Direct Referenced Codes – Update A Direct Referenced Code is a single code, not a member of a value set Reason – “Hiding” a single code within a value set creates additional overhead and hides the intellectual property of the code system. Note: Value sets containing a single code may still be allowed: All except 1 code in a value set has been retired by the code system (no need to convert to direct referenced code) Additional concepts are forthcoming but only 1 code is currently available – E.g., only 1 medication in a class is FDA approved but others are expected – a single code Value set is appropriate

Direct Referenced Codes using HQMF [Includes Value Sets and Direct Referenced Codes] HQMF Measures Published in 2017 for Reporting 2018 HQMF Measures Published in 2018 for Reporting 2019 Data Criteria Section (Examples from CMS136): "Diagnosis: Narcolepsy" using "Narcolepsy Grouping Value Set (2.16.840.1.113883.3.464.1003.114.12.1011)" "Encounter, Performed: Behavioral Health Follow-up Visit" using "Behavioral Health Follow-up Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1054)" "Encounter, Performed: Discharge Services- Observation Care" using "Discharge Services- Observation Care Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1039)" Data Criteria Section (Examples from CMS136): "Diagnosis: Narcolepsy” "Encounter, Performed: Behavioral Health Follow-up Visit” ” Encounter, Performed: Discharge Services- Observation Care” Terminology Section "Narcolepsy Grouping Value Set (2.16.840.1.113883.3.464.1003.114.12.1011)" "Behavioral Health Follow-up Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1054)” “Observation Care Discharge Day Management 99217 CPT 2016 2.16.840.1.113883.6.12” NEW SECTION Value Sets Direct Referenced Codes Note: Value set and direct referenced code examples are for demonstration purposes only.

QRDA – Moving to 2019 Reporting For 2019 Reporting Option 1 For 2018 Reporting QRDA Category I v4 QDM 4.3 Template Value Set OID Value (code) QRDA Category I v5 QDM 5.02 Template Value Set OID Value (code) Direct Referenced Codes (no OID)

QRDA – Moving to 2019 Reporting Opening the discussion about allowing direct referenced codes (i.e., codes without a value set OID) generated further discussion about the need for OIDs universally when also submitting a code. Justification for removing the value set OID from QRDA Category I: If a single instance of a code exists in the EHR and it is included in 2 or more value sets referenced in a measure, the sender must submit the code for each referenced value set. I.e., the QRDA contains multiple references to the same code instance. If the QRDA did not require the value set OID, each instance of the code could be submitted only once. Risks of removing the value set OID requirement completely: Those sending QRDA files would need to retool. Some vendors indicate the retooling would not be problematic and it would remove the need for duplication. Those receiving QRDA files would need to retool AND to validate if the codes received are in the required value sets using data from VSAC rather than the OIDs in the QRDA file. For 2019 Reporting Option 1 QRDA Category I v5 QDM 5.02 Template Value Set OID Value (code) Direct Referenced Codes (no OID)

QRDA – Moving to 2019 Reporting For 2019 Reporting Option 2 – Remove the requirement to send the value set OID For 2019 Reporting Option 1 For 2018 Reporting QRDA Category I v4 QDM 4.3 Template Value Set OID Value (code) QRDA Category I v5 QDM 5.02 Template Value Set OID Value (code) Direct Referenced Codes (no OID) QRDA Category I v5 QDM 5.02 Template Value (code) Direct Referenced Codes (no OID) OR

QRDA – Moving to 2019 Reporting (for NOT DONE) For 2018 Reporting – Data Elements NOT DONE For 2019 Reporting Option 1 – Data Elements NOT DONE For 2019 Reporting Option 2 – Data Elements NOT DONE QRDA Category I v4 QDM 4.3 Template negated Value Set OID NO VALUE QRDA Category I v5 QDM 5.02 Template negated Value Set OID NO VALUE or negated Direct Referenced Codes (no OID) QRDA Category I v5 QDM 5.02 Template NO VALUE or negated Direct Referenced Codes (no OID) OR negated Value Set OID For Data Elements NOT DONE, there is no difference between the options. The OID is still required if a value set exists

Example of duplicates – medication administered – route is repeated so 20 duplicates