CMS 66 - Functional Status Assessment for Total Knee Replacement

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Covered by this topic

Overview

CMS66v8 (2020)

CMS66v9 (2021)

CMS66v10 (2022)

Identifiers

CMS eCQM ID NQF eCQM ID NQF MIPS Quality ID
CMS66v10 – – 375

*MIE only supports data collection and reporting using eCQM specifications

Definitions

Description Percentage of patients 18 years of age and older who received an elective primary total knee arthroplasty (TKA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery
Initial Patient Population 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
Denominator Equals Initial Population
Denominator Exclusions
  • Exclude patients with two or more fractures indicating trauma at the time of the total knee arthroplasty or patients with severe cognitive impairment that starts before or in any part of the measurement period.
  • Exclude patients who are in hospice care for any part of the measurement period.
Numerator Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], 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
Numerator Exclusions –
Denominator Exceptions –

Additional Information

Measure Type Process measure
Measure Scoring Proportion measure
Granularity Patient
Improvement Notation Higher score indicates better quality
Domain Person and Caregiver-Centered Experience and Outcomes

Clinical Instructions

Ensure all 18+ year-old patients with a total knee replacement in the year prior to the measurement period have a functional status assessment during the measurement period.

Workflow

Coming soon.

Evidence

Initial Patient Population

Name Value Set
Encounter, Performed: Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Online Assessments 2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Outpatient Consultation 2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed: Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure CPT Code 99024
Encounter, Performed: Telephone Visits 2.16.840.1.113883.3.464.1003.101.12.1080
Procedure, Performed: Primary TKA Procedure 2.16.840.1.113883.3.464.1003.198.12.1007

Denominator Exclusions

Name Value Set
Diagnosis: Fracture - Lower Body 2.16.840.1.113883.3.464.1003.113.12.1037
Diagnosis: Severe dementia (disorder) SNOMEDCT Code 428351000124105
Encounter, Performed: Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Intervention, Order: Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15

Numerator

Name Value Set
Assessment, Performed: Activities of daily living score [KOOS} LOINC Code 72100-1
Assessment, Performed: Knee injury and osteoarthritis outcome score for joint replacement [KOOSJR] LOINC Code 82324-5
Assessment, Performed: Pain score [KOOS] LOINC Code 72102-7
Assessment, Performed: PROMIS-10 Global Mental Health (GMH) score T-score LOINC Code 71969-0
Assessment, Performed: PROMIS-10 Global Physical Health (GPH) score T-score LOINC Code 71971-6
Assessment, Performed: Quality of life score [KOOS] LOINC Code 72098-7
Assessment, Performed: Sport-recreation score [KOOS] LOINC Code 72099-5
Assessment, Performed: Symptoms score [KOOS] LOINC Code 72101-9
Assessment, Performed: VR-12 Mental component summary (MCS) score - oblique method T-score LOINC Code 72026-8
Assessment, Performed: VR-12 Mental component summary (MCS) score - orthogonal method T-score LOINC Code 72028-4
Assessment, Performed: VR-12 Physical component summary (PCS) score - oblique method T-score LOINC Code 72025-0
Assessment, Performed: VR-12 Physical component summary (PCS) score - orthogonal method T-score LOINC Code 72027-6

Source(s)

eCQI CMS66

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