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 a minimum of once per performance period for patients with a diagnosis of 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 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 patient visits for patients aged 21 years and older with a diagnosis of OA
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
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
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 NOTE: For the purposes of this measure, the method for assessing function and pain is left up to the discretion of the individual MIPS 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).
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 Options:
Performance Met: 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) (1006F)
OR
Performance Not Met: Osteoarthritis symptoms and functional status not assessed, Reason not otherwise specified (1006F with 8P)