain documentation in case of a CMS audit. We will consider updates to the value set in a future publication. We hope this helps.
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| Solution Posted On: | |
| 2023 Performance Period EC eCQMs: |
CMS0125v11
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| Impact: | Patients with certain qualifying advanced illness diagnoses are not excluded from denominator for eCQMs using this data element:
CMS125 - Breast Cancer Screening CMS165 - Controlling High Blood Pressure CMS122 - Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) CMS131 - Diabetes: Eye Exam CMS130 - Colorectal Cancer Screening CMS134 - Diabetes: Medical Attention for Nephropathy |
| Description |
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Several eCQMs have the frailty and advanced illness exclusion. My question is why the value set for Advanced Illness is composed of both SNOMED and ICD10 diagnosis codes, but there are inconsistencies/omissions when comparing the SNOMED code list to the codes in the ICD10 list. One notable discrepancy is found for Multiple Sclerosis. There are 15 SNOMED codes in the 2023 value set that reference Multiple Sclerosis, yet zero ICD10 diagnosis codes. Why is G35 not included? Since a patient with a diagnosis of any of the ICD10 or SNOMED codes listed, during an inpatient encounter or two outpatient encounters on different days, may qualify for the advanced illness criteria, would it be appropriate for internal mapping to be done in the EHR so that the patients with dx G35 would be flagged with one of the SNOMED codes that are in the value set for this diagnosis and therefore would be appropriately excluded? We note that G35 has been added to the value set for 2024, but this will not help our 2023 reporting. |
| Comments |
| Comment by Mathematica EC eCQM Team (Inactive) [ 09/06/23 ] |
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We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience. |
| Comment by Mathematica EC eCQM Team (Inactive) [ 08/29/23 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |