Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed

Last updated: May 17, 2016

CMS Measure ID: CMS61v5
Version: 5
NQF Number: None
Measure Description:

Percentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed.

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 have CHD or CHD Risk Equivalent OR 10-Year Framingham Risk > 20%

Denominator 2: (Moderate Risk)
All patients aged 20 through 79 years who 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 have 0 or 1 Major CHD Risk Factors OR 10-Year Framingham Risk < 10%

** For Denominator 2 and Denominator 3, Fasting 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: (High Risk)
Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period

Numerator 2: (Moderate Risk)
Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period

Numerator 3: (Low Risk)
Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period or up to four (4) years prior to the current measurement period

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patient Reason(s):

Patient Refusal

A fasting LDL-C test is not performed during the measurement period for a valid patient reason.

Measure Steward: Centers for Medicare & Medicaid Services
National Quality Strategy Domain: Effective Clinical Care
Next Version: Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed
Previous Version: Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality.

Guidance:

This is part of a two-part measure which is paired with CMS 64 Preventive Care and Screening: Cholesterol - Risk-Stratified Fasting LDL-C. If the fasting LDL-C test is performed, 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. To meet the numerator criteria for this measure, the patient will 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 a fasting LDL-C performed up to four (4) years prior to the current measurement period

Specifications

Release Notes

Header

  • Added the following definition to the header: CHD: History of CHD includes: • Myocardial Infarction • Myocardial Ischemia • Angina (stable, unstable) • Percutaneous Transluminal Coronary Angioplasty • Coronary Artery Bypass Surgery Added Stroke and Framingham 10-yr CHD risk to CHD Risk Equivalent definition.
  • Copyright updated.
  • Denominator Exceptions updated.
  • Denominator Exclusions 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 $PalliativeCareorPregnancyExclusion, $FraminghamCADRiskfactors, $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>=10%)' in Denominator 2 and 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.

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 the following 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 eplaced 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