CMS66v9 – Functional Status Assessment for Total Knee Replacement

Patients 19 years of age and older who had a primary total knee arthroplasty (TKA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period

– NUMERATOR

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health, Knee Injury and Osteoarthritis Outcome Score [KOOS], KOOS Jr.) in the 90 days prior to or on the day of the primary TKA procedure, and in the 270 – 365 days after the TKA procedure

 – DENOMINATOR EXCLUSIONS

• Patients with two or more fractures indicating trauma at the time of the total knee arthroplasty or patients with severe cognitive impairment that overlaps the measurement period.
• Exclude patients whose hospice care overlaps the measurement period.

For Denominator:

Patients aged 19 years or older at the start of the measurement period with a qualifying encounter during the measurement period. The patient should also have a ‘Primary TKA Procedure’ performed 12 months or less on or before start of the measurement period.

• To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

• To record the ‘Primary TKA Procedure’ performed, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hovers over ‘Sign & Accept’, then click ‘Complete’. The procedure is added to the provider note.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button. 

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button. 

 For Numerator:

Patients satisfying any of the following conditions are included in the numerator:

• Patients having total knee arthroplasty procedure performed with initial and follow up ‘VR12 Oblique Assessments’.
• Patients having total knee arthroplasty procedure performed with initial and follow up ‘VR12 Orthogonal Assessments’.
• Patients having total knee arthroplasty procedure performed with initial and follow up ‘KOOS Assessments’.
• Patients having total knee arthroplasty procedure performed with initial and follow up ‘KOOSJr Assessments’.
• Patients having total knee arthroplasty procedure performed with initial and follow up ‘PROMIS10 Assessments’.

The TKA procedure should be performed 90 days or less on or after initial assessments. The follow up assessments should be performed with the duration of 270 to 365 days after the end of total knee arthroplasty procedure. Moreover, the result for an assessment must not be null and all the assessments pertaining to a specific assessment category must be recorded on the same day.

• To record the ‘Primary TKA Procedure’ performed, navigate to Patient > Provider Notes > Orders > Procedures.
• To document an assessment performed, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an evaluation. Then select ‘Performed’ from the ‘Status’ dropdown and enter the result in the ‘Result’ field.

For Denominator Exclusions:

Exclude patients satisfying any of the following conditions:

• Patients having a ‘Total Knee Arthroplasty Procedure’ performed with two or more diagnoses for lower body fracture. The lower body fracture prevalence period should start less than 1 day on or before start of the total knee arthroplasty procedure.
  • To record the ‘Total Knee Arthroplasty Procedure’ performed, navigate to Patient > Provider Notes > Orders > Procedures.
  • To document the fracture diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.

• Patients having a diagnosis of ‘Severe dementia (disorder)’ overlapping the measurement period. To document the dementia diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
• Patients who received hospice care during the measurement year. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations