CMS249v5 – Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture

Female patients aged 50 to 63 years at the end of the measurement period with an encounter during the measurement period.

A qualifying encounter in this case can include any of the following:

• Office Visit
• Preventive Care Services Established Office Visit, 18 and Up
• Unlisted Preventive Medicine Service
• Preventive Care Services Initial Office Visit, 18 and Up
• Outpatient Consultation
• Online Assessments
• Telephone Visits

– NUMERATOR

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

– DENOMINATOR EXCLUSIONS

Patients with one of the following risk factors:

Note: Risk factors are grouped by when they occur in relation to the measurement period.

1. The following risk factors must be active during the measurement period:
   • BMI ≤ 20 kg/m² (must be the first BMI of 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))
2. The following risk factors may occur at any time in the patient’s history prior to the start of the measurement period:
   • Osteoporosis
   • Osteopenia
3. 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
   • Aromatase inhibitors
   • Documentation of history of hip fracture in parent
4. The following risk factors may occur at any time in the patient’s history or during the measurement period:
   • Glucocorticoids (Oral Only) [cumulative medication duration ≥ 90 days]
   • Osteoporotic fracture
   • Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, cystic fibrosis, malabsorption
   • Chronic malnutrition
   • Chronic liver disease
   • Rheumatoid arthritis
   • Hyperthyroidism
   • Type I Diabetes
   • End stage renal disease
   • Osteogenesis imperfecta
   • Ankylosing spondylitis
   • Psoriatic arthritis
   • Ehlers-Danlos syndrome
   • Cushing’s syndrome
   • Hyperparathyroidism
   • Marfan syndrome
   • Lupus
   • Chemotherapy
   • Multiple myeloma
   • Premature Menopause
   • Double or bilateral oophorectomy
   • Eating disorder
   • Amenorrhea
   • Organ transplant (Major Transplant OR Kidney Transplant OR Bone Marrow Transplant)

NUMERATOR EXCLUSIONS

Patients with a result on one of the following tools, which indicates the patient should be considered for bone density testing, anytime in the patient’s history prior to the time of the first DXA scan during the measurement period:

• FRAX [R] ten-year probability of all major osteoporosis related fracture ≥ 8.4 percent
• ORAI score of ≥ 9
• OSIRIS score of < 1
• OST score of < 2

For Denominator:

To record an encounter, navigate to Patient > Provider Notes > Create Superbill. Here, under the ‘Procedure-CPTs’ heading, search for the relevant encounter code.

For Numerator:

• To document a DXA scan, use the workflow Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the relevant diagnostic study. From the Status drop-down select ‘Ordered’ and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

For Denominator Exclusions:

• The BMI is recorded via Patient > Provider Notes > Vitals. Under this section, note down the ‘Height’ and ‘Weight’ using which the system automatically calculates the BMI of a patient.

• To document alcohol consumption, use the workflow Patient > Clinical > History > + Social. Here, select the ‘Alcohol’ tab and fill out the relevant details regarding the alcohol consumption pattern. Once done, click ‘Save’.

• Any of the following diagnosis:
  • Osteoporosis
  • Osteopenia
  • Osteoporotic fracture
  • Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, cystic fibrosis, malabsorption
  • Chronic malnutrition
  • Chronic liver disease
  • Rheumatoid arthritis
  • Hyperthyroidism
  • Type I Diabetes
  • End stage renal disease
  • Osteogenesis imperfecta
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Ehlers-Danlos syndrome
  • Cushing’s syndrome
  • Hyperparathyroidism
  • Marfan syndrome
  • Lupus
  • Multiple myeloma
  • Premature menopause
  • Eating disorder
  • Amenorrhea

can be recorded through Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

• To record the gastric bypass surgery, use the workflow Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the relevant procedure and fill out its details. Once done, save the changes.

• To order or document the active use of Aromatase Inhibitors or Glucocorticoids (oral only), head over to Patient > Provider Notes > Prescription or Patient > Provider Notes > Medications. Click ‘Add’ and search for the relevant medication. Fill out the details and either click ‘Prescribe’ in case of prescription or click ‘Save’ in case of medications.

• For documenting history of hip fracture in parent, use the workflow Patient > Clinical > History > + Family. Here, search for ‘Hip Fracture’ and select it from the list. The, click the option of ‘Member +’ and choose the parent whom the hip fracture is associated with. Fill out the details as needed and once done, click ‘Save’.

• The following procedures:
  • Organ Transplant (Major, Kidney or Bone Marrow)
  • Double or Bilateral Oophorectomy

can be documented via Patient > Provider Notes > Orders > Procedures. Search for the relevant surgical procedures and fill out the details as needed. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

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

For Numerator Exclusions:

To document the assessments/tools, navigate to Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the relevant assessment. From the ‘Status’ drop-down’ select ‘Performed’ and in the ‘Result’ text field, input the result. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.