Manali

The logic for the exclusion is

Hypertension.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod

The diagnosis starts on 2022/02/08 17:05 and does not have an end time (which means its ongoing)

There are 3 relevant encounters

Encounter 1: 2022/02/08 17:00 - 2022/02/08 18:00
Encounter 2: 2022/06/10 16:00 - 2022/06/10 17:00
Encounter 3: 2022/11/29 17:00 - 2022/11/29 18:00

As a result, the diagnosis overlaps before Encounter 2 and 3. The diagnosis does not overlap before Encounter 1 because it starts during that encounter. That is why Encounter 1 does not meet the exclusion.

The CQL specification (https://cql.hl7.org/03-developersguide.html) is a great resource to understand how measure logic is executed.

-Dave Czulada

hi David,

Any update on our last follow up query?

hi David,

One last follow up query ,

The above patient has 3 eligible visits.
The exclusion code is associated with only one visit. There is no second visit associated with exclusion code.
Whereas on cypress UI 2 visits are expected to meet denominator exclusion.

Manali-

The issue in the linked ticket was that the 2 codes (SNOMEDCT:10745001 and SNOMEDCT:11466000) belonged to different valuesets used in CMS334.

The code 11466000 is included in the valueset for Delivery Procedures (2.16.840.1.113762.1.4.1045.59) and Cesarean Birth (2.16.840.1.113883.3.117.1.7.1.282).

The code 10745001 is only included in the valueset for Delivery Procedures (2.16.840.1.113762.1.4.1045.59).

Because of this, depending on which code you chose, a different results could occur.  Because of this, we released a new bundle (2022.1.1) that removed the conflicting code.  The updated patient in that bundle only included a singular code 11466000.

In this example, both codes I10 and 10725009 belong to the same valueset (Diagnosis of Hypertension-2.16.840.1.113883.3.600.263) within CMS22 and can be used interchangeably without impacting the calculations.

-Dave Czulada

Hi David,

To make it more clearer,  our query is on similar lines which was raised earlier for EH 334 measure wrt code and translation code.

there is a reference ticket is below :

https://oncprojectracking.healthit.gov/support/browse/CYPRESS-2463

Manali-

I'm not sure I understand your question.  Let's see if this clears things up.

Since CMS22 is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit.

For this patient, 2 of the visits qualify for the denominator exclusion and 1 of the visits only qualifies for the denominator.

-Dave Czulada

Hi David,

Any update on our latest query for this particular patient file?

We have one more query for below Patient present in one of the cypress test deck for CMS22v12.
Patient Name- Brian Andrews
As visible on cypress UI,the above patient has 3 visits. Attached Snapshot for the same.
Expected Output on cypress-
2 visits should qualify for Denominator exclusion
1 visit should qualify for IPP

According to your initial response, we can choose any 1 code present in QRDA file expected for 2 visits. As per data, We are left with one more visit which is qualifying for IPP.
Should we check denominator exclusion on Visit level? Is this understanding correct?

Measure specification states:
Denominator Exclusions
"Qualifying Encounter during Measurement Period" QualifyingEncounter
  with ["Diagnosis": "Diagnosis of Hypertension"] Hypertension
    such that Hypertension.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod

Attaching the snippet for your reference.

Manali-

Many valuesets include codes from multiple code systems.  Cypress test patients generally try to include similar codes from each code system that is available.  Historically this was done to help out systems that needed to manually enter the test patients and only supported certain code systems.

Note, when reporting back to Cypress, you can choose to include any of the codes provided in your QRDA file.

-Dave Czulada

Thank you for submitting your question/issue. We will assign this to a team member and respond in one business day