MACRA Monday: Osteoarthritis assessment


If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #109: Osteoarthritis Function and Pain Assessment

This measure is aimed at capturing the percentage of visits that included an assessment of function and pain for patients with a diagnosis of osteoarthritis (OA) who are aged 21 years or older.

What you need to do: Perform an assessment of symptoms and functional status for patients with OA and document it in the medical record. Validated scales and questionnaires may be used but are not required.

Eligible cases include patients aged 21 years and older with a diagnosis of OA and a patient encounter during the performance period. Applicable codes include (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1006F indicates that OA symptoms and functional status were assessed. Add the 8P modifier to CPT II 1006F if the assessment was not performed and the reason is not otherwise specified.

CMS has a full list measures available for claims-based reporting at The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

  • Those who enrolled in Medicare for the first time during a performance period.
  • Those who have Medicare Part B allowed charges of $30,000 or less.
  • Those who have 100 or fewer Medicare Part B patients.
  • Those who are significantly participating in an Advanced Alternative Payment Model (APM).
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