CMS347v4 – Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period

Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD diagnosis

 Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period

Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period

• Patients who have a diagnosis of pregnancy
• Patients who are breastfeeding
• Patients who have a diagnosis of rhabdomyolysis

– DENOMINATOR EXCEPTIONS:

• Patients with adverse effect, allergy, or intolerance to statin medication
• Patients who are receiving palliative care
• Patients with active liver disease or hepatic disease or insufficiency
• Patients with end-stage renal disease (ESRD)
• Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy

For Denominator – 1:

All patients who fulfil the following criteria are included in denominator 1:

• Patient is aged >= 21 and had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.

• Patient had ASCVD diagnosis or procedure before the end of the measurement period.
  • To record the ASCVD diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the ASCVD diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.

• • To document ASCVD procedure, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hovers over ‘Sign & Accept’, then click ‘Complete’.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.  

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button.  

For Denominator – 2: 

All patients who fulfil the following criteria are included in denominator 2:

• Patient is aged >= 21 and had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• Patient has a diagnosis for hypercholesterolemia or has a current/prior LDL result greater than or equal to 190 before the end of the measurement period.
  • To record the hypercholesterolemia diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the hypercholesterolemia diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
  • To perform a ‘LDL Cholesterol’ laboratory test, navigate to Patient > Clinical > Orders & Result > Labs and click on the ‘+ Add Order’ button. Select a Laboratory and search for a ‘LDL Cholesterol’ test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’.

Next, click on the ‘Mark as received’ button.

On the lab result screen, add the observations and click on the ‘Save’ button.

Note:

For LOINC Code Based Labs: Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

For CPT Code Based Labs: When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’.  

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’.  

• Patient does not have a record of ASCVD diagnosis or procedure before the end of the measurement period.

For Denominator – 3:

All patients who fulfil the following criteria are included in denominator 3:

• Patient is aged >= 40 and <= 75, and had a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• Patient has a diagnosis for diabetes during the measurement period. To record the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diabetes diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
• Patient has the highest LDL result greater than or equal to 70 and less than 190 within the three years prior to the end of the measurement period. To perform a laboratory test, navigate to Patient > Clinical > Orders & Result > Labs and click on the ‘+ Add Order’ button. Select a Laboratory and search for a ‘LDL Cholesterol’ laboratory test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’. Next, click on the ‘Mark as received’ button. On the lab result screen, add the observations and click on the ‘Save’ button.
• Patient does not have a diagnosis for hypercholesterolemia or a current/prior LDL result greater than or equal to 190 before the end of the measurement period.
• Patient does not have a record of ASCVD diagnosis or procedure before the end of the measurement period.

For Numerator:

Patients who are actively using or who receive an order (prescription) for statin therapy at any point during the measurement period.

• Currently taking statin therapy through the end of the measurement period. To document current statin therapy, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Add the dosage information and click ‘Save. The medication is added to the provider note.

• Statin therapy ordered during the measurement period. To document current statin therapy, navigate to Patient > Provider Note > Prescriptions. Click ‘Add’ and search for the prescription. Add the dosage information and click ‘Save. The prescription is added to the provider note.

For Denominator Exceptions 1 & 2:

All patients who fulfil any of the following criteria are included in denominator exceptions 1 & 2.

• Patients with adverse effect, allergy, or intolerance to statin medication during the measurement year.
  • To document statin allergy intolerance, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and click ‘Save’.

• • To document statin reaction, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and select a reaction from the ‘Reactions’ dropdown. Then click ‘Save’.
• Patients with a diagnosis for liver disease or hepatic disease or insufficiency during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients who are receiving palliative or hospice care during the measurement year. To record a hospice intervention ordered or performed before the end of the measurement year, navigate to Patient > Clinical > Evaluations. Click ‘+Evaluation’ and search for an intervention. Then click ‘Sign’ or ‘Save’.
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To record palliative care encounter, use the workflow Patient > Provider Note > Diagnosis.

• Patients with a diagnosis for end-stage renal disease (ESRD) during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.

For Denominator Exceptions 3:

All patients who fulfil any of the following criteria are included in denominator exceptions 3.

• Patients with adverse effect, allergy, or intolerance to statin medication during the measurement year.
  • To document statin allergy intolerance, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and click ‘Save’.
  • To document statin reaction, use the workflow Patient > Provider Note > Allergies. Click ‘Add’ and search for an allergen. Add the allergen details and select a reaction from the ‘Reactions’ dropdown. Then click ‘Save’.
• Patients who are receiving palliative or hospice care during the measurement year. To record a hospice intervention ordered or performed before the end of the measurement year, navigate to Patient > Clinical > Evaluations. Click ‘+Evaluation’ and search for an intervention. Then click ‘Sign’ or ‘Save’.
  • To record palliative care encounter, use the workflow Patient > Provider Note > Diagnosis.
• Patients with a diagnosis for liver disease or hepatic disease or insufficiency during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients with a diagnosis for end-stage renal disease (ESRD) during the measurement year. To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy. The LDL laboratory test must have been performed within the three years prior to the end of the measurement period. To perform a laboratory test, navigate to Patient > Clinical > Orders & Result > Labs and click on the ‘+ Add Order’ button. Select a Laboratory and search for a ‘LDL Cholesterol’ laboratory test. Once done, click on the ‘Save’ button or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’. Next, click on the ‘Mark as received’ button. On the lab result screen, add the observations and click on the ‘Save’ button.

For Denominator Exclusions: 

All patients who fulfil any of the following criteria are excluded from the denominator.

• Patients who have a diagnosis of pregnancy or rhabdomyolysis during the measurement period.
• Patients who are breastfeeding during the measurement period.

To record a diagnosis, navigate to Patient > Provider Note > Diagnosis.