Preventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)

Last updated: May 5, 2017

CMS Measure ID: CMS64v6
Version: 6
NQF Number: None
Measure Description:

Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.

Initial Patient Population:

All patients 20 through 79 years of age before the beginning of the measurement period

Denominator Statement:

Denominator 1: (High Risk)

All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD Risk Equivalent OR 10 year Framingham risk > 20%.

Denominator 2: (Moderate Risk)

All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have 2 or more Major CHD Risk Factors OR 10 year Framingham Risk 10-20%.

Denominator 3: (Low Risk)

All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 Major CHD Risk Factors OR 10 year Framingham risk <10%.

**For Denominator 2 and Denominator 3, HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)

Denominator Exclusions:

Patients who have an active diagnosis of pregnancy

OR

Patients who are receiving palliative care

Numerator Statement:

Numerator 1:

Patients whose most recent fasting LDL-C test result is in good control, defined as <100 mg/dL

Numerator 2:

Patients whose most recent fasting LDL-C test result is in good control, defined as <130 mg/dL

Numerator 3:

Patients whose most recent fasting LDL-C test result is in good control, defined as <160 mg/dL

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Domain: Effective Clinical Care
Previous Version: Preventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)
Improvement Notation:

Higher score indicates better quality

Guidance:

This is a two-part measure which is paired with CMS 61: Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed. If the fasting LDL-C results are documented this measure CMS 64 should also be reported.

To be eligible for performance calculations, patients must have at least one face-to-face visit with the eligible professional during the measurement period and have one fasting LDL-C performed during the same measurement period with the exception of patients with 0 or 1 risk factors who may have an fasting LDL-C performed up to four (4) years prior to the current measurement period. To meet the numerator criteria for this measure, the patient's fasting LDL-C (low density lipoprotein) meets or exceeds the recommended LDL-C goal.

Addendum Notes: Removed from Quality Payment Program

Specifications

Release Notes

Header

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Update two broken links.

    Section: Reference

    Source: Measure Lead

Logic

  • Changed QDM category for Palliative Care exclusion from Procedure to Intervention for harmonization with other like MU measures.

    Section: QDM Data Elements

    Source: JIRA (CQM-1546)

  • Replaced datatype 'Diagnosis, Family Hx' with new 'Family history' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Value set Female (2.16.840.1.113883.3.560.100.2): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: QDM Data Elements

    Source: Code System Update

  • Value set Male (2.16.840.1.113883.3.560.100.1): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: QDM Data Elements

    Source: Code System Update

  • Value set Peripheral Arterial or Vascular Disease (2.16.840.1.113762.1.4.1047.21): Renamed Peripheral Arterial or Vascular Disease to Atherosclerosis and Peripheral Arterial Disease.

    Section: QDM Data Elements

    Source: None

  • Changed QDM category for Palliative Care exclusion from Procedure to Intervention for harmonization with other like MU measures.

    Section: QDM Variables

    Source: JIRA (CQM-1546)

  • Replaced datatype 'Diagnosis, Family Hx' with new 'Family history' datatype to conform to QDM 4.2 changes.

    Section: QDM Variables

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Variables

    Source: QDM Standards

  • Value set Peripheral Arterial or Vascular Disease (2.16.840.1.113762.1.4.1047.21): Renamed Peripheral Arterial or Vascular Disease to Atherosclerosis and Peripheral Arterial Disease.

    Section: QDM Variables

    Source: None

Value Set

  • Value set Acute Myocardial Infarction (2.16.840.1.113883.3.464.1003.104.12.1001): Added 21 ICD9CM codes. Added 15 ICD10CM codes.

    Section: None

    Source: None

  • Value set Anti-Hypertensive Pharmacologic Therapy (2.16.840.1.113883.3.600.1476): Added 3 RXNORM codes (1665057, 1719286, 1719290) and deleted 18 RXNORM codes.

    Section: None

    Source: None

  • Value set Atherosclerosis and Peripheral Arterial Disease (2.16.840.1.113762.1.4.1047.21): Added 14 SNOMEDCT codes. Added 14 ICD9CM codes. Added 61 ICD10CM codes.

    Section: None

    Source: None

  • Value set CABG Surgeries (2.16.840.1.113883.3.666.5.694): Added 1 SNOMEDCT code (232722009) and deleted 1 SNOMEDCT code (61236006).

    Section: None

    Source: None

  • Value set Coronary Artery Disease No MI (2.16.840.1.113883.3.526.3.369): Added 1 SNOMEDCT code (443502000).

    Section: None

    Source: JIRA (CQM-1854)

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 11 ICD9CM codes (250.40, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00).

    Section: None

    Source: None

  • Value set Female (2.16.840.1.113883.3.560.100.2): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: None

    Source: Code System Update

  • Value set Ischemic Stroke (2.16.840.1.113883.3.117.1.7.1.247): Added 3 SNOMEDCT codes (230701008, 307363008, 426107000) and deleted 5 SNOMEDCT codes (233964008, 288723005, 300920004, 64586002, 71444005). Deleted 18 ICD10CM codes.

    Section: None

    Source: None

  • Value set Ischemic Vascular Disease (2.16.840.1.113883.3.464.1003.104.12.1003): Added 9 ICD9CM codes (414.3, 414.4, 437.0, 440.0, 440.30, 440.31, 440.32, 440.8, 440.9) and deleted 1 ICD9CM code(413.1). Added 206 ICD10CM codes and deleted 1 ICD10CM code (I20.1).

    Section: None

    Source: None

  • Value set Male (2.16.840.1.113883.3.560.100.1): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: None

    Source: Code System Update

  • Value set Peripheral Arterial or Vascular Disease (2.16.840.1.113762.1.4.1047.21): Renamed Peripheral Arterial or Vascular Disease to Atherosclerosis and Peripheral Arterial Disease.

    Section: None

    Source: None

External Resources