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Osteoporosis Management in Women Who Had a Fracture

Advantage MD. Women 67-85 years of age as of December 31 of the Measurement Year.

The percentage of women 67-85 years of age as of December 31 of the Measurement Year who suffered a fracture and who had either of the following in the six months after the fracture:

  • a bone mineral density (BMD) test.
  • a prescription for a drug to treat osteoporosis.

Fractures of finger, toe, face and skull are not included in this measure.

Appropriate testing or treatment for osteoporosis after the fracture defined by any of the following criteria:

  • A BMD test in any setting, on the IESD or in the 180-day (6-month) period after the IESD.
    • If the IESD was an inpatient stay, a BMD test during the inpatient stay.
  • Osteoporosis therapy on the IESD or in the 180-day (6-month) period after the IESD.
    • If the IESD was an inpatient stay, long-acting osteoporosis therapy during the inpatient stay.
  • A dispensed prescription to treat osteoporosis on the IESD or in the 180-day (6-month) period after the IESD.

Best Practice and Measure Tips

One of the following osteoporosis medications within 180 days of their discharge for a fracture:

  • Bisphosphonates
    • Alendronate
    • Alendronate-cholecalciferol
    • Ibandronate
    • Risedronate
    • Zoledronic acid
  • Other agents
    • Abaloparatide
    • Denosumab
    • Raloxifene
    • Teriparatide
    • Osteoporosis medication must be filled using a member’s Part D prescription drug benefit.
    • BMD test must take place within six months of the fracture.
    • If the fracture resulted in an inpatient stay, a BMD test administered during the stay will close the care opportunity.
    • Documentation that the medications aren’t tolerated is not an exclusion for this measure.
    • If the fracture resulted in an inpatient stay, long-acting osteoporosis therapy administered during the stay will close the care opportunity.
    • See members for an office visit as soon as possible after an event occurs.
    • Osteoporosis medication must be filled using a member’s Part D prescription drug benefit.
    • To help prevent women from being included in this measure incorrectly, please check that fracture codes are not used before a fracture has been verified through imaging.
    • Submit a corrected claim to fix Fracture codes submitted in error to remove the member from measure.
    • A referral for a BMD will not close this care opportunity.
    • Women at risk for osteoporosis should receive a bone density screening every two years.

Measure Exclusions

Required Exclusions:

  • Hospice
  • Palliative Care
  • Fraility, Fraility and Advanced Illness, Living in Long Term Care
  • Members who had a BMD test during the 24 months prior to the fracture
  • Members who had osteoporosis therapy during the 12 months prior to the fracture
  • Members who were dispensed a medication or had an active prescription for medication to treat osteoporosis during the12 months prior to the fracture

Measure Codes

Exclusion Codes:

  • Osteoporosis Medication Therapy Value Set
    • HCPCS: J0897, J1740, J3110, J3489
  • Long-Acting Osteoporosis Medications Value Set
    • HCPCS: J0897, J1740, J3489
  • Bone Mineral Density Tests Value Set
    • CPT/CPT II: 76977, 77078, 77080-82, 77085-86
    • ICD-10 Procedure: BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1