CMS 347v8: 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

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

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

• 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

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.

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-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.