PIPE Exclusion Logic
The following exclusions use Problem List only because they are considered long term diagnoses:
- Asthma- Cystic Fibrosis, COPD, Emphysema, Acute Respiratory Failure
- AMH- Schizophrenia, Bipolar Disorder, Personality Disorder, Intellectual Disability
- Depression- Bipolar Disorder, Schizophrenia/ Psychotic Disorder, Personality Disorder, Pervasive Developmental Disorder
The following exclusions use both problem list and encounter data because they are considered Episodic and they may be less likely to be on a problem list:
- ODC- Pregnancy
- AMH- Depression, Dysthymia
For the Colorectal Cancer Diagnosis exclusions-
For Total Colectomy:
- Encounter dates before or during the end of the measurement period.
- Procedures with Lab Service Dates or Procedure Dates before or during the measurement period.
For Colorectal Cancer Diagnosis:
- Encounters before or during the measurement period.
- Problem Lists with Start/Active Dates before or during the measurement period.
Non-Diagnosis based documentation:
- Urgent Care: the portal will look at encounter data and POS codes to determine urgent care exclusions.
- Deceased patients: The patient status and Date of Death will be used to determine if a patient meets the exclusion for death during the measurement period.
Discontinued exclusions:
- Nursing home: should be submitted in the exclusions file. If a date of when the patient entered the nursing home, or the date when it was documented in the EMR is not available, it is acceptable to submit a proxy date of when the data was pulled. (Discontinued 2023MY)
Diagnosis Based Exclusion Flow Chart_7.31.20.docx
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