Brief Description of Measure:
​CMS249: Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture:
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

Description of Issue:
This measure currently uses ​the value set the value set "BMI Ratio (OID: 2.16.840.1.113883.3.600.1.1490)", which contains a single LOINC code. To align with best practices, we propose to replace this single-code value set with the LOINC direct reference code (DRC) of 39156-6, "Body mass index (BMI) [Ratio]". 

Proposed Solution:
​//Terminology

//Before
valueset "BMI Ratio": 'urn:oid:2.16.840.1.113883.3.600.1.1490'

//After
code "Body mass index (BMI) [Ratio]": '39156-5' from "LOINC" display 'Body mass index (BMI) [Ratio]'

//Logic

//Before
define "First BMI in Measurement Period":
... ["Physical Exam, Performed": "BMI Ratio"] BMI
   ...

//After
... ["Physical Exam, Performed": "Body mass index (BMI) [Ratio]"] BMI
   ...

Rationale for Change:
The eCQM Logic and Guidance v5 (May 2021) Section 5.3 states, "the use of direct reference codes prevents using an alternative identifier for a code system concept and eliminates additional implementation work to unpack the value set". 
Therefore, we propose to replace the value set, "BMI Ratio (2.16.840.1.113883.3.600.1.1490)" with a DRC to align with current best practices.