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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

CMS Measure ID
CMS249v2
Version
2
NQF Number
Not Applicable
Measure 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 Statement
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

Numerator Statement

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

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Previous Version
Measure Scoring
Measure Type
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.

Quality ID
472
Meaningful Measure

Specifications

Attachment Size
CMS249v2.html 89.88 KB
CMS249v2.zip 114.07 KB
CMS249v2-TRN.xlsx 23.32 KB

Release Notes

 

Header

  • Updated eCQM version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated guidance statement with removal of cumulative medication duration as it was outdated.

    Measure Section: Guidance

    Source of Change: ONC Project Tracking System (JIRA): CQM-3153

  • Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated header statements for the FRAX 10-year probability of all major osteoporosis related fracture results from 9.3% to 8.4% based on updated clinical guidelines.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

 

Logic

  • Added logic for glucocorticoid average daily dosing to improve alignment with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added the unit 'drinks/day' to express the average number of drinks per day as a quantity rather than an integer for clarity and to improve alignment with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Changed the probability assessment result from 9.3% to 8.4% in the 'Osteoporosis Fracture Probability Assessment' definition to align with updated clinical guidelines.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Changed definition name from 'Average of More Than Two Drinks Per Drinking Day' to 'First Average Number of Drinks Assessments Indicating More Than Two Per Day' to better align with the measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Changed the probability assessment result from 9.3% to 8.4% in the 'Osteoporosis Fracture Probability Assessment' definition to align with updated clinical guidelines.

    Measure Section: Definitions

    Source of Change: Measure Lead

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

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • ​Added new CQL library for day and month timing (DayMonthTimings-1.2.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MAT) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

 

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 Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.12.1035): Added 9 SNOMED CT codes (737202006, 767809001, 767810006, 768006009, 768125005, 768126006, 768127002, 768288001, 768289009).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Glucocorticoids (oral only) (2.16.840.1.113883.3.464.1003.196.12.1266): Deleted 2 RxNorm codes (197543, 197545).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Marfan's Syndrome (2.16.840.1.113883.3.464.1003.113.12.1048): Added 1 SNOMED CT code (763839005).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Type 1 Diabetes (2.16.840.1.113883.3.464.1003.103.12.1020): Added 24 SNOMED CT codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ten-year probability of all major osteoporosis related fracture (2.16.840.1.113883.3.464.1003.118.12.1081): Removed Ten-year probability of all major osteoporosis related fracture.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Osteoporosis (2.16.840.1.113883.3.464.1003.113.12.1038): Added 1 SNOMED CT code (203657009).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced Ten year probability of hip fracture (2.16.840.1.113883.3.464.1003.118.11.1095) with direct reference code LOINC code (90265-0).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Standardized purpose statement language in value sets across eCQMs. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

 

Value set

  • Replaced Ten year probability of hip fracture (2.16.840.1.113883.3.464.1003.118.11.1095) with direct reference code LOINC code (90265-0).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (307469008)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396140003)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396131002)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (225756002)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396143001)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (307468000)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396139000)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396126004)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (225754004)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396127008)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (307470009)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396125000)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (225752000)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (307439001)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (229797004)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396109005)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396108002)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396107007)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (229798009)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (229799001)).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code (SNOMED CT code (396111001)).

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Oct 10, 2019