G codes and HCPCS modifiers in service request responses

[bjefant]

It looks like a qCDSM id is not separately required, but is included in the G codes. What does everyone think about getting rid of the CDSM id and using the G code only?

I know we discusses 'adheres/does not adhere' versus 'appropriate/not appropriate' in the past, but wondering about normalizing the language to that of CMS, ie, 'adheres/does not adhere'.

Also, the response of 'adheres', 'does not adhere' or 'there is no appropriate use criteria in this CDSM' has HCPCS modifiers. Can these be appended to the verbiage? (see HCPCS modifiers in link below-only ME, MF and MG will apply) .
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11268.pdf

More information here about using G codes instead of a unique consultation identifier: https://www.acr.org/-/media/ACR/NOINDEX/Advocacy/Advocacy-News/2019-FR-AUC-Detailed-Summary-Final.pdf?la=en

[jmandel]

Re: G-Codes, we currently have just one field, with a string type. (The extension is http://fhir.org/argonaut/Extension/pama-rating-qcdsm-consulted)

[jmandel]

Language from CMS talks about

whether that order adheres to AUC, does not adhere to AUC, or if there is no AUC applicable (for example, no AUC is available to address the patient’s clinical condition) in the CDSM consulted.

From discussion on Argonaut call:

• If something "adheres to appropriate-use criteria", does this mean it's "appropriate"? Are these semantic distinctions important?

• We should add language to our spec to make sure that our codes are documented in a way that clearly maps to CMS terminology

• We might not need to change the actual FHIR Coding.code values that go out over the wire -- but this would clarify the correspondences to the CMS guidance (which has, on review, been stable over time).

• Isaac: I think services should strive to determine appropriateness, not just "Adherence to AUCs".