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Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Measure Information 2023 Performance Period
CMS eCQM ID CMS347v6
NQF Number Not Applicable
Description

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Initial Population

Population 1:

All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

Denominator

Equals Initial Population

Denominator Exclusions

Patients who are breastfeeding at any time during the measurement period.

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.

Numerator

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Numerator Exclusions

Not Applicable

Denominator Exceptions

Patients with statin-associated muscle symptoms or an allergy to statin medication.

Patients who are receiving palliative or hospice care.

Patients with active liver disease or hepatic disease or insufficiency.

Patients with end-stage renal disease (ESRD).

Patients with documentation of a medical reason for not being prescribed statin therapy.

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Quality Domain Effective Clinical Care
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality

Guidance

Initial Population Guidance:

The initial population covers three distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure.

-If YES, meets Initial Population 1 risk category

-If NO, screen for next risk category

Initial Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

-If YES, meets Initial Population 2 risk category

-If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period

-If YES, meets Initial Population 3 risk category

-If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

-There is only one performance rate calculated for this measure: the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

-It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure.

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 438
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Next Version No Version Available
Previous Version

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Measure Information 2021 Performance Period 2022 Performance Period 2023 Performance Period
Title Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
CMS eCQM ID CMS347v4 CMS347v5 CMS347v6
NQF Number Not Applicable Not Applicable Not Applicable
Description

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR

*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Initial Population

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period

Population 1:

All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure

Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes

Population 1:

All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

Denominator

All patients who meet one or more of the following criteria (considered at "high risk" for cardiovascular events, under ACC/AHA guidelines):

1) Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD diagnosis

2) Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

Equals Initial Population

Equals Initial Population

Denominator Exclusions Patients who have a diagnosis of pregnancy Patients who are breastfeeding Patients who have a diagnosis of rhabdomyolysis Patients who have a diagnosis of pregnancy at any time during the measurement period Patients who are breastfeeding at any time during the measurement period Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period Patients who are breastfeeding at any time during the measurement period. Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.
Numerator

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator Exceptions

Patients with adverse effect, allergy, or intolerance to statin medication

Patients who are receiving palliative or hospice care

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy

Patients with statin-associated muscle symptoms or an allergy to statin medication

Patients who are receiving palliative or hospice care

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

Patients with statin-associated muscle symptoms or an allergy to statin medication.

Patients who are receiving palliative or hospice care.

Patients with active liver disease or hepatic disease or insufficiency.

Patients with end-stage renal disease (ESRD).

Patients with documentation of a medical reason for not being prescribed statin therapy.

Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Quality Domain Effective Clinical Care Effective Clinical Care Effective Clinical Care
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Guidance

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure. There is only one performance rate calculated for this measure; the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

Denominator Guidance:

The denominator covers three distinct populations. Use the following process to prevent counting patients more than once.

Denominator Population 1:

Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD

-If YES, meets Denominator Population 1 risk category

-If NO, screen for next risk category

Denominator Population 2:

Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

-If YES, meets Denominator Population 2 risk category

-If NO, screen for next risk category

Denominator Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with a LDL-C result of 70 -189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

-If YES, meets Denominator Population 3 risk category

-If NO, patient does NOT meet Denominator criteria and is NOT eligible for measure inclusion

Denominator Guidance for Encounter:

-In order for the patient to be included in the denominator, the patient must have ONE denominator-eligible visit, defined as follows:

--Outpatient encounter visit type

--Encounter, performed: initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented fasting or direct LDL-C level recorded as follows:

To meet Denominator Population 1:

There is no LDL-C result required.

To meet Denominator Population 2:

If a patient has ANY previous fasting or direct laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Denominator Population 3:

If a patient has more than one LDL-C result during the measurement period or during the two years before the start of the measurement period, report the highest level recorded during either time. The Denominator Exception, "Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy" applies only to Denominator Population 3.

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2013 ACC/AHA Guidelines (Stone et al., 2014) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

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.

Initial Population Guidance:

The initial population covers three distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure, before the end of the measurement period

-If YES, meets Initial Population 1 risk category

-If NO, screen for next risk category

Initial Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

-If YES, meets Initial Population 2 risk category

-If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period

-If YES, meets Initial Population 3 risk category

-If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

-There is only one performance rate calculated for this measure: the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

-It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

This eCQM is a patient-based measure.

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.

Initial Population Guidance:

The initial population covers three distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure.

-If YES, meets Initial Population 1 risk category

-If NO, screen for next risk category

Initial Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

-If YES, meets Initial Population 2 risk category

-If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period

-If YES, meets Initial Population 3 risk category

-If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

-There is only one performance rate calculated for this measure: the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

-It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure.

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 438 438 438
Meaningful Measure Management of Chronic Conditions Management of Chronic Conditions Management of Chronic Conditions
Telehealth Eligible Yes Yes Yes
Next Version CMS347v5 CMS347v6 No Version Available
Previous Version No Version Available

Release Notes

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Added Ezetimibe/Rosuvastatin (Roszet), a new fixed-dose combination statin, to the Statin Medication Therapy List to align with measure intent.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Added guidance for conversion of LDL value to milligrams per deciliter (mg/dL) for consistency with numerator logic requirements.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Removed diagnosis of pregnancy as a denominator exclusions to align with the new FDA recommendations.

    Measure Section: Denominator Exclusions

    Source of Change: Expert Work Group Review

  • Added exception for documentation of a medical reason for not being prescribed statin therapy to align with guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Updated grammar, wording, and formatting to improve readability and consistency.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated narrative description, rate aggregation, and guidance to clarify the intent to look for only active diagnoses of atherosclerotic cardiovascular disease (ASCVD).

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

Logic

  • Removed 'Diagnosis': 'Pregnancy or Other Related Diagnoses' to align with the new FDA recommendations.

    Measure Section: Denominator Exclusions

    Source of Change: Expert Work Group Review

  • Replaced the 'Has Order for or Receiving Hospice Care or Palliative Care' definition with Hospice and Palliative Care shared libraries and QDM datatypes for consistency and to reduce clinician and implementer burden.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added 'Has Medical Reason for Not Ordering Statin Therapy' to align with guidelines and for consistency with other eCQMs.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Replaced value set Preventive Care Services Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429).

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Replaced the 'Has Order for or Receiving Hospice Care or Palliative Care' definition with Hospice and Palliative Care libraries and QDM datatypes for consistency and to reduce clinician and implementer burden.

    Measure Section: Definitions

    Source of Change: Measure Lead

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

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Added Hospice Library v4.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Added Palliative Care Exclusion Library v2.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Revised measure logic to look for only active diagnoses of atherosclerotic cardiovascular disease (ASCVD), as inactive diagnoses do not represent high-risk of cardiovascular event.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

    Measure Section: Multiple Sections

    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.

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 24 ICD-10-CM codes based on validity of code during timing of look back period.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Cerebrovascular Disease, Stroke, TIA (2.16.840.1.113762.1.4.1047.44): Deleted 1 SNOMED CT code (288723005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Liver Disease (2.16.840.1.113762.1.4.1047.42): Deleted 1 SNOMED CT code (197279005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added direct reference code SNOMED CT code (428361000124107) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (428371000124100) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575): Added 2 RxNorm codes (2535747, 2535750) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added direct reference code LOINC code (71007-9) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (45755-6) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Added 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback. Added 2 CPT codes (99377, 99378) based on review by technical experts, SMEs, and/or public feedback. Added 1 HCPCS code (G0182) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Statin Allergen (2.16.840.1.113762.1.4.1110.42): Added 1 SNOMED CT code (96302009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set CABG Surgeries (2.16.840.1.113883.3.666.5.694): Added 17 ICD-10-PCS codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (309814006) based on terminology update.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Myocardial Infarction (2.16.840.1.113883.3.526.3.403): Added 23 SNOMED CT codes based on terminology update. Deleted 1 SNOMED CT code (371068009) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Removed value set Pregnancy or Other Related Diagnoses (2.16.840.1.113883.3.600.1.1623) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Medical Reason (2.16.840.1.113883.3.526.3.1007) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (373066001) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572): Added 2 RxNorm codes (2535745, 2535749) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030) with direct reference code CPT code (99429) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Aug 29, 2022