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CMS Measure ID: CMS137v10    Performance/Reporting Period: 2022    Version: 10    NQF Number: Not Applicable
Description:

Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported.

a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis

b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.

Data Elements and coded QDM Attributes contained within the eCQM

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Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of alcohol and drug dependence.
Data Element Scope: This value set may use a model element related to Diagnosis.
Inclusion Criteria: Includes concepts that represent a diagnosis of alcohol and drug abuse and dependence.
Exclusion Criteria: Excludes concepts that represent a diagnosis of alcohol and drug use.

Constrained to codes in the Diagnoses: Alcohol And Drug Dependence value set (2.16.840.1.113883.3.464.1003.106.12.1001)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
  • Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of alcohol and drug dependence.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of alcohol and drug abuse and dependence.
    Exclusion Criteria: Excludes concepts that represent a diagnosis of alcohol and drug use.

    Constrained to codes in the Diagnosis: Alcohol and Drug Dependence value set (2.16.840.1.113883.3.464.1003.106.12.1001)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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 prevalencePeriod references the time from the onset date to the abatement date.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for detoxification visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for alcohol and drug detoxification.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Detoxification Visit value set (2.16.840.1.113883.3.464.1003.101.12.1059)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for same day inpatient hospital discharge services.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for the evaluation and management of a patient that results in discharge on the same date as admission.
    Exclusion Criteria: Excludes concepts that represent encounters other than same day inpatient hospital discharge services.

    Constrained to codes in the Encounter, Performed: Discharge Services - Hospital Inpatient Same Day Discharge value set (2.16.840.1.113883.3.464.1003.101.12.1006)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for inpatient hospital discharge services.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for hospital discharge day management.
    Exclusion Criteria: Excludes concepts that represent encounters other than inpatient hospital discharge services.

    Constrained to codes in the Encounter, Performed: Discharge Services - Hospital Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1007)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters in the emergency department.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for care provided to new and established patients in the emergency department.
    Exclusion Criteria: Excludes concepts that represent an encounter not representative of ED visits, including critical care and observation services.

    Constrained to codes in the Encounter, Performed: Emergency Department Visit 1 value set (2.16.840.1.113883.3.464.1003.101.12.1010)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of inpatient hospitalization encounters.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for inpatient hospitalizations.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for inpatient hospital care.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for initial hospital care for the evaluation and management of a patient.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Hospital Inpatient Visit - Initial value set (2.16.840.1.113883.3.464.1003.101.12.1004)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for initial hospital observation care.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for initial observation care for the evaluation and management of a patient.
    Exclusion Criteria: Excludes concepts that represent an encounter not representative of observation care, including critical care and ED visits.

    Constrained to codes in the Encounter, Performed: Hospital Observation Care - Initial value set (2.16.840.1.113883.3.464.1003.101.12.1002)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for an outpatient visit.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.
    Exclusion Criteria: No exclusions.

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

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: Includes concepts that represent an encounter using online modalities.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter using online modalities.
    Exclusion Criteria: Excludes concepts that represent encounters other than online.

    Constrained to codes in the Encounter, Performed: Online Assessments value set (2.16.840.1.113883.3.464.1003.101.12.1089)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for telephone visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for assessment, evaluation and management services to a patient by telephone.
    Exclusion Criteria: Excludes concepts that represent an encounter for telephone assessment, evaluation and management services that last for less than five minutes.

    Constrained to codes in the Encounter, Performed: Telephone Visits value set (2.16.840.1.113883.3.464.1003.101.12.1080)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "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.

    The "Encounter, Performed" participant references the primary participant.

    Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

    Timing:

    • The relevantPeriod addresses:
      • startTime - The time the encounter began (admission time).
      • stopTime - The time the encounter ended (discharge time).
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

    Notes:

    • negation rationale 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 and must not use relevantPeriod.
    • The locationPeriod is an attribute of the attribute facility location that addresses:
      • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
      • stopTime - the time the patient departed from the location.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of interventions to identify patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use a model element related to Procedure or Intervention.
    Inclusion Criteria: Includes concepts that represent a procedure or intervention for hospice care.
    Exclusion Criteria: Excludes concepts that represent palliative care or comfort measures.

    Constrained to codes in the Intervention, Order: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Order"

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

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

    Note: negation rationale 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 and must not use relevantPeriod.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for alcohol and drug dependence treatment.
    Data Element Scope: This value set may use a model element related to Intervention.
    Inclusion Criteria: Includes concepts that represent an encounter for alcohol and drug abuse and dependence treatment.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Intervention, Performed: Alcohol and Drug Dependence Treatment value set (2.16.840.1.113883.3.464.1003.106.12.1005)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Performed"

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

    Timing:

    • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
    • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the intervention begins.
      • stopTime - The time the intervention ends.
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

    Notes:

    • Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
    • negation rationale 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 and must not use relevantPeriod.
       
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of interventions to identify patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use a model element related to Procedure or Intervention.
    Inclusion Criteria: Includes concepts that represent a procedure or intervention for hospice care.
    Exclusion Criteria: Excludes concepts that represent palliative care or comfort measures.

    Constrained to codes in the Intervention, Performed: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Performed"

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

    Timing:

    • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
    • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the intervention begins.
      • stopTime - The time the intervention ends.
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

    Notes:

    • Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
    • negation rationale 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 and must not use relevantPeriod.
       
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for psychotherapy visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for individual psychotherapy services.
    Exclusion Criteria: Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.

    Constrained to codes in the Intervention, Performed: Psych Visit - Psychotherapy value set (2.16.840.1.113883.3.526.3.1496)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Performed"

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

    Timing:

    • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
    • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the intervention begins.
      • stopTime - The time the intervention ends.
    • author dateTime references the time the action was recorded.
    • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

    Notes:

    • Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
    • negation rationale 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 and must not use relevantPeriod.
       
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for opiate antagonist medications.
    Data Element Scope: This value set may use a model element related to Medication.
    Inclusion Criteria: Includes concepts that represent generic, human use and prescribable opiate antagonist medications.
    Exclusion Criteria: Excludes concepts that represent non-prescribable or branded drugs and concepts that represent components or ingredients.

    Constrained to codes in the Medication, Order: Opiate Antagonists value set (2.16.840.1.113883.3.464.1003.198.12.1132)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Medication, Order"

    Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

    Timing:

    • relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end.
    • In the initial publication of QDM 5.5, relevantPeriod referenced the validity period, i.e., the time period for which the ordered supply is authorized by the prescription authorizing the dispensing event.
    • For clarification, see Appendix 6.4 with additional guidance for referencing relevantPeriod updating the definition for Medication, Order, "Medication Dispensed", and "Substance, Order".
    • author dateTime references the date and time the medication order (prescription) is authored.

    Notes:

    • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
    • negation rationale 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 and must not use relevantPeriod.

    Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.

    Direct Reference Code

    Constrained to 'Birth date' LOINC code

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Birthdate"

    The "Patient Characteristic Birthdate" should document the patient’s date of birth.

    Timing: The "Patient Characteristic, Birthdate" is a single point in time representing the date and time of birth. It does not have a start and stop time.

    Note: "Patient Characteristic Birthdate" is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

    Value Set Description from VSAC
    Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    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 5.5 Guidance Update)

    "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: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
    Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
    Inclusion Criteria: All codes in the code system
    Exclusion Criteria: none

    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 5.5 Guidance Update)

    "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 relevantPeriod 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: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    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 5.5 Guidance Update)

    "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: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
    Data Element Scope: Gender
    Inclusion Criteria: Male and Female only.
    Exclusion Criteria: 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 5.5 Guidance Update)

    "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.