Back to top
Top
CMS Measure ID:
Version:
2
NQF Number:
None
Performance/Reporting Period
2019
Description:

Patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater (indicated by HCPCS code) and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent prostate cancer diagnosis.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with prostate cancer diagnoses.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Prostate Cancer value set (2.16.840.1.113883.3.526.3.319)

QDM Datatype and Definition (QDM Version 5.3)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent bone density x-ray studies.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnostic Study or Order. The intent of this data element is to identify patients with low bone mineral density.
Inclusion Criteria: Includes only relevant concepts associated with Dual-energy X-ray absorptiometry (DXA, DEXA) with 1 or more axial sites, axial skeleton (hips, pelvis, spine) or 1 or more appendicular skeleton sites (radius, wrist, heel).
Exclusion Criteria: No Exclusions.

Constrained to codes in the Diagnostic Study, Order: DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care value set (2.16.840.1.113762.1.4.1151.38)

QDM Datatype and Definition (QDM Version 5.3)

Diagnostic Study, Order

Data elements that meet criteria using this datatype should document a request by a clinician or appropriately licensed care provider to an appropriate provider or organization to perform the diagnostic study indicated by the QDM category and its corresponding value set. The request may be in the form of a consultation or a direct order to the organization that performs the diagnostic study. Diagnostic studies are those that are not performed in the clinical laboratory. Such studies include but are not limited to imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, vascular laboratory testing, and others.

Timing: The time the order is signed; Author dateTime.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent bone density x-ray studies.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnostic Study or Order. The intent of this data element is to identify patients with low bone mineral density.
Inclusion Criteria: Includes only relevant concepts associated with Dual-energy X-ray absorptiometry (DXA, DEXA) with 1 or more axial sites, axial skeleton (hips, pelvis, spine) or 1 or more appendicular skeleton sites (radius, wrist, heel).
Exclusion Criteria: No Exclusions.

Constrained to codes in the Diagnostic Study, Performed: DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care value set (2.16.840.1.113762.1.4.1151.38)

QDM Datatype and Definition (QDM Version 5.3)

Diagnostic Study, Performed

Data elements that meet criteria using this datatype should document the completion of the diagnostic study indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – when the diagnostic study is initiated
  • stopTime – when the diagnostic study is completed

Examples:

  • Initiation of a treadmill stress test to the time the treadmill stress test has completed
  • Initiation of the ultrasound study until completion of the ultrasound study

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who have had an office or other outpatient visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity. This is a grouping value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Office Visit 1 value set (2.16.840.1.113883.3.464.1003.101.12.1001)

QDM Datatype and Definition (QDM Version 5.3)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime - the time the patient arrived at the location;
  • stopTime - the time the patient departed from the location

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent androgen deprivation therapy as identified for urology care.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. This data element is to list androgen deprivation therapy for urology care for prostate cancer.
Inclusion Criteria: Includes only relevant concepts associated with androgen deprivation therapy medications.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medication, Active: Androgen deprivation therapy for Urology Care value set (2.16.840.1.113762.1.4.1151.48)

QDM Datatype and Definition (QDM Version 5.3)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a reason for patient refusal.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale.
Inclusion Criteria: Includes only relevant concepts associated with identifying a patient's reason for refusing treatment.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Patient Reason Refused value set (2.16.840.1.113883.3.600.791)

QDM Attribute and Definition (QDM Version 5.3)

Negation Rationale

The QDM attribute, negation rationale indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the 'negation rationale' attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes that any information expected will be in a clinical record. The situation is different when something that normally would be expected to be done is specifically not done because of a valid clinical reason (such as the patient is allergic, they are suffering from a complication, or some other rationale. In this case, the 'thing not done' is rarely documented, especially as a code, in the patient record. To express such lack of evidence, an eCQM author should use a CQL 'not exists' expression noted in the examples, and they must also capture the Negation rationale to capture a reason for the absence, i.e., the reason must be included to qualify as a negation rationale type expression. The syntax in the human readable HQMF is described in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, 'Procedure, Performed not done.' QDM 5.5 uses the syntax, 'Procedure, not Performed' and this is then associated with either a DRC or a value set used to identify 'the expected thing,' that in this case was not done. Negation Rationale attribute value indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent whether the patient is Hispanic or not; ethnicity category defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Ethnicity.
Inclusion Criteria: Includes only relevant concepts associated with ethnicity defined as Hispanic or Latino, or Not Hispanic or Latino.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Ethnicity

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Payer.
Inclusion Criteria: Includes only relevant concepts associated with payer codes in the code system.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Payer: Payer value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Payer

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the first day of insurance coverage with the referenced payer
  • stopTime – the last day of insurance coverage with the referenced payer

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the general race category reported by the patient - subject may have more than one; defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Race.
Inclusion Criteria: Includes only relevant concepts associated with the following race categories: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, Other Race, White.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Race: Race value set (2.16.840.1.114222.4.11.836)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Race

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent male.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Sex.
Inclusion Criteria: Includes only relevant concepts associated with appropriate male gender concepts.
Exclusion Criteria: Excludes concepts representing female gender.

Constrained to codes in the Patient Characteristic Sex: Male value set (2.16.840.1.113883.3.560.100.1)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Sex

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent gender identity restricted to only male and female used in administrative situations requiring a restriction to these two categories.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Sex.
Inclusion Criteria: Includes relevant concepts associated with gender concepts for male and female only.
Exclusion Criteria: Excludes any gender identity that is not male or female.

Constrained to codes in the Patient Characteristic Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

QDM Datatype and Definition (QDM Version 5.3)

Patient Characteristic Sex

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent codes for injection of leuprolide acetate for intended twelve-month period.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to include androgen deprivation therapy for equal to or greater than 12 months. This is accomplished by indicating the CPT code and then a modifier such as J1950,cont which is non-billable but allows for reporting the intent.
Inclusion Criteria: Includes only relevant HCPCS concepts associated with injection of leuprolide acetate intended for 12 months or greater.
Exclusion Criteria: Excludes injection of leuprolide acetate intended for a period of less than 12 months.

Constrained to codes in the Procedure, Order: Injection Leuprolide Acetate value set (2.16.840.1.113762.1.4.1151.16)

QDM Datatype and Definition (QDM Version 5.3)

Procedure, Order

Data elements that meet criteria using this datatype should document a request for the procedure indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime.