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  2. CQM-6659

CPT Code missing from Value set for denominator exclusion: CMS249v5

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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      Thank you for your inquiry for CMS249v5 (2024 performance period), Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture.
      We will review this code during the next Annual Update. Any changes will be included in a future release. Equivalent services can be mapped to the measure's value set. If mapping is done, you should maintain documentation in case of a CMS audit.
      Show
      Thank you for your inquiry for CMS249v5 (2024 performance period), Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture. We will review this code during the next Annual Update. Any changes will be included in a future release. Equivalent services can be mapped to the measure's value set. If mapping is done, you should maintain documentation in case of a CMS audit.
    • CMS0249v5
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      Patients with billed procedure code CPT 58571 for hysterectomy, total, abdominal, robot-assisted, with bilateral salpingo-oophorectomy (possible open) are not being excluded from this metric becasue this CPT code is missing from the value set valueset "Bilateral Oophorectomy" (2.16.840.1.113883.3.526.3.471)
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      Patients with billed procedure code CPT 58571 for hysterectomy, total, abdominal, robot-assisted, with bilateral salpingo-oophorectomy (possible open) are not being excluded from this metric becasue this CPT code is missing from the value set valueset "Bilateral Oophorectomy" (2.16.840.1.113883.3.526.3.471)

      This metric is looking for the appropriate use of DEXA scans in women under 65 who do not meet the risk factor profile for osteoporotic fracture. Patients are in numerator if a dexa scan is ordered without documentation to exclude from numerator or denominator. Lower performance (less in numerator) is better. 

      Numerator exclusion: one of these screening tools any time in pt's hx BEFORE dexa scan ordered: FRAX[R] >=8.4%; ORAI >=9; OSIRIS <1; OST <2

      Denominator Exclusion:

      • During measurement year: BMI <= 20 kg/m2; Alcohol consumption (> two units per day 
      • history prior to measurement year: osteoporosis or oseopenia
      • prior to measurement year and not active in measurement year: Gastric bypass; active rx/order for Aromatase inhibitors; history of hip fracture in parent
      • in history or during measurement year: osteoporotic fractures; malabsorption syndromes; chronic malnutrition; chronic liver disease; RA; hyperthyroidism; Type 1 DM; ESRD; Osteogenesis imperfecta; psoriatic arthritis; ehlers danlos syndrome; cushings syndrome; hyperparathyroidims; lupus; marfans syndrome; multiple lyeloma; premature menopause; eating disorder; amenorrhea; procedure in pt history: chemo or has double or bilateral oopherectomy.

      We have a patient who was ordered a Dexa scan which is putting the patient in the numerator. However, DEXA ordered d/t history of bilateral BSO in 2022, billed procedure CPT code 58571. A history of a BSO is a denominator exclusion for this metric if occurred anytime in patient history or during MY. Looking at the value set (valueset "Bilateral Oophorectomy" (2.16.840.1.113883.3.526.3.471), this CPT code is not included.

            edave Mathematica EC eCQM Team
            hclodfe1 Heather Clodfeler
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