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Proposed solution
Add the following conditions, diagnoses, and procedures as denominator exclusions to the measures:
1. Partial hip/knee arthroplasty procedure
2. Revision procedure, removal of implanted device, and resurfacing procedure
3. Malignant neoplasm
4. Mechanical complications
5. Patients with a second total hip/knee arthroplasty procedure
6. Patients who die within 300 days of the procedure
The change below will also apply to CMS66, but reflect 'knee arthroplasty'.
CMS56
//Header: Denominator Exclusions – add
Exclude patients with a partial hip arthroplasty procedure at any point in the patient’s history before the start of the total hip arthroplasty.
Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure at any point in the patient’s history before the start of the total hip arthroplasty.
Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.
Exclude patients with a mechanical complication on the day of the total hip arthroplasty.
Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.
Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.
//Logic – before
define "Denominator Exclusions":
[…]
//Logic – after
define "Denominator Exclusions":
[…]
or "Has Partial Hip Arthroplasty Procedure"
or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
or "Has Mechanical Complication"
or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
or "Death Within 300 Days of the THA Procedure"
//CMS56 uses “Partial Arthroplasty of Hip” and CMS66 uses “Partial Arthroplasty of Knee”
define "Has Partial Hip Arthroplasty Procedure":
exists ( ["Procedure, Performed": "Partial Arthroplasty of Hip"] PartialTHAProcedure
with "Total Hip Arthroplasty Procedure" THAProcedure
such that Global."NormalizeInterval" ( PartialTHAProcedure.relevantDatetime, PartialTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
with ["Procedure, Performed": "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] RevisionTHAProcedure
such that Global."NormalizeInterval" ( RevisionTHAProcedure.relevantDatetime, RevisionTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Malignant Neoplasm of Lower and Unspecified Limbs":
exists ( ["Diagnosis": "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm
with "Total Hip Arthroplasty Procedure" THAProcedure
such that MalignantNeoplasm.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Mechanical Complication":
exists ( ["Diagnosis": "Mechanical Complications Excluding Upper Body"] MechanicalComplications
with "Total Hip Arthroplasty Procedure" THAProcedure
such that MechanicalComplications.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
with ["Procedure, Performed": "Primary THA Procedure"] ElectiveTHAProcedure
such that THAProcedure.id !~ ElectiveTHAProcedure.id
and start of Global."NormalizeInterval" ( ElectiveTHAProcedure.relevantDatetime, ElectiveTHAProcedure.relevantPeriod ) during Interval[( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) - 1 year, ( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) + 1 year] )
define "Death Within 300 Days of the THA Procedure":
exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
with "Total Hip Arthroplasty Procedure" THAProcedure
such that date from Deceased.expiredDatetime during Interval[date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ), date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) + 300 days] )
//Terminology – add
valueset "Lower Body Fractures Excluding Ankle and Foot" (OID: 2.16.840.1.113883.3.464.1003.1178)
valueset "Malignant Neoplasms of Lower and Unspecified Limbs" (OID: 2.16.840.1.113883.3.464.1003.1180)
valueset "Mechanical Complications Excluding Upper Body" (OID: 2.16.840.1.113883.3.464.1003.1182)
valueset "Partial Arthroplasty of Hip" (OID: 2.16.840.1.113883.3.464.1003.1184)
valueset "Partial Arthroplasty of Knee" (OID: 2.16.840.1.113883.3.464.1003.1192)
valueset "Removal, Revision and Supplement Procedures of the Lower Body and Spine" (OID: 2.16.840.1.113883.3.464.1003.1189)
code "Dead (finding)": '419099009' from "SNOMEDCT" display 'Dead (finding)'
Rationale for change
This change aligns with the related measure in development and current evidence. Additionally, stakeholders support adding these exclusions to accurately identify patients receiving THA and TKA.
Show
Proposed solution
Add the following conditions, diagnoses, and procedures as denominator exclusions to the measures:
1. Partial hip/knee arthroplasty procedure
2. Revision procedure, removal of implanted device, and resurfacing procedure
3. Malignant neoplasm
4. Mechanical complications
5. Patients with a second total hip/knee arthroplasty procedure
6. Patients who die within 300 days of the procedure
The change below will also apply to CMS66, but reflect 'knee arthroplasty'.
CMS56
//Header: Denominator Exclusions – add
Exclude patients with a partial hip arthroplasty procedure at any point in the patient’s history before the start of the total hip arthroplasty.
Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure at any point in the patient’s history before the start of the total hip arthroplasty.
Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.
Exclude patients with a mechanical complication on the day of the total hip arthroplasty.
Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.
Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.
//Logic – before
define "Denominator Exclusions":
[…]
//Logic – after
define "Denominator Exclusions":
[…]
or "Has Partial Hip Arthroplasty Procedure"
or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
or "Has Mechanical Complication"
or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
or "Death Within 300 Days of the THA Procedure"
//CMS56 uses “Partial Arthroplasty of Hip” and CMS66 uses “Partial Arthroplasty of Knee”
define "Has Partial Hip Arthroplasty Procedure":
exists ( ["Procedure, Performed": "Partial Arthroplasty of Hip"] PartialTHAProcedure
with "Total Hip Arthroplasty Procedure" THAProcedure
such that Global."NormalizeInterval" ( PartialTHAProcedure.relevantDatetime, PartialTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
with ["Procedure, Performed": "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] RevisionTHAProcedure
such that Global."NormalizeInterval" ( RevisionTHAProcedure.relevantDatetime, RevisionTHAProcedure.relevantPeriod ) starts on or before start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Malignant Neoplasm of Lower and Unspecified Limbs":
exists ( ["Diagnosis": "Malignant Neoplasms of Lower and Unspecified Limbs"] MalignantNeoplasm
with "Total Hip Arthroplasty Procedure" THAProcedure
such that MalignantNeoplasm.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has Mechanical Complication":
exists ( ["Diagnosis": "Mechanical Complications Excluding Upper Body"] MechanicalComplications
with "Total Hip Arthroplasty Procedure" THAProcedure
such that MechanicalComplications.prevalencePeriod overlaps Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) )
define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":
exists ( "Total Hip Arthroplasty Procedure" THAProcedure
with ["Procedure, Performed": "Primary THA Procedure"] ElectiveTHAProcedure
such that THAProcedure.id !~ ElectiveTHAProcedure.id
and start of Global."NormalizeInterval" ( ElectiveTHAProcedure.relevantDatetime, ElectiveTHAProcedure.relevantPeriod ) during Interval[( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) - 1 year, ( start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) ) + 1 year] )
define "Death Within 300 Days of the THA Procedure":
exists ( ["Patient Characteristic Expired": "Dead (finding)"] Deceased
with "Total Hip Arthroplasty Procedure" THAProcedure
such that date from Deceased.expiredDatetime during Interval[date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ), date from start of Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) + 300 days] )
//Terminology – add
valueset "Lower Body Fractures Excluding Ankle and Foot" (OID: 2.16.840.1.113883.3.464.1003.1178)
valueset "Malignant Neoplasms of Lower and Unspecified Limbs" (OID: 2.16.840.1.113883.3.464.1003.1180)
valueset "Mechanical Complications Excluding Upper Body" (OID: 2.16.840.1.113883.3.464.1003.1182)
valueset "Partial Arthroplasty of Hip" (OID: 2.16.840.1.113883.3.464.1003.1184)
valueset "Partial Arthroplasty of Knee" (OID: 2.16.840.1.113883.3.464.1003.1192)
valueset "Removal, Revision and Supplement Procedures of the Lower Body and Spine" (OID: 2.16.840.1.113883.3.464.1003.1189)
code "Dead (finding)": '419099009' from "SNOMEDCT" display 'Dead (finding)'
Rationale for change
This change aligns with the related measure in development and current evidence. Additionally, stakeholders support adding these exclusions to accurately identify patients receiving THA and TKA.