Total Knee Replacement Specifications 2014 (01/01/2012 to 12/31/2012 Dates of Procedure)

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Merry Lyons
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1 Summary of Changes Removed following ICD-9 Procedure s: Total Knee Replacement (Bicompartmental, Partial Knee Replacement, Tricompartmental, Unicompartmental (hemijoint)) Revision of Knee Replacement, not otherwise specified. Description Methodology For patients ages 18 and older who undergo a primary or revision total knee replacement procedure during the measurement period, the following measures will be captured: 1. Average post-operative functional status at one year for patients undergoing total knee replacement as measured by the Oxford Knee Score tool. 2. Average post-operative quality of life at one year for patients undergoing total knee replacement as measured by the EQ-5D tool. All functional status and quality of life measures will be reported as separate rates (stratified) for primary knee replacement and for revision knee replacement. Population identification is accomplished via a query of a practice management system or electronic medical record (EMR) to identify the population of eligible patients (denominator). Data elements are either extracted from an EMR system or abstracted through medical record review. Data is submitted via the direct data submission process using MNCM s data portal to upload a data file. Full population data is required. The submission file is to include all total knee replacement procedures performed by a medical group/clinic site. Records are to be submitted for all patients, whether or not an assessment was completed at each pre- or post-operative phase as rates of success in obtaining functional status measures will be calculated from the submitted file. One row of data will be equal to one procedure date and the subsequent follow-up functional status scores for that procedure of a patient undergoing total knee replacement. Both the pre-operative and post-operative functional status scores for the procedure will be contained within the patient record (procedure based record). Page 1

Average post-operative functional status at one year for patients undergoing total knee replacement as measured by the Oxford Knee Score tool. 2.

2 Rationale Annually there are over 500,000 total knee replacement procedures performed in the US. It is projected that by 2030, the volume of this procedure will increase to over 3.48 million per year due to the aging babyboomers, increased obesity and indications for total knee replacement that extend to both younger as well as older patients. 1 From 2000 to 2006, the Medicare total knee replacement rate overall in the United States increased by 58%, from 5.5 to 8.7 per 1, Total knee replacement revisions currently represent 8.2% of all Medicare dollars spent. 3 During this same timeframe, total knee replacement rates in Minnesota regions increased from 7.2 to 8.6 per 1,000 to 10.8 to 12.9 per 1, It is estimated that annual hospital charges for total knee replacement will approach 40.8 billion dollars annually by Measurement Period Denominator For consumers, there is a lack of publicly reported information that would provide patients with an understanding of potentially how well they will function after having total knee replacement surgery. These measures will provide outcome data for patients that currently does not exist. Measurement period will be for patients undergoing a total knee replacement procedure with a date of procedure between 01/01/2012 to 12/31/2012. Patient who meets each of the following criteria is included in the population: Patients age 18 and older at the start of the procedure measurement period (date of birth was on or prior to 01/01/1994; no upper age limit). Patients who underwent a primary or revision total knee replacement with a procedure date between 01/01/2012 to 12/31/2012. Patient had a following CPT code: , 27486, (see Tables 1 and 2). Eligible specialties: Orthopedic surgery Eligible providers: Orthopedic surgeons who perform total knee replacement procedures. 1 Kurtz S. Future caseload. American Association of Orthopedic Surgeons Annual Meeting CDC. Racial disparities in total knee replacement among medicare enrollees -- United States, MMWR Weekly. 2009;58(6): Ong K, et. al. Economic burden of revision hip and knee arthroplasty in medicare enrollees. Clinical Orthopaedics and Related Research. 2006;446: The Dartmouth Institute for Health Policy & Clinical Practice. Trends and regional variation in hip, knee and shoulder replacement. Robert Wood Johnson Foundation Kurtz S, et. al. Future clinical and economic impact of revision total hip and knee arthroplasty. Journal of Bone and Joint Surgery. 2007;89(3): Page 2

1 From 2000 to 2006, the Medicare total knee replacement rate overall in the United States increased by 58%, from 5.5 to 8.7 per 1,000. 2 Total knee replacement revisions currently represent 8.

3 Primary Total Knee Replacement Definition: Primary total knee replacement is the first total knee replacement for this particular knee joint. Revision Total Knee Replacement Definition: Revision total knee replacement is the replacement of the previous failed total knee prosthesis with a new prosthesis. Some of the reasons for failure include wear, loosening, infection, fracture, instability, and patient related factors. Patients with bilateral knee replacements (both knees replaced on the same day, during the same procedure) are included. This would be one procedure based record for submission. Patients with sequential knee replacements (each knee replaced on a separate day, during a separate procedure) are included. This patient would have two procedure based records, one for each procedure. Patients with either a primary a revision total knee replacement are included, however the functional status outcome rates will be reported separately (stratified). Allowable Exclusions There are no allowable exclusions. All patients undergoing a total knee replacement are to be included. Patients who are lost to follow-up are included, because an average change in the functional state is being calculated; thus rates are only calculated for those patients who are assessed. Patients who do not have any assessment scores are to be included in the submission file with the fields for scores and dates left blank. Process measures will be calculated to determine the rate of success of obtaining functional status assessments. Page 3

$Some of the reasons for failure include wear, loosening, infection, fracture, instability, and patient related factors.$

4 Functional Status Tools Oxford Knee Score- a patient completed survey consisting of 12 structured questions asking the patient to describe the impact of their knee function in the following areas: level of pain, self-care, getting in and out of a car, length of time able to walk, sitting, kneeling, night pain, interference with usual work, limping and ability to climb or descend stairs. A scale of 0 to 48 is used where 48 is the best possible knee-related functional status. 6 EQ-5D- a patient completed survey designed to describe current health state consisting of six structured questions asking the patient to describe their general (not related to their knee function) mobility, self-care, usual activities, pain/ discomfort and anxiety/ depression. A visual analog with a 100 point scale is used where patients rate their current health state today. Measures 1) Average change in functional status score at one year (Rates stratified by Primary versus Revision total knee replacement) 2) Average change in quality of life score at one year (Rates stratified by Primary versus Revision total knee replacement) The average change between pre-operative and post-operative functional status is calculated for patients undergoing a total knee replacement (defined by the Table 1 CPT codes) who have a completed Oxford Knee Score obtained pre-operatively and at one year (9 to 15 months) post-operatively. The average change between pre-operative and post-operative quality of life is calculated for patients undergoing a total knee replacement (defined by the Table 2 CPT codes) who have a completed EQ-5D obtained pre-operatively and at one year (9 to 15 months) post-operatively. Primary Total Knee Replacement Procedure CPT s Table 1: CPT s for Identifying Primary Total Knee Replacement Procedures Description Arthroplasty, knee hinge prosthesis Arthroplasty, knee condyle and plateau, medial OR lateral compartment 6 Reference for Score: Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br Jan; 80(1):63-9. Page 4

A scale of 0 to 48 is used where 48 is the best possible knee-related functional status.

5 Description Arthroplasty, knee condyle and plateau, medial AND lateral compartment with or without patellar resurfacing (total knee arthroplasty) Revision Total Knee Replacement Procedure CPT s Table 2: CPT s for Identifying Revision Total Knee Replacement Procedures Description Revision of total knee arthroplasty, with or without allograft, 1 component Revision of total knee arthroplasty, with or without allograft, femoral and entire tibial component Page 5

Revision Total Knee Replacement Procedures Description 27486 Revision of total knee arthroplasty, with or without

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014 Description Methodology For patients ages 18 years and older who undergo a lumbar discectomy/laminotomy or lumbar spinal fusion procedure during the measurement year, the following measures will be calculated: