2018 MIPS Measure #352: Total Knee Replacement: Preoperative Antibiotic Infusion with Proximal Tourniquet

Measure Description

Percentage of patients regardless of age undergoing a total knee replacement who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet

Instructions

This measure is to be submitted each time a procedure for total knee replacement is performed during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. 

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Denominator

Patients regardless of age undergoing a total knee replacement performed

Denominator Criteria (Eligible Cases):

All patients regardless of age

AND

Patient procedure during the performance period (CPT): 27438, 27442, 27445, 27446, 27447

Numerator

Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet (tourniquet around the proximal thigh)

Numerator Options:

Performance Met:

Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet (G9301)

OR

Denominator Exception:

Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used) (G9300)

OR

Performance Not Met:

Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given (G9302)