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

Last updated: September 14, 2018

CMS Measure ID: CMS249v1
Version: 1
NQF Number: None
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 Patient Population:

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

Denominator Statement:

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

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:

Gastric bypass

FRAX[R] ten-year probability of all major osteoporosis related fracture >= 9.3 percent

Aromatase inhibitors

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

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Domain: Efficiency and Cost Reduction
Improvement Notation:

Lower score indicates better quality

Guidance:

CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed.

To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions.

For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.

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 9.3 percent or higher as determined by the FRAX.

Meaningful Measure: Appropriate Use of Healthcare

Specifications

Release Notes

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 1 SNOMEDCT code (735733008).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Lupus (2.16.840.1.113883.3.464.1003.117.12.1010): Added 1 SNOMEDCT code (25380002).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Malabsorption Syndromes (2.16.840.1.113883.3.464.1003.199.12.1050): Added 7 SNOMEDCT codes (197494007, 235724004, 735718000, 737195007, 762269004, 762270003, 762271004).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Marfan's Syndrome (2.16.840.1.113883.3.464.1003.113.12.1048): Added 3 SNOMEDCT codes (15960021000119107, 15993551000119100, 16055631000119106).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Osteopenia (2.16.840.1.113883.3.464.1003.113.12.1049): Added 4 SNOMEDCT codes (735613004, 735614005, 735615006, 735616007).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Osteoporosis (2.16.840.1.113883.3.464.1003.113.12.1038): Added 3 SNOMEDCT codes (735617003, 735618008, 739301006).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Rheumatoid Arthritis (2.16.840.1.113883.3.464.1003.113.12.1005): Added 15 SNOMEDCT codes and deleted 5 SNOMEDCT codes (10713006, 19514005, 398726004, 239920006, 445345005).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Type 1 Diabetes (2.16.840.1.113883.3.464.1003.103.12.1020): Added 1 SNOMEDCT code (368521000119107).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

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