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May 2013

HEDIS specifications for LDL-C medical record documentation have changed

The 2013 Healthcare Effectiveness Data and Information Set® specifications for LDL-Cs have changed for Cholesterol Management for Patients with Cardiovascular Conditions and Comprehensive Diabetes Care.

This includes Blue Cross Blue Shield of Michigan and Blue Care Network Health e-Blue entries and data received from electronic medical records and disease management registries, as well as paper medical records.

Following are the 2013 documentation requirements for LDL-C medical records:

  • At a minimum, include in the medical record a note indicating the date when the LDL-C test was performed and the result.
  • Calculate LDL-C levels from total cholesterol, HDL-C and triglycerides, using the Friedewald equation if the triglycerides are less than or equal to 400 mg/dL. For example:
    LDL-C = total cholesterol – HDL – triglycerides/5
  • If measuring lipoprotein (a), use the following calculation:
    LDL-C = total cholesterol – HDL – triglycerides/5 – 0.3 [lipoprotein (a)]

These formulas are used when all levels are expressed in mg/dL and cannot be used if triglycerides are greater than 400 mg/dL. Do not use the Friedewald equation if a direct or calculated result is present in the medical record for the most recent LDL-C test.

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
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