[CQM-7549] CMS 146 respiratory condition exclusions - missing some diagnoses Created: 12/26/24 Updated: 01/03/25 Resolved: 01/03/25 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Moderate |
| Reporter: | Hannah Galvin | Assignee: | AIR EC eCQM Team |
| Resolution: | Answered | Votes: | 0 |
| Labels: | None | ||
| Contact Name: | Hannah Galvin |
| Contact Email: | hagalvin@challiance.org |
| Contact Phone: | 617-665-2381 |
| Institution/Name: | Cambridge Health Alliance |
| Solution: | Thank you for your inquiry about CMS146v12 (2024 Performance Period) and CMS146v13 (2025 Performance Period). According to the measure steward, the National Committee for Quality Assurance (NCQA), NCQA does not include otitis “media” in the measure because oral antibiotics are not indicated for otitis media.
Regarding the additional information and suggestion, NCQA conducts regular reviews of the codes within value sets, as well as when related JIRA inquiries come in. Currently, the 'Competing Conditions for Respiratory Conditions' value set accurately reflects the intended codes for this measure. |
| Solution Posted On: | |
| 2025 Performance Period EC eCQMs: |
CMS0146v13
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| 2024 Performance Period EC eCQMs: |
CMS0146v12
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| Impact: | Cases being counted as failing to meet measure when patient was prescribed antibiotics for concomitant ear infection, as clinically appropriate. |
| Description |
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I have a question about CMS 146. Specifically, the Value Set for Competing Conditions for Respiratory Conditions, OID 2.16.840.1.113883.3.464.1003.102.12.1017, is an exclusion - but seems to be missing some diagnoses for otitis media, for example ICD-10 H65.92. Please assess if this VSAC value set is comprehensive for respiratory condition exclusions. We have at least one documented case that technically failed to meet the measure due to the fact that the patient was prescribed antibiotics for otitis media H65.92; pharyngitis dx was also given but strep test not performed as patient was already getting antibiotics for AOM - this is clinically appropriate care. |
| Comments |
| Comment by AIR EC eCQM Team [ 12/27/24 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |