CMS 347v6: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Measure: Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

  • All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR

  • Patients aged ≥ 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

  • Patients aged 40-75 years with a diagnosis of diabetes
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator

Denominator 1: All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure

Denominator 2: 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

Denominator 3: Patients aged 40-75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes
Numerator Patients who are actively using or who receive an order (prescription) for statin therapy 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
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

This eCQM requires a lab interface to be met. Customers interested in a lab interface should contact Sevocity Support to begin the process of a new interface setup. Interface setup requirements and fees vary per request.

Patients who meet the following criteria will be included in the denominator:

  • Have an active diagnosis of clinical ASCVD during the Measurement Period or who have ever had an ASCVD procedure

    AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99395, 99396, 99397, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

The patient must have an active diagnosis of clinical ASCVD during Measurement Period. Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for clinical ASCVD can be located here.

To document an ASCVD procedure as an order, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937, 92941, 92943

HCPCS: S2205, S2206, S2207, S2208, S2209

Order Status must be marked as Complete.

To document an ASCVD procedure from the patient history, Go to Encounter > Past History > Structured > Surgical History and select the hardcoded Coronary artery bypass graft node

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 20 years at the beginning of the Measurement Period

    AND

  • Had an LDL cholesterol (LDL-C) lab result ≥ 190 mg/dL or was previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

    AND

  • Do not have an active diagnosis of ASCVD or any prior ASCVD procedure

  • AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99395, 99396, 99397, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

To document the LDL-C lab result, it must be stored as an e-Lab in the patient chart.

  1. From the Clinic Inbox, select the lab result to be stored and click View
    1. If the lab result is systematically matched to a patient, the Patient section will be populated in the lab result display
    2. If the lab result is not matched or the matched patient needs to be changed, the user will need to search for the patient
  2. Optional: click Select to search for and select a patient
  3. Select the I have verified the following lab results belong to the above patient checkbox
  4. Click Sign/Route
  5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis code for familial hypercholesterolemia is:

ICD-10: E78.01

See Denominator 1 for eligible codes.

Patients who meet the following criteria will be included in the denominator:

  • Age ≥ 40 years and ≤ 75 years at the beginning of the Measurement Period

    • AND

  • Have a diagnosis of diabetes during the Measurement Period

    • AND

  • Do not have an active diagnosis of ASCVD or any prior ASCVD procedure or an LDL-C lab result ≥ 190 mg/dL or a previous or current diagnosis of familial hypercholesterolemia

    • AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99395, 99396, 99397, 99429, 99401, 99402, 99403, 99404, 99385, 99386, 99387

HCPCS: G0438, G0439

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for diabetes can be located here.

See Denominator 1 for eligible codes.

See Denominator 2 for eligible criteria.

A patient will be counted as an exception for this measure if they meet any of the following conditions:

  • Is in hospice care for any part of the Measurement Period

  • Is receiving palliative care for any part of the Measurement Period

  • Has a diagnosis of hepatitis, liver disease, statin associated muscle symptoms, or ESRD

  • Has an allergy to statin medication

  • Has a medical reason for not being prescribed statin therapy

To document hospice care ambulatory services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

To document hospice care encounter services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9996, G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

Palliative care services can be documented using the FACIT-Pal Questionnaire flowsheet, as an order, or as a diagnosis.

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard

  2. Click Add New Flowsheet

  3. Select the FACIT-Pal Questionnaire flowsheet and click Add

  4. Click Add Column

  5. Populate the patient's responses to the questions as appropriate

  6. Click OK to save

Go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9054, M1017

Order Status must be marked as Complete.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis code for palliative care is:

ICD-10: Z51.5

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for these exceptions are:

Hepatitis A

ICD-10: B15.0, B15.9

Hepatitis B

ICD-10: B16.0, B16.1, B16.2, B16.9, B18.0, B18.1, B19.10, B19.11

Liver Disease

ICD-10: B17.0, B17.10, B17.11, B17.2, B17.8, B17.9, B18.2, B18.8, B18.9, B19.0, B19.20, B19.21, B19.9, K70.0, K70.10, K70.11, K70.2, K70.30, K70.31, K70.40, K70.41, K70.9, K71.0, K71.10, K71.11, K71.2, K71.3, K71.4, K71.50, K71.51, K71.6, K71.7, K71.8, K71.9, K72.00, K72.01, K72.10, K72.11, K72.90, K72.91, K73.0, K73.1, K73.2, K73.8, K73.9, K74.00, K74.01, K74.02, K74.1, K74.2, K74.3, K74.4, K74.5, K74.60, K74.69, K75.4, O98.411, O98.412, O98.413, O98.419B17.0, B17.10, B17.11, B17.2, B17.8, B17.9, B18.2, B18.8, B18.9, B19.0, B19.20, B19.21, B19.9, K70.0, K70.10, K70.11, K70.2, K70.30, K70.31, K70.40, K70.41, K70.9, K71.0, K71.10, K71.11, K71.2, K71.3, K71.4, K71.50, K71.51, K71.6, K71.7, K71.8, K71.9, K72.00, K72.01, K72.10, K72.11, K72.90, K72.91, K73.0, K73.1, K73.2, K73.8, K73.9, K74.00, K74.01, K74.02, K74.1, K74.2, K74.3, K74.4, K74.5, K74.60, K74.69, K75.4, O98.411, O98.412, O98.413, O98.419

Statin Associated Muscle Symptoms

ICD-9: 359.9, 729.1

ICD-10: G72.0, G72.9, M60.9, M79.10

End Stage Renal Disease

ICD-10: N18.6

To document a patient allergy to statin medication:

  1. Go to Encounter > Allergies/Meds Hx

  2. Click Manage Allergies/Med Hx

  3. From the Allergies section, click the Add Allergen icon ()

  4. From the Allergen field, search for and add one of the following items :

    • rosuvastatin

    • simvastatin

    • fluvastatin

    • pravastatin

    • lovastatin

    • atorvastatin

    • pitavastatin

    • Statins-Hmg-Coa Reductase Inhibitors

  5. Optional: populate additional information about the allergy

  6. Click Save

To document a medical reason the patient was not prescribed statin therapy:

  1. Go to Encounter > Orders/Procedure > Orders/Referrals

  2. Click Add to add one of the following eligible codes:

    3. HCPCS: G8815, G8817

  3. Order Status must be Not Performed

  4. Not Performed Reason must be Procedure contraindication

  5. Click Add to save

A patient will be excluded from this measure if they meet any of the following conditions:

  • Are breastfeeding at any time during the Measurement Period
  • Have a diagnosis of rhabdomyolysis at any time during the Measurement Period

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for these exclusions are:

Breastfeeding

ICD-10: O91.03, O91.13, O91.23, O92.03, O92.13, O92.5, O92.70, O92.79, Z39.1

Rhabdomyolysis

ICD-10: M62.82, T79.6XXA, T79.6XXD, T79.6XXS

A patient will be counted in the numerator if they are actively using or receive a prescription for statin therapy at any time during the Measurement Period.

To prescribe a medication for statin therapy, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible medications can be located here.

https://ecqi.healthit.gov/ecqm/ec/2023/cms347v6

 

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