CMS153v11 – Chlamydia Screening in Women

Women 16 to 24 years of age by the end of the measurement period who are sexually active and who had a visit in the measurement period

– NUMERATOR

Women with at least one chlamydia test during the measurement period

– DENOMINATOR EXCLUSIONS

• Women who are only eligible for the initial population due to a pregnancy test and who had an order for an x-ray or for a specified medication within 7 days of the pregnancy test.
• Exclude patients who are in hospice care for any part of the measurement period.

For Denominator:

Include female patients aged 16 – 24 at the start of the measurement period with a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

Additionally, female patients should fulfill one of the following criteria during the measurement period:

• Assessments identifying sexual activity:
  • To record an assessment, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an assessment. Select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ dropdown.
  • Sexual activity can also be recorded via the workflow Patient > Clinical > History > Social > Sexual. Select ‘Active’ from the ‘Sexually Active’ dropdown. Then click ‘Save’.

• Diagnoses identifying sexual activity: To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’.

• Diagnostic studies identifying sexual activity: Use the workflow Patient > Clinical > Orders & Results > Radiology. Click ‘+ Order’ and add the radiology order details. Once done, hover over ‘Sign’ tab and click ‘Queue’.

Mark the radiology order as completed by clicking the ‘Mark As Completed’ button.

Note:

For LOINC Codes Based Labs: Please ensure that the test code is mapped to a LOINC Code from the Settings. To map a LOINC with the radiology test code, navigate to Settings > EHR > Radiology. Select the radiology test and navigate to the ‘Code’ tab. Then, click on a code. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

For CPT Codes Based Labs: When a CPT code is added to a test order, please ensure that the CPT code is present in the ‘Procedures’.

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

• Laboratory tests identifying sexual activity: To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs and click ‘+ Add Order’ button.

Here, select a laboratory and search for the lab test. Once done, click on the ‘Save’ or ‘Sign’ button.

Next, click on the ‘Mark As Received’ button.

On the ‘Edit Lab Result’ screen, add the observations and click on the ‘Save’ button.

Note:

For LOINC Codes Based Labs: Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

For CPT Codes Based Labs: When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’. 

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

• Procedures identifying sexual activity: Navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hovers over ‘Sign & Accept’, then click ‘Complete’. The procedure is added to the provider note.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button.

• Active contraceptive medications: Navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’.

• Ordered contraceptive medications: Navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

For Numerator:

Include female patients with ‘Chlamydia Screening’ lab test performed during the measurement period. The test result must not be null.

To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs and click ‘+ Add Order’ button. Then select a laboratory and search for the lab test. Once done, click on the ‘Save’ or ‘Sign’ button. Next, click on the ‘Mark As Received’ button. On the ‘Edit Lab Result’ screen, add the observations and click on the ‘Save’ button.

For Denominator Exclusions:

Exclude patients satisfying any of the following conditions:

1. Patients who were in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
   • 385763009: Hospice Care (Regime/Therapy)
   • 385765002: Hospice Care Management (Procedure)

1. • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

• • Patients with hospice care assessment performed during the measurement period. To document the assessment, follow the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an evaluation. Then select ‘Performed’ from the ‘Status’ dropdown and enter ‘Yes’ in the ‘Result’ field.
  • Patients with hospice encounter during the measurement period. To document the hospice encounter, follow the workflow Patient > Clinical > Evaluations.

2. Female patients with pregnancy test exclusion. The patient should satisfy any of the following two conditions:
   • The patient should have ‘X-Ray Study (all inclusive)’ diagnostic study ordered 7 days or less after day of ‘Pregnancy Test’. The pregnancy test should be ordered during the measurement period. To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs. To document the X-ray diagnostic study, navigate to Patient > Clinical > Orders & Results > Radiology.
   • The patient should have ‘Isotretinoin’ medication ordered 7 days or less after day of ‘Pregnancy Test’. The pregnancy test should be ordered during the measurement period. To record medication, use the workflow Patient > Provider Note > Prescription. To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs.
3. Female patients with no record of diagnoses identifying sexual activity.
4. Female patients with no record of active contraceptive medications.
5. Female patients with no record of laboratory tests identifying sexual activity but not pregnancy.
6. Female patients with no record of procedures identifying sexual activity.
7. Female patients with no record of assessments identifying sexual activity.
8. Female patients with no record of ordered contraceptive medications.
9. Female patients with no record of diagnostic studies identifying sexual activity.