NQF 0064 (Additional) - Diabetes: Low Density Lipoprotein (LDL) Management and Control (2012)

Measure: NQF 0064 (Additional Measure)

Measure Title: Diabetes: Low Density Lipoprotein (LDL) Management and Control

Measure Description: The percentage of patients 18-75 years of age with Diabetes (Type 1 or Type 2) who had LDL-Cholesterol < 100 mg/dL.

Quality Measure Documentation Workflow

In order for the Clinical Quality Measure report to generate, the following must be documented in the relevant patient's chart:

1. Patient's must be between age 18-75 years of age at the start of the reporting period and have at least one face-to-face encounter with the provider during the reporting period.

2. Patients must have a diagnosis of Diabetes (Type 1 or Type 2) documented in the Summary Active Problems or the Assessment field of the encounter using one of the following ICD codes:
250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.

3. Two documentation options:

(a) Documentation that LDL-Cholesterol was < 100 mg/dL. Inserting the shortcut code "PQRIdmLDL" in the encounter Plan field or Summary Interventions field will allow the user to select from a group of specific SMARText CPT codes that can be used to document for this measure. The encounter Plan field or Summary Interventions field must inlcude the CPT code listed below:

  • 3048F

 

OR

(b) Documentation in the Lab chart section using a Lab Test that is named one of the following: "LDL-C, LDL Cholesterol, LDL-Calculated, LDL Calculated, or LDL"* with a structured result < 100 on the last LDL.
*Note: It is very important that the name of the lab test exactly matches one of the items listed above. To edit your lab test names in SOAPware, go to Tools > Lab Tests.

Measure Calculation Details

Eligible Providers will be required to report two population criteria for this Clinical Quality Measure.

Population Criteria #1: Patient between 18-75 years of age that have had a LDL test

Numerator Calculation:

The numerator for this measurement is calculated based on the following:

1. The number of patients in the denominator who have one of the following documented during the reporting period:

(a) The following SMARText CPT code documented in the Summary Interventions for or the encounter Plan field using "PQRIdmLDL":

  • 3048F: LDL < 100

The following codes will not increase the numerator

  • 3049F: LDL = 100-129
  • 3050F: >= 130
  • 3048F-8P: LDL NOT Performed

OR

(b) Documentation of a structured LDL Cholesterol lab test in the Labs chart section using one of the following Lab Test Names: "LDL-C, LDL Cholesterol, LDL-Calculated, LDL Calculated, or LDL"*.
*Note: It is very important that the name of the lab test exactly matches one of the items listed above. To edit your lab test names in SOAPware, go to Tools > Lab Tests.

The following lab test results will increase numerator #1:

Test Name Value

  • LDL Cholesterol with a value of < 100
  • LDL Cholesterol with a value of => 100
  • LDL Calculated with a value of < 100
  • LDL Calculated with a value of => 100
  • LDL-Calculated with a value of < 100
  • LDL-Calculated with a value of =>100
  • LDL with a value of < 100
  • LDL with a value of => 100
  • LDL-C with a value of < 100
  • LDL-C with a value of => 100

Denominator Calculation:

The denominator for this measurement is calculated based on the following:

1. The number of patients who were between the ages of 18 and 75 at the start of the reporting period and have at least one face-to-face encounter with the provider during the reporting period;

2. And have a diagnosis of Diabetes (Type 1 or Type 2) in the Summary Active Problems field or encounter Assessment field documented using one of the following ICD9 codes:
250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648

Population Criteria #2: Patient between 18-75 years of age that have had a LDL test < 100 mg/dL

Numerator Calculation:

The numerator for this measurement is calculated based on the following:

1. The number of patients in the denominator who have one of the following documented during the reporting period:

(a) The following SMARText CPT code documented in the Summary Interventions for or the encounter Plan field using "PQRIdmLDL":

  • 3048F: LDL < 100

The following codes will not increase the numerator

  • 3049F: LDL = 100-129
  • 3050F: >= 130
  • 3048F-8P: LDL NOT Performed

OR

(b) Documentation of a structured LDL Cholesterol lab test in the Labs chart section using one of the following Lab Test Names: "LDL-C, LDL Cholesterol, LDL-Calculated, LDL Calculated, or LDL"*.
*Note: It is very important that the name of the lab test exactly matches one of the items listed above. To edit your lab test names in SOAPware, go to Tools > Lab Tests.

The following lab test results will increase numerator #1:

Test Name Value

  • LDL Cholesterol with a value of < 100
  • LDL Calculated with a value of < 100
  • LDL-Calculated with a value of < 100
  • LDL with a value of < 100
  • LDL-C with a value of < 100

Denominator Calculation:

The denominator for this measurement is calculated based on the following:

1. The number of patients who were between the ages of 18 and 75 at the start of the reporting period and have at least one face-to-face encounter with the provider during the reporting period;

2. And have a diagnosis of Diabetes (Type 1 or Type 2) in the Summary Active Problems field or encounter Assessment field documented using one of the following ICD9 codes:
250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648

Report Clinical Quality Measures to CMS/States

All of the items listed in the above steps need to be documented as structured data (as detailed above) in order to allow the user to capture the numerator, denominator and percentage for this quality measure.

For information on how to export the numerator, denominator and percentage for each Clinical Quality Measure, Click here.

For more information on reporting clinical quality measures, Click here.