CMS64v6 – Preventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)

All patients of age 20 – 79 years before the beginning of the measurement period.

All patients aged 20 through 79 years who have one of the following:

• Calculated LDL-C test performed during the measurement period and have CHD
• CHD Risk Equivalent OR 10 year Framingham risk > 20%

Patients whose most recent fasting LDL-C test result is in good control, defined as < 100 mg/dL.

All patients aged 20 through 79 years who have one of the following:

• Had a fasting LDL-C
• A calculated LDL-C during the measurement period AND have 2 or more Major CHD Risk Factors
• 10 year Framingham Risk 10-20%

Patients whose most recent fasting LDL-C test result is in good control, defined as < 130 mg/dL

Patients with one of the following:

• A fasting LDL-C test performed during the measurement period.
• A calculated LDL-C performed up to 4 years prior to the current measurement period and have 0 or 1 Major CHD Risk Factors.
• 10 year Framingham risk <10%

Patients whose most recent fasting LDL-C test result is in good control, defined as < 160 mg/dL

All patients:

• • With an active diagnosis of pregnancy.

OR

• Who are receiving palliative care.

For Denominator:
All patients 20-79 years of age before the beginning of the measurement period and have one of the following:

• Calculated LDL-C test performed during the measurement period and have CHD (Patient > Clinical > Orders and Results > Lab)
• CHD Risk Equivalent OR 10 year Framingham risk > 20% (Patient > Clinical > Diagnosis)

are considered as the High Risk Patients and they get included in the High Risk Patient Denominator of this measure.

All patients 20-79 years of age before the beginning of the measurement period and have one of the following:

• Calculated LDL-C test performed during the measurement period and have CHD (Patient > Clinical > Orders and Results > Lab)
• Current Tobacco Smoker (Patient > Clinical > History > Social)

are considered as the Moderate Risk Patients and they get included in the Moderate Risk Patient Denominator of this measure.

All patients 20-79 years of age before the beginning of the measurement period and have one of the following:

• Calculated LDL-C test performed during the measurement period and have CHD (Patient > Clinical > Orders and Results > Lab)
• Current Tobacco Smoker (Patient > Clinical > History > Social)
• Laboratory Test: High Density Lipoprotein(HDL) (Patient > Clinical > Orders and Results > Lab)

are considered as the Low Risk Patients and they get included in the Low Risk Patient Denominator of this measure.

For Numerator:
In order to get included in the High Risk Numerator of the this measure, patient’s most recent fasting LDL-C test result should be is in good control, defined as < 100 mg/dL.

For Moderate Risk Numerator, patient’s most recent fasting LDL-C test result should be is in good control, defined as < 130 mg/dL and for Low Risk Numerator, fasting LDL-C test result should be < 160 mg/dL.

Denominator Exclusions:
If the patient has one of the following,

• Receiving Palliative Care
• An active diagnosis of pregnancy

then the patient can no longer be a part of this measure.