[#CQM-6429] CMS165v11 Exclusion logic for BP's taken during day of Inpatient or ED encounter

[CQM-6429] CMS165v11 Exclusion logic for BP's taken during day of Inpatient or ED encounter Created: 09/14/23 Updated: 02/06/24 Resolved: 09/27/23
Status:	Closed
Project:	eCQM Issue Tracker
Component/s:	None

Type:

EC eCQMs - Eligible Clinicians

Priority:

Moderate

Reporter:

Jeff Jennings (Inactive)

Assignee:

Mathematica EC eCQM Team

Resolution:

Answered

Votes:

Labels:

None

Contact Name:

Jeff

Contact Email:

jeff.jennings@oracle.com

Solution:

Thank you for your inquiry regarding CMS165v11, Controlling High Blood Pressure (2023 performance period). A qualifying blood pressure reading would be one that is NOT documented on the same day as an ED visit. In your scenario, the qualifying blood pressure documented on day 1, NOT on the same day as an ED visit, should count towards the numerator. Please see relevant logic below for your reference.

Qualifying Diastolic Blood Pressure Reading

        ["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP
          without ( ["Encounter, Performed": "Encounter Inpatient"]
            union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"] ) DisqualifyingEncounter
            such that Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod
          where DiastolicBP.result.unit = 'mm[Hg]'
            and Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of "Measurement Period"

Blood Pressure Days

        ( "Qualifying Diastolic Blood Pressure Reading" DBPExam
            return date from Global."LatestOf" ( DBPExam.relevantDatetime, DBPExam.relevantPeriod )
        )
          intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam
              return date from Global."LatestOf" ( SBPExam.relevantDatetime, SBPExam.relevantPeriod )
          )

Lowest Diastolic Reading on Most Recent Blood Pressure Day

        First("Qualifying Diastolic Blood Pressure Reading" DBPReading
            where Global."LatestOf"(DBPReading.relevantDatetime, DBPReading.relevantPeriod)same day as "Most Recent Blood Pressure Day"
            sort by(result as Quantity)
        )

Solution Posted On:

09/27/23 11:25 AM

2023 Performance Period EC eCQMs:

CMS0165v11

Description

Question about the exclusion logic for BP's taken during Inpatient or ED encounter

Example:
Patient had Office Visit on day 1 with a qualifying blood pressure reading documented
ED visit on Day 3 with a qualifying blood pressure reading documented

Would the previous most recent BP taken during the office visit qualifying the patient for the numerator or would the most recent BP result taken during the ED visit cause the patient to be excluded from the numerator?

["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP
  without ( ["Encounter, Performed": "Encounter Inpatient"]
    union ["Encounter, Performed": "Emergency Department Visit"] ) DisqualifyingEncounter
    such that Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod
  where DiastolicBP.result.unit = 'mm[Hg]'
    and Global."LatestOf" ( DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod ) during day of "Measurement Period

Comments

Comment by Mathematica EC eCQM Team [ 09/22/23 ]

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 [ 09/15/23 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

Generated at Thu Apr 03 19:41:47 EDT 2025 using Jira 9.12.16#9120016-sha1:6bee0863f3e6dbb91e4be2d992a3b6761c21c9e0.

[CQM-6429] CMS165v11 Exclusion logic for BP's taken during day of Inpatient or ED encounter Created: 09/14/23 Updated: 02/06/24 Resolved: 09/27/23