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

Last updated: July 12, 2017

CMS Measure ID: CMS64v5
Version: 5
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
Domain: Effective Clinical Care
Next Version: Preventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)
Previous Version: Preventive Care and Screening: Risk-Stratified Cholesterol – Fasting Low Density Lipoprotein (LDL-C)
Measure Score: Proportion
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.

Specifications

Release Notes

Header

  • Copyright updated.
  • Definition updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • eMeasure version number incremented from 5.0.000 to 5.1.000.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variables $FraminghamCADRiskFactors, $PalliativeCareorPregnancyExclusion, $RecentLowHDLResult, $RecentHighHDLResult, $CHDandCHDRiskIndicators to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed extraneous AND from Initial Population 1, 2, and 3.
  • Removed superfluous 'Occurrence A of' from the 'Risk Category Assessment: Framingham coronary heart disease 10 year risk (result>20%) in Denominator 1, 'Risk Category Assessment: Framingham coronary heart disease 10 year risk (result>=10%) in Denominator 2 and 'Risk Category Assessment: Framingham coronary heart disease 10 year risk (result<10%) in Denominator 3.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Updated Denominator logic to reflect the replacement of CHD or CHD Risk Equivalent 2.16.840.1.113883.3.600.863.
  • Updated logic for applying 'AND' logical operator in the left-hand side or right-hand side of a timing clause.

Value Sets

  • Changed name of the value set, Current Cigarette Smoker OID 2.16.840.1.113883.3.600.2390 to Current Tobacco Smoker and added the following codes (59978006, 82302008).
  • Retired CHD or CHD Risk Equivalent 2.16.840.1.113883.3.600.863 - Replaced with the following value sets: Acute Myocardial Infarction Grouping Value Set (2.16.840.1.113883.3.464.1003.104.12.1001), Hemorrhagic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.212), Ischemic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.247), Ischemic Vascular Disease Grouping Value Set (2.16.840.1.113883.3.464.1003.104.12.1003), Coronary Artery Disease No MI 2.16.840.1.113883.3.526.3.369), PCI Grouping Value Set (2.16.840.1.113762.1.4.1045.67), CABG Surgeries Grouping Value Set (2.16.840.1.113883.3.666.5.694), Carotid Intervention Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.204), Diabetes Grouping Value Set (2.16.840.1.113883.3.464.1003.103.12.1001), Abdominal Aortic Aneurysm (2.16.840.1.113762.1.4.1047.17), and Peripheral Arterial Disease (2.16.840.1.113762.1.4.1047.21).
  • Value set Acute Myocardial Infarction (OID 2.16.840.1.113883.3.464.1003.104.12.1001): Added 2 SNOMED codes (17531000119105, 23311000119105 ).
  • Value set Anti-Hypertensive Pharmacologic Therapy (OID 2.16.840.1.113883.3.600.1476): Deleted 3 RXNORM codes (197562, 197563, 197564) and added 15 RXNORM codes (308614, 282486, 197417, 197418, 197419, 104222, 197977, 198110, 198111, 198112, 198312, 245284, 198313, 245283, 198319).
  • Value set Diagnosis of hypertension grouped (OID 2.16.840.1.113883.3.600.263) name changed to 'Diagnosis of hypertension'; Deleted 8 SNOMED codes (160273004, 26174007, 275944005, 276789009, 302192008, 390925005, 401118009, 412779008).
  • Value set Ischemic Vascular Disease (OID 2.16.840.1.113883.3.464.1003.104.12.1003): Added 1 ICD10CM code (I25.84)
  • Value set Palliative Care (OID 2.16.840.1.113883.3.600.1.1579): Added Comfort Measures value set (OID 1.3.6.1.4.1.33895.1.3.0.45) which included the addition of 4 SNOMED codes (133918004, 182964004,385736008, 385763009).
  • Value set Pregnancy (OID 2.16.840.1.113883.3.600.1622) has been replaced with Pregnancy Dx (OID 2.16.840.1.113883.3.600.1.1623).
  • Value set Pregnancy Dx (OID 2.16.840.1.113883.3.600.1.1623): Deleted 2 SNOMED codes (289908002, 386322007).

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.

External Resources