CMS249v2 – Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture

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

– NUMERATOR

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

-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

For Denominator:
All Female patients aged between 50 to 64 years with an encounter during the measurement period are included in the denominator of this measure.

The documentation of the first encounter takes place when one visit code is documented on the patient’s eSuperbill/ charge. To record any of the following encounter, navigate to Patient > Provider Note > eSuperbill.

• Office Visit
• Preventive Care Services – Established Office Visit, 18 and Up
• Preventive Care Services – Other
• Preventive Care Services-Initial Office Visit, 18 and Up
• Outpatient Consultation

For Numerator:

All female patients who received an order for at least one DXA scan in the measurement period are included in numerator.

• DXA (Dual energy Xray Absorptiometry) Scan (Patient > Clinical > Evaluation)

For Denominator Exclusions:

All patients with a combination of risk factors (as determined by age) or one of the independent risk factors
are excluded from denominator.

Patient has age Dependent 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 may occur any time in the patient’s history but must be active during the measurement period.

• White (race)
• BMI Ratio <= 20 kg/m2 (must be the first BMI of the measurement period) (Patient > Clinical > Physical Exam)
• Tobacco Use Screening (Patient > Clinical > Evaluation )
• Average Number of Drinks per Drinking Day > 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 (Patient > Clinical > Diagnosis)

The following risk factors may occur at any time in the patient’s history or during the measurement period, to document any of the following Combination Risk Factors, navigate to workflow mentioned ahead

• Rheumatoid Arthritis (Patient > Clinical > Diagnosis)
• Hyperthyroidism
• Malabsorption Syndromes
• Chronic Liver Disease
• Chronic Malnutrition
• History of hip fracture in parent (Patient > Clinical > Evaluation )
• Osteoporotic Fractures Patient > Clinical > Diagnosis.
• Osteoporosis Before Measurement Period (Patient > Clinical > Diagnosis)
• Glucocorticoids (oral only)  (>= 5 mg/per day) [cumulative medication duration >= 90 days] (Patient > Clinical > Active)

INDEPENDENT RISK FACTORS

The following risk factors may occur at any time in the patient’s history and must not start during the measurement period:

• Osteoporosis  (Patient > Clinical > Diagnosis)
• The following risk factors may occur at any time in the patient’s history:
• Type 1 Diabetes  (Patient > Clinical > Diagnosis)
• End Stage Renal Disease
• Osteogenesis Imperfecta
• Ankylosing Spondylitis
• Psoriatic Arthritis
• Ehlers Danlos Syndrome
• Cushings Syndrome
• Marfan’s Syndrome
• Hyperparathyroidism
• Lupus
• Gastric Bypass Surgery (Patient > Provider Note > eSuperbill)
• Aromatase Inhibitors (Patient > Provider Note > Medication)
• Ten-year probability of all major osteoporosis related fracture >= 9.3 percent  (Patient > Clinical > Evaluation)