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NCQA Updates to HSRP and DRP

NCQA is making minor changes to its Heart-Stroke Recognition Program (HSRP) and Diabetes Recognition Program (DRP), effective May 1. Changes will provide additional clarification for the Statin Therapy for Patients With Cardiovascular Disease (SPC) HEDIS measure and will streamline the release of future program updates.

HSRP and DRP Updates Will Be Released Annually on November 1

To provide a predictable schedule for HSRP/DRP requirement updates, all policy, coding and clarification update notices will be sent each November 1. Notices will contain information about upcoming changes and the effective implementation date.

Provide NDC List for Applicable Measures

As HEDIS measures evolve, more information may be necessary for measurement. NCQA will provide NDC codes for practices to use when submitting measurement data. Links to NDC lists will be available in the “Resources” section of the data collection tool.

Click here to view the NDC codes for Statin Therapy for Patients With Cardiovascular Disease in HSRP.

Updated Value Set and Data Dictionary Codes for HSRP

The list of eligible ICD-9 and ICD-10 codes to identify patients with ischemic vascular disease (IVD) has changed. The list of codes and the value set table will be updated to ensure that practices have the most current list to identify patients for the sample.

ICD Codes Removed From the IVD Value Set

ICD-9 Codes

ICD-10 Codes

444.1, 444.21, 444.22, 444.81, 444.89, 444.9

I24.1, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09, I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.30, I63.311, I63.312, I63.319, I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40, I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441. I63.442, I63.449, I63.49, I63.6, I63.8, I63.9, I70.0, I70.8, I70.90, I70.91, I74.01, I74.09, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8, I74.9

Clarifications to SPC

Updates clarify two items in this measure:

  1. Clarify the child-bearing age exclusion language. Women who are pregnant or could become pregnant should not use statins. The current language does not take into account the variations in child-bearing age. The language will be modified to identify patients whose chart documents that they are trying to become pregnant or are using specific drugs for in vitro fertilization.
  2. Provide instructions for identifying statin therapy by intensity (high, medium, low). The medication table and explanations will classify statin therapies according to their intensity. This change will help label statin intensity in the data collection tool.


Description

Prescription

High-intensity statin therapy

  • Atorvastatin 40–80 mg
  • Amlodipine-atorvastatin 40–80 mg
  • Ezetimibe-atorvastatin 40–80 mg
  • Rosuvastatin 20–40 mg
  • Simvastatin 80 mg
  • Ezetimibe-simvastatin 80 mg

Moderate-intensity statin therapy

  • Atorvastatin 10–20 mg
  • Amlodipine-atorvastatin 10–20 mg
  • Ezetimibe-atorvastatin 10–20 mg
  • Rosuvastatin 5–10 mg
  • Simvastatin 20–40 mg
  • Ezetimibe-simvastatin 20–40 mg
  • Niacin-simvastatin 20–40 mg
  • Sitagliptin-simvastatin 20–40 mg
  • Pravastatin 40–80 mg
  • Lovastatin 40 mg
  • Niacin-lovastatin 40 mg
  • Fluvastatin XL 80 mg
  • Fluvastatin 40 mg bid
  • Pitavastatin 2–4 mg

Low-intensity statin therapy

  • Simvastatin 10 mg
  • Ezetimibe-simvastatin 10 mg
  • Sitagliptin-simvastatin 10 mg
  • Pravastatin 10–20 mg
  • Lovastatin 20 mg
  • Niacin-lovastatin 20 mg
  • Fluvastatin 20–40 mg
  • Pitavastatin 1 mg