[CQM-6486] CMS816v2 : Query Regarding Numerator Created: 10/04/23  Updated: 02/06/24  Resolved: 10/13/23

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs Priority: Moderate
Reporter: gayatri kulkarni (Inactive) Assignee: Joelencia Leflore
Resolution: Answered Votes: 0
Labels: None

Solution: Thank you for your inquiry specific to CMS816v2 Hospital Harm – Severe Hypoglycemia. All three of your scenarios (Patients A, B, and C) meet the numerator criteria. In each case, a severe hypoglycemic event occurred during the inpatient encounter. The conditions that define a severe hypoglycemic event are met, which include the following during the encounter:

- A glucose result less than 40 mg/dL. [Patient A glucose = 0 mg/dL; Patient B glucose = 2 mg/dL; Patient C glucose = 10 mg/dL]

AND

 - A hypoglycemic medication administered within 24 hours prior to the start of the severe hypoglycemic event (i.e., the glucose result less than 40 mg/dL). [Patient A, B, and C were all administered the hypoglycemic medication 1 hour prior to the documented glucose test values]

AND

- No subsequent repeat test for glucose with a result greater than 80 mg/dL within five minutes of the time of the initial glucose test with result less than 40mg/dL. [Patient A, B, and C have no documented repeat glucose test]

To answer your final query: Yes, a value of 0 mg/dL as the result of a glucose test is considered valid, so does meet the condition of a glucose result < 40 mg/dL for the measure.
Solution Posted On:
2023 Reporting Period Hosp Inpt eCQMs:
CMS0816v2
Last Commented Date:

 Description   

Hi Team,

Consider statements below from CMS816v2:

A hypoglycemic medication administered within 24 hours prior to the start of the severe hypoglycemic event (i.e., the glucose result less than 40 mg/dL)

Encounter With Severe Hypoglycemic Harm Event :
"Encounter With Hypoglycemic Medication Administration" QualifyingEncounter
  where exists ( ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] BloodGlucoseLab1
      with ["Medication, Administered": "Hypoglycemics Severe Hypoglycemia"] HypoglycemicMed
        such that Global."NormalizeInterval" ( HypoglycemicMed.relevantDatetime, HypoglycemicMed.relevantPeriod ) starts 24 hours or less before or on BloodGlucoseLab1.relevantDatetime
          and Global."NormalizeInterval" ( HypoglycemicMed.relevantDatetime, HypoglycemicMed.relevantPeriod ) starts during Global."HospitalizationWithObservation" ( QualifyingEncounter )
      without ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] BloodGlucoseLab2
        such that BloodGlucoseLab2.relevantDatetime during Global."HospitalizationWithObservation" ( QualifyingEncounter )
          and BloodGlucoseLab2.relevantDatetime 5 minutes or less after BloodGlucoseLab1.relevantDatetime
          and BloodGlucoseLab2.result > 80 'mg/dL'
      where BloodGlucoseLab1.relevantDatetime during Global."HospitalizationWithObservation" ( QualifyingEncounter )
        and BloodGlucoseLab1.result < 40 'mg/dL'
  )

Scenario1 :

Patient A aged 21 years with

Start of InpatientEncounter.relevantPeriod = 11/12/2023 4:00

End of InpatientEncounter.relevantPeriod = 11/12/2023 7:00

having Glucose Lab Test Mass Per Volume documented on 11/12/2023 6:00 with value 0 mg/dL and with Hypoglycemics Severe Hypoglycemia medication administered on 11/12/2023 5:00 

 

Patient B aged 21 years with

Start of InpatientEncounter.relevantPeriod = 11/12/2023 4:00

End of InpatientEncounter.relevantPeriod = 11/12/2023 7:00

having Glucose Lab Test Mass Per Volume documented on 11/12/2023 5:00 with value 2 mg/dL and with Hypoglycemics Severe Hypoglycemia medication administered on 11/12/2023 4:00 

 

Patient C aged 21 years with

Start of InpatientEncounter.relevantPeriod = 11/12/2023 4:00

End of InpatientEncounter.relevantPeriod = 11/12/2023 7:00

having Glucose Lab Test Mass Per Volume documented on 11/12/2023 6:00 with value -10 mg/dL and with Hypoglycemics Severe Hypoglycemia medication administered on 11/12/2023 5:00 

Query : 

Which of the above patients will qualify for the numerator? Can glucose value 0 be considered as valid glucose value?

 Comments   
Comment by Joelencia Leflore [ 11/20/23 ]

Thank you for your follow-up question regarding CMS816v2. We cannot comment on how glucose values for your organization are documented in the EHR nor if the values can or will be documented as ‘negative’. This should be addressed by your EHR implementation experts. For the purposes of the measure, only glucose values documented as a quantity (e.g., 0, 40, 50.5, 800, etc.) will be acceptable when evaluating the glucose results.

Comment by Joelencia Leflore [ 11/07/23 ]

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

Comment by gayatri kulkarni (Inactive) [ 10/17/23 ]

Hi JLeflore ,

Thank you for the response.

We have an additional question as follows:

Is there any chance of glucose value to be documented as negative?

Please let us know.

Thank you.

Comment by Joelencia Leflore [ 10/12/23 ]

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 gayatri kulkarni (Inactive) [ 10/09/23 ]

Hi,

gentle reminder.

Thank you.

Comment by Joelencia Leflore [ 10/04/23 ]

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

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