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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
109 0000 Process Yes Person and Caregiver-Centered Experience and Outcomes Claims

Measure Description

Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain

Instructions

This measure is to be submitted one time during the performance period for patients with osteoarthritis seen during the performance period. The assessment can be completed either during a denominator eligible encounter or via electronic/mobile system. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: No notes for this Quality ID

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

Patient visits with assessment for level of function and pain documented (may include the use of a standardized scale or the completion of an assessment questionnaire, such as an SF-36, AAOS Hip & Knee Questionnaire)

Numerator Instructions:

Acceptable assessments for Pain Assessment include the following:

  • Visual Analog Scale (VAS)
  • PROMIS
  • Numeric Pain Rating System

Acceptable assessments for Functional Assessment include the following:

General Quality of Life

  • Veterans RAND 12 (VR-12)
  • PROMIS (PROMIS 10 or CAT)
  • EuroQol-5D (EQ-5D)

Foot and Ankle

  • Foot and Ankle Ability Measure (FAAM)
  • Foot and Ankle Disability Index (FADI)

Knee (Anterior Cruciate Ligament)

  • International Knee Documentation Committee (IKDC) Subjective Knee Form (Pedi-IKDC)
  • Marx Activity Rating Scale

Knee (Osteoarthritis)

  • Knee Injury and Osteoarthritis Outcome Score (KOOS)
  • Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS Jr.)

Hip (Osteoarthritis)

  • Hip Disability and Osteoarthritis Outcomes Survey (HOOS)
  • Hip Disability and Osteoarthritis Outcomes Survey Jr. (HOOS Jr.)

Shoulder

  • American Shoulder and Elbow Surgeons Standardized Shoulder

Assessment Form (ASES)

  • Oxford Shoulder Score (OSS)
  • Single Assessment Numeric Evaluation (SANE)

Shoulder (Instability)

  • American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES)
  • Western Ontario Shoulder Instability Index (WOSI)

Elbow

  • Disabilities of the Arm, Shoulder, and Hand Score (DASH)
  • Quick-DASH

Wrist

  • Disabilities of the Arm, Shoulder, and Hand Score (DASH)
  • Quick-DASH

Hand

  • Disabilities of the Arm, Shoulder, and Hand Score (DASH)
  • Quick-DASH

Numerator Quality-Data Coding Options

Denominator Exclusion:

No data available

Performance Met: CPT II 1006F:
Osteoarthritis Symptoms and Functional Status Assessed

Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire)

Performance Not Met: CPT II 1006F with 8P:
Osteoarthritis Symptoms and Functional Status not Assessed, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 1006F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Osteoarthritis symptoms and functional status not assessed, Reason not otherwise specified

NUMERATOR NOTE: For the purposes of this measure, the method for assessing function and pain is left up to the discretion of the individual eligible clinician and based on the needs of the patient. The assessment may be done via a validated instrument (though one is not required) that measures pain and various functional elements including a patient’s ability to perform activities of daily living (ADLs)

Denominator

All patient visits for patients aged 21 years and older with a diagnosis of OA

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 21 years on date of encounter

AND

Diagnosis for osteoarthritis (OA) (ICD-10-CM): M15.0, M15.1, M15.2, M15.3, M15.4, M15.8, M15.9,
M16.0, M16.10, M16.11, M16.12, M16.2, M16.30, M16.31, M16.32, M16.4, M16.50, M16.51,M16.52,
M16.6, M16.7, M16.9, M17.0, M17.10, M17.11, M17.12, M17.2, M17.30, M17.31, M17.32, M17.4, M17.5,
M17.9, M18.0, M18.10, M18.11, M18.12, M18.2, M18.30, M18.31, M18.32, M18.4, M18.50,M18.51,
M18.52, M18.9, M19.011, M19.012, M19.019, M19.021, M19.022, M19.029, M19.031, M19.032,M19.039,
M19.041, M19.042, M19.049, M19.071, M19.072, M19.079, M19.111, M19.112, M19.119,M19.121,
M19.122, M19.129, M19.131, M19.132, M19.139, M19.141, M19.142, M19.149, M19.171,M19.172,
M19.179, M19.211, M19.212, M19.219, M19.221, M19.222, M19.229, M19.231, M19.232,M19.239,
M19.241, M19.242, M19.249, M19.271, M19.272, M19.279, M19.90, M19.91, M19.92, M19.93

 

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