CMS249v5 – Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
CMS249v5
Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period
– DENOMINATOR
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.
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))
The following risk factors may occur at any time in the patient’s history prior to the start of the measurement period:
Osteoporosis
Osteopenia
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
The following risk factors may occur at any time in the patient’s history or during the measurement period:
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
– APPLICATION WORKFLOW
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.
eSuperbill for Encounter
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’.
Example of DXA Scan via Evaluations
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.
BMI Recorded via Vitals
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’.
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’.
Example of Osteoporosis Diagnosis
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.
Example of Gastric Bypass via Procedures
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.
Example of Glucocorticoid Prescription
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’.
History of Hip Fracture
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’.
Example of Oophorectomy Procedure
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’.
