CMS 122v9: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Measure: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period
Measure Type High Priority Measure Scoring
Outcome Yes A lower percentage indicates better quality
Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period
Numerator Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%
Denominator Exceptions None
Denominator Exclusions
  • Patients whose hospice care overlaps the measurement period
  • Patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period
  • Patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured

This eCQM requires a lab interface to be met. Customers interested in a lab interface should contact Sevocity Support to begin the process of a new interface setup. Interface setup requirements and fees vary per request.

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 18 years and < 75 years at the beginning of the Measurement Period

    AND

  • Have an active diagnosis of Type 1 or Type 2 diabetes during the Measurement Period

    AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC/EP

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

HCPCS: G0438, G0439

The patient must have an active diagnosis of Type 1 or Type 2 diabetes during Measurement Period. Patients with a diagnosis of secondary diabetes due to another condition are not counted.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for diabetes can be located here.

A patient will be excluded from this measure if they meet any of the following conditions:

  • Is in hospice care during the Measurement Period
  • Age is ≥ 65 at the start of the Measurement Period and has spent more than 90 consecutive days during the Measurement Period living in long term care
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of advanced illness
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of frailty

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Pending or Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

To document a stay in long term care:

  1. Go to Chart > Admissions and click Add
  2. Select a Place of Service
  3. Optional: select a Facility
  4. Populate the Admit Date
  5. Optional: populate the Discharge Date
  6. Click OK

If the admissions event does not have a Discharge Date when the eCQM report is generated, the length of stay will be calculated with a discharge date of the Reporting Period end date or the Measurement Period end date, whichever occurs first.

A patient has evidence of advanced illness if they meet any of the following criteria:

  • Had an inpatient encounter with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
  • Had 2 or more outpatient encounters with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
    • Diagnosis must be active during all eligible encounters
  • Was prescribed medication for dementia during the Measurement Period or in the year prior

"Advanced illness" refers to a wide range of conditions and includes diseases such as Alzheimer's disease, cancer, and heart failure.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for advanced illness can be located here.

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439, G0463, T1015

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible dementia medications can be located here.

A patient has evidence of frailty if they meet any of the following criteria:

  • Has an active diagnosis of Frailty during the Measurement Period
  • Has an active diagnosis of Frailty Symptom during the Measurement Period
  • Is using a frailty device during the Measurement Period
  • Has a frailty encounter during the Measurement Period

"Frailty" refers to a range of conditions that includes falls and problems affecting mobility.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for frailty can be located here.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for frailty symptoms are:

ICD-10: R26.0, R26.1, R26.2, R26.89, R26.9, R41.81, R53.1, R53.81, R53.83, R54, R62.7, R63.4, R63.6, R64

The use of a frailty device can be documented in the patient's Medical or Social History.

To document the patient's use of oxygen:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Oxygen use node

    1. Optional: select continuously or when ambulating

To document the patient's use of a respiratory assistive device:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Respiratory assistive device node

    1. Optional: select BIPAP, CPAP, Home ventilator, or Ventilator

To document a patient's bedridden status:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Mobilizing/Moving subnode

  4. Select Bedridden

  5. Click OK to save

To document a patient's use of mobility aids:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Use of Mobility Aids subnode

  4. Select Dependent on cane, Dependent on walker, or Dependent on wheelchair

  5. Click OK to save

CPT: 99504, 99509

HCPCS: G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031

A patient will be counted in the numerator if they have an e-Lab result with an HbA1c level of > 9% stored to their chart during the Measurement Period. If there are multiple HbA1c results within the Measurement Period, the most recent result will be counted toward the numerator.

A patient will be included in the numerator if the most recent HbA1c result is missing or if there are no HbA1c tests performed and no results documented during the Measurement Period.

  1. From the Clinic Inbox, select the lab result to be stored and click View
  2. Click Select to search for and select a patient
  3. Verify patient displayed matches the lab result and select the I have verified the following lab results belong to the above patient checkbox
  4. Click Sign/Route
  5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.

https://ecqi.healthit.gov/ecqm/ep/2021/cms122v9

 

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