[CQM-7519] Class III obesity is not included in the valueset for 2024 or 2025 Created: 12/11/24 Updated: 02/04/25 Resolved: 12/23/24 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals | Priority: | Moderate |
| Reporter: | Jennifer Harlos | Assignee: | Mathematica EH eCQM Team |
| Resolution: | Answered | Votes: | 5 |
| Labels: | None | ||
| Contact Name: | Jennifer Harlos |
| Contact Email: | jlharlos@anthc.org |
| Solution: | Thank you for your question about CMS1028 Severe Obstetric Complications. The eCQM specifications, including the value sets utilized within are reviewed and updated on an annual basis. The measure developer will review ICD-10-CMS code E66.813 for inclusion in a future Annual Update. Clinically equivalent services may be mapped to the codes used in the measure’s value sets. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit. We hope this helps. |
| Solution Posted On: | |
| 2025 Reporting Period EH/CAH eCQMs: |
CMS1028v3
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| 2024 Reporting Period EH/CAH eCQMs: |
CMS1028v2
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| Impact: | Providers are documenting class III obesity on the chart and coders are coding it, but we still aren't having this count in as a risk adjustment in the PC-07 measure. Over 15% of our patients would qualify for this coding according to their BMI. I understand the limitations of BMI, especially in the context of pregnancy, but I wonder if there could be a better way to capture this, through pulling the prepregnancy BMI from a discreet field, or pulling the admission BMI, even at a level higher than morbid obesity in a nonpregnant person, say above 45 or 50, as an additional way to capture these cases beyond just relying on a diagnosis code. This would capture this risk factor more accurately. |
| Last Commented Date: |
| Description |
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My coding department is now using an E66.813 code to code for Class III (AKA morbid or severe) obesity. This is not on the valueset for this measure for this year or next. This is already a very difficult risk factor to capture because providers most often document the BMI, but we've had to work with them a lot, with not that much success, to get them to write "morbid/severe/class III obesity" on the chart as well so that it can be coded. Now that's not even being coded to a code that is recognized on this measure. |
| Comments |
| Comment by Jennifer Harlos [ 02/04/25 ] |
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Our vendor has replied that they cannot map the Class III obesity code to the Morbid Obesity code used in the VSAC because "to qualify as a certified vendor we have to stick to the value set and cannot change. If we did change it, we could be in a sticky situation with CMS." Is this true? Is there any other avenue to address this for 2025? The specifications should really list "morbid obesity" instead of "BMI >=40, as that's what the measure is truly collecting. If it were collecting anyone whose admission BMI was >= to 40 we would be capturing 4x the number of patients than we are right now through morbid obesity coding only. |
| Comment by Mathematica EH eCQM Team [ 01/31/25 ] |
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Thank you for your follow-up question about CMS1028 Severe Obstetric Complications. At this time, the diagnostic code is not yet in value set in the VSAC due to the timing of the annual value set review and update process. Since your department has already implemented the use of this code, the code itself could be mapped to the codes documented in the value set. We advise that documentation of this rationale be maintained for that action in case of a CMS audit. |
| Comment by Mathematica EH eCQM Team [ 01/16/25 ] |
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Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible. |
| Comment by Jennifer Harlos [ 01/15/25 ] |
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I have circled back with our EHR vendor and they have asked for clarification on what you said in response about mapping clinically equivalent services. "Clinically equivalent services may be mapped to the codes used in the measure’s value sets. We are unable to provide specific guidance related to the mapping of codes...If mapping is conducted, you should maintain documentation in case of a CMS audit." What are you suggesting we map if the diagnostic codes used are not part of the VSAC? Thank you! |
| Comment by Jennifer Harlos [ 01/15/25 ] |
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I have circled back with our EHR vendor and they have asked for clarification on what you said in response about mapping clinically equivalent services. "Clinically equivalent services may be mapped to the codes used in the measure’s value sets. We are unable to provide specific guidance related to the mapping of codes...If mapping is conducted, you should maintain documentation in case of a CMS audit." What are you suggesting we map if the diagnostic codes used are not part of the VSAC? Thank you! |
| Comment by Jennifer Harlos [ 01/15/25 ] |
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I have circled back with our EHR vendor and they have asked for clarification on what you said in response about mapping clinically equivalent services. "Clinically equivalent services may be mapped to the codes used in the measure’s value sets. We are unable to provide specific guidance related to the mapping of codes...If mapping is conducted, you should maintain documentation in case of a CMS audit." What are you suggesting we map if the diagnostic codes used are not part of the VSAC? Thank you! |
| Comment by Mathematica EH eCQM Team [ 12/19/24 ] |
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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 EH eCQM Team [ 12/12/24 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |