Measure ID: MIPS 351·Orthopedics·2026 Performance Year

2026 MIPS Measure #351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk

Percentage of patients regardless of age undergoing a total knee or total hip replacement who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., History of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), Myocardial Infarction (MI), Arrhythmia and Stroke).

Process – High PriorityOrthopedicsPatient Safety

Measure ID:MIPS 351 (Quality ID 351)

Collection:MIPS CQM

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

All patients, regardless of age

ANDPatient procedure during the performance period

Exclusions

None

Numerator

Patients who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke).

Reporting Codes

Performance Met:

G9298Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke)

Performance Not Met:

G9299Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke, reason not given)

VBCA Insights

Why This Measure Matters

Knee and hip replacement patients face real risks: blood clots (DVT/PE) and heart problems in the postoperative period, especially if they have prior cardiac events or clot history. This measure ensures you're documenting a risk assessment within 30 days before surgery, checking for prior MI, arrhythmia, stroke, or thromboembolism. That assessment guides whether you need prophylactic blood thinners, extra monitoring, or modified surgical plans. Knowing the risk prevents catastrophe.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 351 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM) or through qualified registry submission.

🧮MIPS Score Simulator

Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.

Your Performance Rate:%Benchmarks vary by collection type

💡 Tip: Enter your performance rate to compare MIPS points across all collection types. The same rate can score differently depending on how you submit.

2026 MIPS 351 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 351 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 92.60%Topped Out

Decile	Performance Rate Range	Points
Decile 1	84.00 - 85.99%	1 – 1.9
Decile 2	86.00 - 87.99%	2 – 2.9
Decile 3	88.00 - 89.99%	3 – 3.9
Decile 4	90.00 - 91.99%	4 – 4.9
Decile 5	92.00 - 93.99%	5 – 5.9
Decile 6	94.00 - 95.99%	6 – 6.9
Decile 7	96.00 - 97.99%	7 – 7.9
Decile 8	98.00 - 98.99%	8 – 8.9
Decile 9	99.00 - 99.99%	9 – 9.9
Decile 10	100.00%	10

Specialty Measure Sets

Orthopedic Surgery

Related Measures

Orthopedics

MIPS 350: Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative (Non-MIPS 459: Back Pain After Lumbar Surgery MIPS 461: Leg Pain After Lumbar Surgery MIPS 470: Functional Status After Primary Total Knee Replacement MIPS 471: Functional Status After Lumbar Surgery

Patient Safety

MIPS 130: Documentation of Current Medications in the Medical Record MIPS 145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy MIPS 155: Falls: Plan of Care MIPS 164: Coronary Artery Bypass Graft (CABG): Prolonged Intubation MIPS 168: Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration MIPS 181: Elder Maltreatment Screen and Follow-Up Plan MIPS 259: Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured MIPS 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before MIPS 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia MIPS 354: Anastomotic Leak Intervention MIPS 355: Unplanned Reoperation within the 30-Day Postoperative Period MIPS 357: Surgical Site Infection (SSI)MIPS 374: Closing the Referral Loop: Receipt of Specialist Report MIPS 384: Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating MIPS 385: Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement MIPS 392: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation MIPS 393: Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation,MIPS 413: Door to Puncture Time for Endovascular Stroke Treatment MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse MIPS 432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic MIPS 513: Patient Reported Falls and Plan of Care

Official Resources

📄 CMS Measure Specification (PDF)🔗 QPP Quality Payment Program

Clinical Context

Clinical Rationale

Prior to a total knee or total hip replacement, the patient’s venous thromboembolic and cardiovascular risk should be evaluated. A population-based study of all Olmstead County, Minnesota, patients undergoing a total hip or knee arthroplasty from 1994 - 2008, reported that patients undergoing a total hip or total knee arthroplasty with a previous history of a cardiac event or a thromboembolic event were associated with an increased risk of a 90-day cardiac or thromboembolic event following surgery.

A study using the Danish national resident registries compared all patients undergoing a primary total hip replacement and total knee replacement from 1998 – 2007 to control groups not undergoing one of the procedures and found that the MI rate 2 weeks after total knee replacement was increased 31-fold compared to the control group. The MI rate 2 weeks after total hip replacement was increased 25-fold compared to the control group.

Any preoperative disease state should be identified and managed prior to surgery to minimize the risk of the surgical procedure. This measure is designed for use by physicians and eligible health care professionals managing ongoing care for all patients undergoing a total knee or hip replacement. This measure addresses the preoperative period.

Clinical Recommendations

Perioperative mortality and morbidity due to coronary artery disease (CAD) are untoward complications of noncardiac surgery. Major adverse cardiac events (MACE) after noncardiac surgery is often associated with prior CAD events. The stability and timing of a recent MI impact the incidence of perioperative morbidity and mortality. A validated risk-prediction tool can be useful in predicting the risk of perioperative MACE in patients undergoing noncardiac surgery. (Class IIa Level of Evidence: B)

Implementation Notes

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 procedure measure is submitted each time a procedure is performed during the performance period.

Frequently Asked Questions

Who is eligible for MIPS 351?

All patients regardless of age undergoing a total knee or total hip replacement.

Is MIPS 351 the same as MIPS 351?

Yes. CMS uses zero-padded three-digit Quality IDs (351) in official specifications, while clinicians often search for MIPS 351 or Quality ID 351 without the leading zero. Both refer to the same 2026 MIPS quality measure reported through the Quality Payment Program (QPP).

What codes do I submit for MIPS 351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk?

Submission codes: G9298 (Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke)); G9299 (Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke, reason not given))

How do I report MIPS Measure 351 in 2026?

MIPS Measure 351 (Quality ID 351) is reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM) via qualified registry, or Medicare Part B claims where applicable.

Is MIPS 351 a topped-out measure?

Yes, MIPS 351 is currently topped out, which means most clinicians perform well on this measure and it may be subject to a 7-point scoring cap.

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