Statin therapy for patients with diabetes (SPD) exclusions.

Make sure to document HEDIS® Quality Measure exclusions.

The Statin Therapy for Patients with Diabetes (SPD) measure is a key performance metric used by NCQA to assess the quality of care provided to individuals with diabetes.

Measure Criteria: The SPD measure is the percentage of US Family Health Plan beneficiaries aged 40-75 with diabetes who do not have clinical Atherosclerotic Cardiovascular Disease (ASCVD) who have at least one fill of a statin medication during the measurement year.

Our goal is to ensure eligible patients with diabetes are prescribed a statin unless they meet certain exclusion criteria. 

Documenting exclusions.

Documentation of exclusions each year is important to maintain accurate information and properly exclude patients from this measure calculation.

EXCLUSIONS

Patients are excluded if, at any point during the measurement year, any of the following apply.

• Are in hospice or palliative care.
• Have a diagnosis of myalgia, myositis, myopathy, or rhabdomyolysis.
• Are a Medicare member ≥ 66 years old as of December 31 and enrolled in an institutional special needs plan (I-SNP) or in long-term care (LTC).

Patients are excluded if, at any point during the measurement year OR the year prior to the measurement year, any of the following apply.

• Have a diagnosis of cirrhosis, end-stage renal disease (ESRD), or are on dialysis.
• Are pregnant.
• Are receiving in-vitro fertilization (IVF) or have received ≥1 clomiphene prescription.
• Are ≥ 66 years old as of December 31 and have both frailty and advanced illness.
• Have a diagnosis of ischemic vascular disease (IVD)

Patients are excluded if, at any point during the year prior to the measurement year, they:

• Have a diagnosis of myocardial infarction (MI).
• Have had a coronary artery bypass graft (CABG).
• Have had a percutaneous coronary intervention (PCI).
• Have had other revascularization procedures.

Patients are excluded if, at ANY time during the member’s history through the measurement year, they have had the following:

• Myalgias or rhabdomyolysis caused by a statin.

ICD-10 documentation examples.

Hospice or Palliative Care
Z51.5

End-Stage Renal Disease (ESRD)
N18.6, Z99.2, N19

Rhabdomyolysis or Myopathy
M62.82, G72.9, G72.89

Pregnancy
O09.90, Z33.1

Cirrhosis
K70.30, K71.7, P78.81

_{ICD-10 code list is illustrative and not comprehensive.}