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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
024 0045 Process Yes Communication and Care Coordination Claims, Registry

Measure Description

Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s ongoing care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is reported by the physician who treats the fracture and who therefore is held accountable for the communication.

Instructions

This measure is to be submitted after each occurrence of a fracture during the performance period. It is anticipated that eligible clinicians who treat the fracture will submit this measure. Each occurrence of a fracture is identified by either an ICD- 10-CM diagnosis code for fracture or osteoporosis and a CPT service code OR an ICD-10-CM diagnosis code for fracture or osteoporosis and a CPT procedure code for surgical treatment of a fracture.

NOTE: Patients with a fracture should have documentation in the medical record of communication from the clinician treating the fracture to the clinician managing the patient’s on-going care that the fracture occurred and that the patient was or should be tested or treated for osteoporosis. If multiple fractures occurring on the same date of service are submitted on the same claim form, only one instance of submission will be counted. Claims data will be analyzed to determine unique occurrences. Documentation must indicate that communication to the eligible clinician managing the on- going care of the patient occurred within three months of treatment for the fracture. The CPT Category II code should be submitted during the episode of care (e.g., treatment of the fracture). The submission of the code and documentation of communication do not need to occur simultaneously.

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients with documentation of communication with the physician or other clinician managing the patient’s on-going care that a fracture occurred and that the patient was or should be considered for osteoporosis testing or treatment

Definition

Communication – May include documentation in the medical record indicating that the clinician treating the fracture communicated (e.g., verbally, by letter, through shared electronic health record, a bone mineral density test report was sent) with the clinician managing the patient’s on-going care OR a copy of a letter in the medical record outlining whether the patient was or should be treated for osteoporosis.

Numerator Quality-Data Coding Options

Denominator Exclusion: G9688:
Patient receiving Hospice Services, Patient Not Eligible:

Patient using hospice services any time during the measurement period.

Performance Met: CPT II 5015F:
Post Fracture Care Communication Documented

Documentation of communication that a fracture occurred and that the patient was or should be tested or treated for osteoporosis.

Performance Not Met: 5015F with 8P:
Post Fracture Care not Communicated, Reason not Otherwise Specified

No documentation of communication that a fracture occurred and that the patient was or should be tested or treated for osteoporosis, reason not otherwise specified.

Append a submission modifier (8P) to CPT Category II code 5015F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Denominator

Adults aged 50 years and older who experienced a fracture, except fractures of the finger, toe, face or skull

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 50 years on date of encounter

AND

Diagnosis for a fracture, except fractures of the finger, toe, face or skull (ICD-10-CM)

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