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Measure: CMS75

Children Who Have Dental Decay or Cavities

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS75v12 2024 12.0.000 Children Who Have Dental Decay or Cavities
CMS75v11 2023 11 Children Who Have Dental Decay or Cavities
CMS75v10 2022 10.0.000 Children Who Have Dental Decay or Cavities
CMS75v9 2021 9.2.000 Children Who Have Dental Decay or Cavities
CMS75v8 2020 8.1.000 Children Who Have Dental Decay or Cavities
CMS75v7 2019 7.2.000 Children Who Have Dental Decay or Cavities
CMS75v6 2018 6.1.000 Children Who Have Dental Decay or Cavities
CMS75v5 2017 5.1.000 Children Who Have Dental Decay or Cavities

Description

Percentage of children, 6 months - 20 years of age at the start of the measurement period, who have had tooth decay or cavities during the measurement period

Guidance

This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationChildren, 6 months - 20 years of age, with a clinical oral evaluation during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients who are in hospice care for any part of the measurement period.Webchart Instructions
NumeratorChildren who had a diagnosis of cavities or decayed teeth in any part of the measurement periodWebchart Instructions
Numerator ExclusionsNot applicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS75v10 75 2022 10.0.000 Not Applicable 61947125-4376-4a7b-ab7a-ac2be9bd9138
Steward Developer Endorsed By
National Committee for Quality Assurance Centers for Medicare & Medicaid Services (CMS)
Scoring Method Measure Type Stratification Risk Adjustment
Proportion OUTCOME None None

Rate Aggregation

None

Improvement Notation

A lower score indicates better quality

Rationale

Dental caries is the most chronic disease among youth aged 6-19 years. Data from the National Health and Nutrition Examination Survey from 2015-2016 showed that approximately 45.8% of children and youth aged 2-19 years had total caries (untreated and treated). Prevalence of total dental caries (untreated and treated) in primary or permanent teeth increases with age, going from 21.4%, 50.5%, and 53.8% among ages 2-5, 6-11, and 12-19, respectively. Total dental caries was highest in Hispanic youths aged 2-19 at 57.1% compared to 48.1% for non-Hispanic black, 44.6% for non-Asian, and 40.4% for non-Hispanic white youth. Monitoring prevalence of untreated and total caries is vital to preventing and controlling oral disease (Fleming & Afful, 2018). Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities (Edelstein & Chinn, 2009). Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums (Data Resource Center for Child and Adolescent Health, 2007).

Clinical Recommendation Statement

This is an outcome measure. As such, no clinical recommendations are included.

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Dental Caries 2.16.840.1.113883.3.464.1003.125.12.1004
Encounter, Performed Clinical Oral Evaluation 2.16.840.1.113883.3.464.1003.125.12.1003
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1

References

CITATIONData Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative. (2007). 2007 National Survey of Children’s Health. Baltimore, MD: Author.
CITATIONEdelstein, B. L., & Chinn, C. H. (2009). Update on disparities in oral health and access to dental care for America’s children. Academic Pediatrics, 9(6), 415-419.
CITATIONFleming, E., & Afful, J. (2018). Prevalence of total and untreated dental carries among youth: United States, 2015-2016. NCHS Data Brief No. 307. Hyattsville, MD: National Center for Health Statistics.

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. 

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms75v1