Communication with the Physician or Other Clinician Managing On-Going Care Post-

Measure Specification

This measure aims to improve the communication and coordination from the physician treating the fracture in the acute care setting to the physician or clinician who is responsible for follow-up care for osteoporosis. Patients who experience a fragility fracture should either be treated or screened for the presence of osteoporosis. Although the fracture may be treated by the orthopedic surgeon, the testing and/or treatment is likely to be under the responsibility of the physician providing on-going care.

It is important the physician or other clinician providing on- going care for the patient be made aware the patient has sustained a fracture so that the proper care and treatment plan can be put in place to prevent a secondary fracture from occurring. This measure holds the physician who treated the fracture accountable for this communication to the on-going care provider.

The most important risk factors for osteoporosis-related fractures are a prior low-trauma fracture as an adult and a low BMD in patients with or without fractures. (Watts, et al., 2010) BMD measurement should be performed in all women 40 years old or older who have sustained a fracture. (AACE) The decision to measure bone density should follow an individualized approach.

It should be considered when it will help the patient decide whether to institute treatment to prevent osteoporotic fracture. It should also be considered in patients receiving glucocorticoid therapy for 2 months or more and patients with other conditions that place them at high risk for osteoporotic fracture. (NIH) The most commonly used measurement to diagnose osteoporosis and predict fracture risk is based on assessment of BMD by dual-energy X-ray absorptiometry (DXA).

(NIH) Measurements of BMD made at the hip predict hip fracture better than measurements made at other sites while BMD measurement at the spine predicts spine fracture better than measures at other sites. (NIH) The single most powerful predictor of a future osteoporotic fracture is the presence of previous such fractures.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this episode measure is submitted once for each occurrence of a particular illness or condition during the performance period. Patients with a fracture should have documentation in the medical record of communication from the clinician treating the fracture to the clinician managing the patient’s on-going care that the fracture occurred and that the patient was or should be tested or treated for osteoporosis.

If multiple fractures occurring on the same date of service are submitted on the same claim form, only one instance of submission will be counted. Claims data will be analyzed to determine unique occurrences. Documentation must indicate that communication to the MIPS eligible clinician managing the on-going care of the patient occurred within three months of treatment for the fracture.

The CPT Category II code should be submitted during the episode of care (e.g., treatment of the fracture). The submission of the code and documentation of communication do not need to occur simultaneously. Eligible cases are determined, and must be reported, if either of the following conditions (submission criteria) are met.