Measure Description
Percentage of patients regardless of age undergoing a total knee or total hip replacement with documented shared decision- making with discussion of conservative (non-surgical) therapy (e.g., non-steroidal anti-inflammatory drug (NSAIDs), analgesics, weight loss, exercise, injections) prior to the procedure.
Instructions
This measure is to be submitted each time a procedure for total knee or total hip replacement is performed during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients regardless of age undergoing a total knee or total hip replacement
Denominator Criteria (Eligible Cases):
All patients, regardless of age
AND
Patient procedure during the performance period (CPT): 27438, 27442, 27445, 27446, 27447, 27130
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
Numerator
Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g. NSAIDs, analgesics, weight loss, exercise, injections) prior to the procedure
Numerator Options:
Performance Met: Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., NSAIDs, analgesics, weight loss, exercise, injections) prior to the procedure (G9296)
OR
Performance Not Met: Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., NSAIDs, analgesics, weight loss, exercise, injections) prior to the procedure not documented, reason not given (G9297)
Rationale
A trial of non-surgical therapy should be used prior to surgery, when possible. Non-surgical therapy may include the use of NSAIDs, other analgesics, exercise, or injections. For patients with severe disability, the patient and surgeon may decide after a thorough review of conservative options that the optimal treatment is to proceed with the operative intervention.
This measure is designed for use by physicians and eligible health care professionals managing ongoing care for all patients undergoing a total knee or hip replacement. This measure addresses the preoperative period.
Clinical Recommendation Statements
AAOS Management of Osteoarthritis of the Knee (Non-Arthroplasty) (3rd Edition), 2021
AAOS recommends self-management programs to improve pain and function for patients with knee osteoarthritis. (Strong Recommendation)
AAOS recommends patient education programs to improve pain in patients with knee osteoarthritis. (Strong Recommendation)
AAOS recommends supervised exercise, unsupervised exercise, and/or aquatic exercise over no exercise to improve pain and function for treatment of knee osteoarthritis. (Strong Recommendation)
AAOS recommends sustained weight loss to improve pain and function in overweight and obese patients with knee osteoarthritis. (Moderate Recommendation)
AAOS recommends topical nonsteroidal anti-inflammatory drugs (NSAIDs) be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated. (Strong Recommendation)
AAOS recommends oral NSAIDs to improve pain and function in the treatment of knee osteoarthritis when not contraindicated. (Strong Recommendation)
AAOS Management of Osteoarthritis of the Hip, 2017
AAOS recommends NSAIDs to improve short-term pain, function, or both in patients with symptomatic osteoarthritis of the hip. (Strong Recommendation)
AAOS recommends the use of intraarticular corticosteroids to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip. (Strong Recommendation)
AAOS recommends the use of physical therapy as a treatment to improve function and reduce pain for patients with osteoarthritis of the hip and mild to moderate symptoms. (Strong Recommendation)
OARSI Guidelines for the Non-surgical Management of Knee, Hip, and Polyarticular Osteoarthritis (Bannuru R, Osani M, Vaysbrot E, Trojian T, et al, 2019)
For patients with Hip OA, only structured land-based exercise programs were considered eligible for Core Treatment designation. Arthritis education was considered a standard of care. Structured land-based exercise programs, dietary weight management in combination with exercise, and mind-body exercise (such as Tai Chi and Yoga) were considered by the panel to be effective and safe for all patients with Knee OA, regardless of comorbidity. These treatments are recommended for use alone or along with interventions of any recommendation level, as deemed appropriate for the individual. Education about OA is considered a standard of care. Core Treatments (treatments deemed appropriate for use by the majority of patients in nearly any scenario and deemed safe for use in conjunction with first line and second line treatments)