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 ​The Measure Developer received feedback from the QDM standards team that the current LOINC code applied to assess the number of alcoholic drinks per day may be specific to the emergency department setting. ​To address the potential implementation concern, ​t​he Measure Developer proposes adding another LOINC code that may be a part of another generic panel not specific to the emergency department setting: LOINC code 74013-4 "Alcoholic drinks per day". The currently applied direct reference code and the additional LOINC code above will be part of an existing value set that will be applied to the logic. Goal of review Obtain clinical feedback

Proposed solution ​//Before code "Alcoholic drinks per drinking day - Reported" ("LOINC Code (11287-0)") define "First Average Number of Drinks Assessment Indicating More Than Two Per Day":         First(["Assessment, Performed": "Alcoholic drinks per drinking day - Reported"] AverageDrinks             where ...         ) //After valueset "Average Number of Drinks per Drinking Day" (2.16.840.1.113883.3.464.1003.106.12.1018) - This value set includes a single code: "Alcoholic drinks per drinking day - Reported" ("LOINC Code (11287-0)") - Add code 74013-4 “Alcoholic drinks per day” ("LOINC Code (74013-4)") define "First Average Number of Drinks Assessment Indicating More Than Two Per Day":         First(["Assessment, Performed": "Average Number of Drinks per Drinking Day"] AverageDrinks             where ...         ) Rationale for change The additional code to capture number of alcoholic drinks per day is agnostic of setting and can be more generally applied to meet measure criterion.