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Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture

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Measure Information 2022 Performance Period
CMS eCQM ID CMS249v4
NQF Number 3475e
Description

Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period
Initial Population

Female patients ages 50 to 64 years with an encounter during the measurement period
Denominator

Equals Initial Population
Denominator Exclusions

Exclude patients with a combination of risk factors (as determined by age) or one of the independent risk factors

Ages: 50-54 (>=4 combination risk factors) or 1 independent risk factor

Ages: 55-59 (>=3 combination risk factors) or 1 independent risk factor

Ages: 60-64 (>=2 combination risk factors) or 1 independent risk factor

COMBINATION RISK FACTORS [The following risk factors are all combination risk factors; they are grouped by when they occur in relation to the measurement period]:

The following risk factors may occur any time in the patient's history but must be active during the measurement period:

White (race)

BMI <= 20 kg/m2 (must be the first BMI of the measurement period)

Smoker (current during the measurement period)

Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor))

The following risk factor may occur any time in the patient's history and must not start during the measurement period:

Osteopenia

The following risk factors may occur at any time in the patient's history or during the measurement period:

Rheumatoid arthritis

Hyperthyroidism

Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption

Chronic liver disease

Chronic malnutrition

Osteoporotic fracture

The following risk factors may occur any time in the patient's history prior to the start of the measurement period but do not need to be active at the start of the measurement period:

Documentation of history of hip fracture in parent

Glucocorticoids [cumulative medication duration >= 90 days]

INDEPENDENT RISK FACTORS (The following risk factors are all independent risk factors; they are grouped by when they occur in relation to the measurement period):

The following risk factors may occur at any time in the patient's history and must not start during the measurement period:

Osteoporosis

The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period:

Gastric bypass

FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent

Aromatase inhibitors

The following risk factors may occur at any time in the patient's history or during the measurement period:

Type I Diabetes

End stage renal disease

Osteogenesis imperfecta

Ankylosing spondylitis

Psoriatic arthritis

Ehlers-Danlos syndrome

Cushing's syndrome

Hyperparathyroidism

Marfan syndrome

Lupus
Numerator

Female patients who received an order for at least one DXA scan in the measurement period
Numerator Exclusions

Not Applicable
Denominator Exceptions

None
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Lower score indicates better quality
Guidance

There are two ways that a patient can be excluded from the measure:

1. The patient has a specific number of "combination" risk factors (the number of risk factors varies by age).

2. The patient has one or more of the "independent" risk factors, including a 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.
MIPS Quality ID 472
Telehealth Eligible Yes
Next Version
CMS249v5
Previous Version
CMS249v3

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Measure Information 2021 Performance Period 2022 Performance Period 2023 Performance Period
Title Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
CMS eCQM ID CMS249v3 CMS249v4 CMS249v5
NQF Number 3475e 3475e 3475e
Description

Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period

Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period
Initial Population

Female patients ages 50 to 64 years with an encounter during the measurement period

Female patients ages 50 to 64 years with an encounter during the measurement period

Female patients ages 50 to 63 years at the start of the measurement period with an encounter during the measurement period
Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population
Denominator Exclusions Exclude patients with a combination of risk factors (as determined by age) or one of the independent risk factors Ages: 50-54 (>=4 combination risk factors) or 1 independent risk factor Ages: 55-59 (>=3 combination risk factors) or 1 independent risk factor Ages: 60-64 (>=2 combination risk factors) or 1 independent risk factor COMBINATION RISK FACTORS [The following risk factors are all combination risk factors; they are grouped by when they occur in relation to the measurement period]: The following risk factors may occur any time in the patient's history but must be active during the measurement period: White (race) BMI <= 20 kg/m2 (must be the first BMI of the measurement period) Smoker (current during the measurement period) Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor)) The following risk factor may occur any time in the patient's history and must not start during the measurement period: Osteopenia The following risk factors may occur at any time in the patient's history or during the measurement period: Rheumatoid arthritis Hyperthyroidism Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption Chronic liver disease Chronic malnutrition The following risk factors may occur any time in the patient's history and do not need to be active at the start of the measurement period: Documentation of history of hip fracture in parent Osteoporotic fracture Glucocorticoids (>= 5 mg/per day) [cumulative medication duration >= 90 days] INDEPENDENT RISK FACTORS (The following risk factors are all independent risk factors; they are grouped by when they occur in relation to the measurement period): The following risk factors may occur at any time in the patient's history and must not start during the measurement period: Osteoporosis The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period: Gastric bypass FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent Aromatase inhibitors The following risk factors may occur at any time in the patient's history or during the measurement period: Type I Diabetes End stage renal disease Osteogenesis imperfecta Ankylosing spondylitis Psoriatic arthritis Ehlers-Danlos syndrome Cushing's syndrome Hyperparathyroidism Marfan syndrome Lupus Exclude patients with a combination of risk factors (as determined by age) or one of the independent risk factors Ages: 50-54 (>=4 combination risk factors) or 1 independent risk factor Ages: 55-59 (>=3 combination risk factors) or 1 independent risk factor Ages: 60-64 (>=2 combination risk factors) or 1 independent risk factor COMBINATION RISK FACTORS [The following risk factors are all combination risk factors; they are grouped by when they occur in relation to the measurement period]: The following risk factors may occur any time in the patient's history but must be active during the measurement period: White (race) BMI <= 20 kg/m2 (must be the first BMI of the measurement period) Smoker (current during the measurement period) Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor)) The following risk factor may occur any time in the patient's history and must not start during the measurement period: Osteopenia The following risk factors may occur at any time in the patient's history or during the measurement period: Rheumatoid arthritis Hyperthyroidism Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption Chronic liver disease Chronic malnutrition Osteoporotic fracture The following risk factors may occur any time in the patient's history prior to the start of the measurement period but do not need to be active at the start of the measurement period: Documentation of history of hip fracture in parent Glucocorticoids [cumulative medication duration >= 90 days] INDEPENDENT RISK FACTORS (The following risk factors are all independent risk factors; they are grouped by when they occur in relation to the measurement period): The following risk factors may occur at any time in the patient's history and must not start during the measurement period: Osteoporosis The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period: Gastric bypass FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent Aromatase inhibitors The following risk factors may occur at any time in the patient's history or during the measurement period: Type I Diabetes End stage renal disease Osteogenesis imperfecta Ankylosing spondylitis Psoriatic arthritis Ehlers-Danlos syndrome Cushing's syndrome Hyperparathyroidism Marfan syndrome Lupus Exclude patients with one of the following risk factors. Risk factors are grouped by when they occur in relation to the measurement period. The following risk factors must be active during the measurement period: BMI <= 20 kg/m2 (must be the first BMI of the measurement period) Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor)) The following risk factors may occur at any time in the patient's history prior to the start of the measurement period: Osteoporosis Osteopenia The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period: Gastric bypass Aromatase inhibitors Documentation of history of hip fracture in parent The following risk factors may occur at any time in the patient's history or during the measurement period: Glucocorticoids [cumulative medication duration >= 90 days] Osteoporotic fracture Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption Chronic malnutrition Chronic liver disease Rheumatoid arthritis Hyperthyroidism Type I Diabetes End stage renal disease Osteogenesis imperfecta Ankylosing spondylitis Psoriatic arthritis Ehlers-Danlos syndrome Cushing's syndrome Hyperparathyroidism Marfan syndrome Lupus Chemotherapy Multiple myeloma Premature menopause Double or bilateral oophorectomy Eating disorder Amenorrhea Organ transplant
Numerator

Female patients who received an order for at least one DXA scan in the measurement period

Female patients who received an order for at least one DXA scan in the measurement period

Female patients who received an order for at least one DXA scan in the measurement period
Numerator Exclusions

Not Applicable

Not Applicable

Exclude patients with a result on one of the following tools, which indicates the patient should be considered for bone density testing, anytime in the patient’s history prior to the time of the first DXA scan during the measurement period:

FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent

ORAI score of >=9

OSIRIS score of <1

OST score of <2
Denominator Exceptions

None

None

None
Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Lower score indicates better quality

Lower score indicates better quality

Lower score indicates better quality
Guidance

There are two ways that a patient can be excluded from the measure:

1. The patient has a specific number of "combination" risk factors (the number of risk factors varies by age).

2. The patient has one or more of the "independent" risk factors, including a 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

There are two ways that a patient can be excluded from the measure:

1. The patient has a specific number of "combination" risk factors (the number of risk factors varies by age).

2. The patient has one or more of the "independent" risk factors, including a 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Patients are excluded from the measure if they have one or more risk factors for osteoporosis, including a result indicating that the patient should be considered for bone density testing on one of the following risk assessment instruments:

• 10-year probability of major osteoporotic fracture of 8.4 percent or higher as determined by the FRAX

• ORAI score of >=9

• OSIRIS score of <1

• OST score of <2

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID 472 472 472
Telehealth Eligible Yes Yes Yes
Next Version CMS249v4 CMS249v5 No Version Available
Previous Version No Version Available
CMS249v3
CMS249v4
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Specifications
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CMS249v4.html 95.24 KB
CMS249v4.zip 97.16 KB
CMS249v4-TRN.xlsx 20.15 KB

Data Element Repository

Value Sets
Value Sets to be used with CMS249v4

Release Notes

CMS249v4-TRN.xlsx

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the clinical recommendation statement to align with current clinical recommendations.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Removed the dosage requirement for glucocorticoids in the denominator exclusions to avoid excluding appropriate patients from the population.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the denominator exclusions statement to exclude patients with an osteoporotic fracture at any point in their medical history.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Added online assessments and telephone visits as appropriate encounters based on the increased use of telehealth services.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Removed the function DosesPerDay as it is no longer needed because of the removal of the dosage requirements for glucocorticoids.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised several definitions to remove the dosage requirements for glucocorticoids to avoid excluding appropriate patients from the population.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the Osteoporotic Fracture from Patient History definition to exclude patients with an osteoporotic fracture at any point in their medical history.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added Count of Distinct Age Dependent Combination Risk Factors and updated several definitions to accurately capture risk factors and reduce implementation burden.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Revised several definitions to remove the dosage requirements for glucocorticoids to avoid excluding appropriate patients from the population.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added the RiskFactorInPatientHistory function to accurately capture risk factors and reduce implementation burden.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Removed the function DosesPerDay as it is no longer needed because of the removal of the dosage requirements for glucocorticoids.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Revised the Osteoporotic Fracture from Patient History definition to exclude patients with an osteoporotic fracture at any point in their medical history.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Condensed the measure's CQL library name to improve readability.

    Measure Section: Logic

    Source of Change: Measure Lead

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Added value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Ankylosing Spondylitis (2.16.840.1.113883.3.464.1003.113.12.1045): Added 1 SNOMED CT code (786077003) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set DXA (Dual energy Xray Absorptiometry) Scan (2.16.840.1.113883.3.464.1003.113.12.1051): Deleted 2 LOINC codes (38269-7, 62910-5) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Glucocorticoids (oral only) (2.16.840.1.113883.3.464.1003.196.12.1266): Added 2 RxNorm codes (2121587, 2261802) based on terminology update. Deleted 3 RxNorm codes (199343, 199771, 199967) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Osteoporotic Fractures (2.16.840.1.113883.3.464.1003.113.12.1050): Added 12 ICD-10-CM codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Rheumatoid Arthritis (2.16.840.1.113883.3.464.1003.113.12.1005): Added 27 SNOMED CT codes based on terminology update. Deleted 6 SNOMED CT codes (201764007, 239941000, 239943002, 287006005, 400054000, 402433007) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 4 ICD-10-CM codes (M05.7A, M05.8A, M06.0A, M06.8A) based on terminology update.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Type 1 Diabetes (2.16.840.1.113883.3.464.1003.103.12.1020): Added 7 SNOMED CT codes (138901000119108, 421075007, 421365002, 421437000, 421893009, 609566000, 71721000119101) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 5 SNOMED CT codes (421920002, 4783006, 75682002, 76751001, 769219006) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed direct reference codes SNOMED CT codes (307469008, 396140003, 396131002, 225756002, 396143001, 307468000, 396139000, 396126004, 225754004, 396127008, 307470009, 396125000, 225752000, 307439001, 229797004, 396109005, 396108002, 396107007, 229798009, 229799001, 396111001) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.12.1035): Added 3 ICD-10-CM codes (K74.00, K74.01, K74.02) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Current Tobacco Smoker (2.16.840.1.113883.3.600.2390): Added 2 SNOMED CT codes (450811000124104, 450821000124107) based on terminology updates.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Malabsorption Syndromes (2.16.840.1.113883.3.464.1003.199.12.1050): Added 2 ICD-10-CM codes (K90.41, K90.49) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Jan 27, 2023