CMS61v6 – Preventive Care and Screening: Cholesterol – Fasting Low Density Lipoprotein (LDL-C) Test Performed

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:

• CHD
• CHD Risk Equivalent.
• 10-Year Framingham Risk > 20%

Patients with:

• • A documentation of Laboratory Test, LDL Code, performed during the Measurement Period.

OR

• • All of the following three tests:

• 1. Laboratory Test: Total Cholesterol, performed during the measurement period.
  2. Laboratory Test: High Density Lipoprotein (HDL), performed during the measurement period.
  3. Laboratory Test: Triglycerides, performed during the measurement period

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

• Two or more Major CHD Risk Factors.
• 10-Year Framingham Risk 10-20%

Patients with one of the following:

• A fasting LDL-C test performed during the measurement period.
• A calculated LDL-C during the measurement period

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

• 0 or 1 Major CHD Risk Factors.
• 10-Year Framingham Risk < 10%

Patients with one of the following:

• A fasting LDL-C test performed during the measurement period.
• A calculated LDL-C during the measurement period.
• A calculated LDL-C up to four years prior to the current measurement period

All patients:

• • With an active diagnosis of pregnancy.

OR

• Who are receiving palliative care.

– DENOMINATOR EXCEPTION

Patient Reason(s):
Patient Refusal
A fasting LDL-C test is not performed during the measurement period for a valid patient reason.

For Denominator:

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

• CHD
• CHD Risk Equivalent
• 10-Year Framingham Risk > 20%

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

If the patient of the same age, has Two or more CHD Risk Factors or 10-year Framingham Risk 10-20%, he is considered as a Moderate Risk Patient and is included in the Moderate Risk denominator of this measure.

CHD Risk Factors include:

1. 1. Hypertension
   2. Tobacco use

1. Raised blood glucose (diabetes)
2. Physical inactivity
3. Unhealthy diet
4. Cholesterol/lipids
5. Overweight and obesity

One of the following conditions must satisfy for the patient to be considered as Moderate Risk Denominator patient.

1. Three CAD Risk factors should be documented.
2. Two CAD Risk Factors and lab result of LowHDL.
3. Two CAD Risk Factors and male patient of age 45 years or older/ Female patient of age 55 years or older.
4. One CAD Risk Factors with labe result of LowHDL and male patient of age 45 years or older/Female patient of age 55 years or older.

   

If the patient of the same age, has 0 or 1 Major CHD Risk Factors or 10-year Framingham Risk < 10%, he is considered as a Low Risk Patient and is included in the Low Risk denominator of this measure.

For Numerator:

In order to get included in the Numerator(High, Moderate, Low) of the this measure a patient must have a documentation of:

1. 1. Laboratory test, LDL Code, performed during the measurement period.

Or

All of the following tests:

1. Laboratory Test: Total Cholesterol, performed during the measurement period.
2. Laboratory Test: High Density Lipoprotein (HDL), performed during the measurement period.
3. Laboratory Test: Triglycerides, performed during the measurement period

   

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.

Denominator Exceptions:

A fasting LDL-C test is not performed during the measurement period for a valid patient reason. To learn more about how to document a lab test not performed, please click here.