This has been addressed with Cypress 2.6

OK will do. In agreement with your example, the LOINC 71955-9 used <=180 days before surgery could have been related to heart failure, as in my example. Then the FS 60-180 could have been the knee related FS - which doesn't seem like the an intended outcome.

Rich,

You raise a very good point that there is a significant amount of crosswalk between the codes listed in the Functional Status, Result value sets for Heart Failure, Knee Replacements and Hip Replacements. This is because the PROMIS and VR assessment surveys can be applied to numerous health conditions. Fortunately, each value set also contains assessments that are unique to the specific condition (i.e. KOOS for Knees, HOOS for Hips, and KCCQ for cardiovascular outcomes).

To your point that the presence of LOINC code 71955-9 (PROMIS- 29 Sleep Disturbance score - T score) in a patient record could “meet the measure” for numerous conditions (i.e. 71955-9 completed for heart failure on 2/1/13 and 6/1/13, might also count towards a knee functional assessment for a knee replacement on 2/10/13). That is accurate, however two occurrences of the 71955-9 code would need to be present in relation to the knee replacement – one <= 180 days before surgery and another between 60-180 days post-op.

Having said this, it is definitely preferable that a functional status assessment of a body part or health condition is unique and specific to the intention of the assessment. I recommend that you post your concern about the degree of crosswalk between the value sets on the CQM Issue Tracker. The feedback will be very helpful to the measure stewards as they consider changes for the next annual update.

Yes, it's an issue with functional status templates lacking assessments, so it will affect any measure that has a function status assessment.

Because the data is limited for certification I am able to work around it. After I posted this ticket yesterday, I noticed that CMS90 and CMS66 will have issues with this patient as well. Do you agree?

A somewhat related issue is that the functional status codes cross the different value sets for these measures. For example code 71955-9 on the same patient example, is in all 3 value sets:

"Functional Status, Result: Functional Status Assessment for Hip Replacement" using "Functional Status Assessment for Hip Replacement Grouping Value Set (2.16.840.1.113883.3.464.1003.118.12.1029)"
"Functional Status, Result: Functional Status Assessment for Knee Replacement" using "Functional Status Assessment for Knee Replacement Grouping Value Set (2.16.840.1.113883.3.464.1003.118.12.1030)"
"Functional Status, Result: Functional Status Assessment for Heart Failure" using "Functional Status Assessment for Heart Failure Grouping Value Set (2.16.840.1.113883.3.464.1003.118.12.1031)"

Without uniqueness, theoretically a patient could have an FS with code 71955-9 with the intent to record for heart failure diagnosis, but then meet the measure for hip replacement since the code is generic and doesn't have a qualifier for the type of FS being performed. Is this this intent, to have an FS occur without a direct correlation to the procedure performed (all specification logic and value sets considered)? If this requires a new ticket, just let me know.

Thanks.

You are correct that this is an issue with Cypress. We are currently working on a fix, tentatively scheduled to be included in Cypress 2.6. We'll discuss this issue with ONC/CMS and get guidance in place for folks who are attesting to this measure with the 2.5 measure bundle.

If this issue is affecting certification, please let us know.