CMS347v6 – Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

All patients who have an active diagnosis of clinical ASCVD (Atherosclerotic Cardiovascular Disease) or ever had an ASCVD procedure.

An ASCVD diagnosis can include a diagnosis of any of the following:

• Myocardial Infraction
• Cerebrovascular Disease Stroke or TIA
• Atherosclerosis and Peripheral Arterial Disease
• Ischemic Heart Disease or Other Related Diagnoses
• Stable and Unstable Angina

An ASCVD procedure can include any of the following:

• PCI (Percutaneous Coronary Intervention)
• CABG (Coronary Artery Bypass Grafting) Surgeries
• Carotid Intervention
• CABG, PCE Procedure

If Yes, then patient meets Denominator 1 risk category and does not need to be screened for other denominator criteria. If no, then screen for Denominator 2 risk category.

Equals Initial Population 1

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

The Statin Therapy medication can include any of the following:

• Low Intensity Statin Therapy
• Moderate Intensity Statin Therapy
• High Intensity Statin Therapy

Note: ONLY statin therapy meets the measure numerator criteria (NOT other cholesterol lowering medications).

Patients aged ≥ 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C ≥ 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

If Yes, then patient meets Denominator 2 risk category and does not need to be screened for Denominator 3 criteria. If no, then screen for Denominator 3 risk category.

Equals Initial Population 2

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

The Statin Therapy medication can include any of the following:

• Low Intensity Statin Therapy
• Moderate Intensity Statin Therapy
• High Intensity Statin Therapy

Note: ONLY statin therapy meets the measure numerator criteria (NOT other cholesterol lowering medications).

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

If Yes, then patient meets Denominator 3 risk category. If no, patient does NOT meet Denominator criteria and is NOT eligible for measure inclusion.

Equals Initial Population 3

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

The Statin Therapy medication can include any of the following:

• Low Intensity Statin Therapy
• Moderate Intensity Statin Therapy
• High Intensity Statin Therapy

Note: ONLY statin therapy meets the measure numerator criteria (NOT other cholesterol lowering medications).

• Annual Wellness Visit
• Office Visit
• Outpatient Consultation
• Outpatient Encounters for Preventive Care
• Preventive Care Services Established Office Visit, 18 and Up
• Unlisted preventive medicine service
• Preventive Care Services Individual Counseling
• Preventive Care Services Initial Office Visit, 18 and Up

– DENOMINATOR EXCLUSIONS:

• Patients who are breastfeeding at any time during the measurement period.
• Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.

– DENOMINATOR EXCEPTIONS:

• Patients with statin-associated muscle symptoms or an allergy to statin medication.
• Patients who are receiving palliative or hospice care.
• Patients with active liver disease or hepatic disease or insufficiency.
• Patients with end-stage renal disease (ESRD).
• Patients with documentation of a medical reason for not being prescribed statin therapy.

Note: The documentation of medical reasons for not prescribing statin therapy should happen during a qualifying encounter (which can include any of the ones mentioned in the criteria for denominator).

For Denominator – 1:

• To record a diagnosis, navigate to Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

• The documentation of an ASCVD procedure can be done via Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the relevant procedure. Fill out the details and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• To record an encounter, head over to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant encounter code.

For Denominator – 2: 

• For LDL-C testing, use the workflow Patient > Provider Notes > Orders > Procedures or Patient > Provider Notes > Orders > Lab. Click ‘Add’ and search for the relevant laboratory test. Fill out the details and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• To document the Hypercholesterolemia diagnosis, navigate to Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

• To record an encounter, head over to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant encounter code.

For Denominator – 3:

• The diabetes diagnosis can be documented via Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out any details needed and once done, click ‘Save’.
• To record an encounter, head over to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant encounter code.

For Numerator:

• To order Statin Therapy, use the workflow Patient > Provider Notes > Prescription. Click ‘Add’ and search for the relevant medication. Fill out the details and once done, click ‘Prescribe’.

• To document an active Statin Therapy prescription, navigate to Patient > Provider Notes > Medications. Click ‘Add’ and search for the relevant medication. Fill out the details and once done, click ‘Save’.

For Denominator Exclusions: 

To document a diagnosis, use the workflow Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

For Denominator Exceptions:

• To record an allergy or intolerance to statin medication, head over to Patient > Provider Notes > Allergy. Click ‘Add’ and search for the relevant allergy or intolerance. Fill out the details and once done, click ‘Save’.

• For documenting a diagnosis, use the workflow Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out any details needed, and once done, click ‘Save’.
• To document a patient receiving hospice care, navigate to Patient > Provider Notes > Evaluations. Hospice Care can also be recorded by the workflow Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant hospice care code.

• To record a palliative assessment, navigate to Patient > Provider Notes > Evaluations.

• To record a palliative encounter, navigate to Patient > Provider Notes > Create Superbill or use the workflow Patient > Provider Notes > Diagnoses. Here, a diagnosis for ‘Encounter for palliative care’ is to be documented.
• To record a palliative intervention, navigate to Patient > Provider Notes > Evaluations or head over to Patient > Provider Notes > Create Superbill and search for the relevant palliative care intervention code.
• The documentation of medical reasons for not prescribing statin therapy can be done via Patient > Provider Notes > Medications > Current > Discontinue. Here, the reason for discontinuing an active medication is to be selected from the drop-down.