CMS 347v7: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

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

• Have a 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

Encounter Codes Eligible for Denominator 1

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

Diagnosis

The patient must have a 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.

ASCVD Procedure

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 to 75 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 a diagnosis of ASCVD or any prior ASCVD procedure

  AND

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

Encounter Codes Eligible for Denominator 2

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

LDL-C Result

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.

Diagnosis

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

ICD-10: E78.01

ASCVD Diagnosis and Procedure

See Denominator 1 for eligible codes.

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

• Age is 40 to 75 years at the beginning of the Measurement Period

AND

• Have a diagnosis of diabetes during the Measurement Period

AND

• Do not have a 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

Encounter Codes Eligible for Denominator 3

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

Diagnosis

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

ASCVD Diagnosis and Procedure

See Denominator 1 for eligible codes.

LDL-C Result and Familial Hypercholesterolemia Diagnosis

See Denominator 2 for eligible criteria.

• Age is 40 to 75 years at the beginning of the Measurement Period

AND

• Have a 10-year ASCVD risk score of ≥ 20 percent during the Measurement Period

  AND

• Do not have a diagnosis of diabetes during the Measurement Period

AND

• Do not have a diagnosis of ASCVD during the Measurement Period 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

Encounter Codes Eligible for Denominator 4

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

ASCVD Risk Score

To document an ASCVD Risk Score for a patient:

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

2. Click Add New Flowsheet

3. Select the ASCVD Risk Score flowsheet and click Add

4. Click Add Column

5. Enter the score in the Value field

6. Click OK to save

Diagnosis

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

ASCVD Procedure

See Denominator 1 for eligible codes.

LDL-C Result and Familial Hypercholesterolemia Diagnosis

See Denominator 2 for eligible criteria.

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.

FACIT-Pal Questionnaire Flowsheet

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

Palliative Care Services Order

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

HCPCS: G9054

Order Status must be marked as Complete.

Palliative Care Diagnosis

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 > Manage Allergies/Med Hx or Chart > Medications/Assessments > Modify

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

3. 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

4. Optional: populate additional information about the allergy

5. 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:

HCPCS: G8815, G8817

3. Order Status must be Not Performed

4. Not Performed Reason must be Procedure contraindication

5. Click Add to save

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