Patient Patient covered by an Alliance employer on the Patient covered by a Quality Path employer on Qualifiers date of surgery the date of surgery Exclusion Diagnoses are not present Surgery provided by a QualityPath physician Patient admitted to a QualityPath hospital Exclusion Diagnoses are not present Index To trigger the bundle, the following elements must be To trigger the bundle, the following elements must be Procedure present: present: UB Claim contains ICD-9 CM Procedure 81.54 CPT=27447, 27447-50 or 27447-58 CPT=27447 (Arthroplasty, knee condyle and (Arthroplasty, knee condyle and plateau, medial plateau, medial and lateral compartments), and lateral compartments) unilateral CPT=27446, 27446-50, or 27446-58 27447- 50 Bilateral procedure during the same (Arthroplasty, knee, condyle and plateau, medial operative session or lateral compartment) 58- Staged procedure by the same Patient has opted to participate in the Quality physician during the postoperative period Path program and has contacted The Alliance CPT=27446 (Arthroplasty, knee, condyle and prior to the procedure. plateau, medial or lateral compartment) 50 Bilateral procedure during the same operative session 27446- 58 Staged procedure by the same physician during the postoperative period Episode Period Beginning on the date of admission for the Beginning on the date of admission for the primary procedure and ending 90 days after the primary procedure and ending 90 days after the surgery date for a unilateral or bilateral surgery date for a unilateral or bilateral procedure procedure, and ending 90 days after the second and ending 90 days after the second procedure procedure for a staged procedure. for a staged procedure. Inclusion (Osteoarthritis ICD-9 715.XX )must be present Patient’s primary diagnosis is osteoarthritis Diagnosis on the 1500 claim form (surgeon’s claim) 715.xx)
Patient Qualifiers Patient covered by an Alliance employer on the date of surgery Exclusion Diagnoses are not present Patient covered by a Quality Path employer on the date of surgery Surgery provided by a QualityPath physician Patient admitted to a QualityPath hospital Exclusion Diagnoses are not present Index Procedure To trigger the bundle, the following elements must be present: UB Claim contains ICD-9 CM Procedure 81.54 CPT=27447 (Arthroplasty, knee condyle and plateau, medial and lateral compartments), unilateral 27447- 50 Bilateral procedure during the same operative session 58- Staged procedure by the same physician during the postoperative period CPT=27446 (Arthroplasty, knee, condyle and plateau, medial or lateral compartment) 50 Bilateral procedure during the same operative session 27446- 58 Staged procedure by the same physician during the postoperative period To trigger the bundle, the following elements must be present: CPT=27447, 27447-50 or 27447-58 (Arthroplasty, knee condyle and plateau, medial and lateral compartments) CPT=27446, 27446-50, or 27446-58 (Arthroplasty, knee, condyle and plateau, medial or lateral compartment) Patient has opted to participate in the Quality Path program and has contacted The Alliance prior to the procedure. Episode Period Beginning on the date of admission for the primary procedure and ending 90 days after the surgery date for a unilateral or bilateral procedure, and ending 90 days after the second procedure for a staged procedure. Beginning on the date of admission for the primary procedure and ending 90 days after the surgery date for a unilateral or bilateral procedure and ending 90 days after the second procedure for a staged procedure. Inclusion Diagnosis (Osteoarthritis ICD-9 715.XX )must be present on the 1500 claim form (surgeon’s claim) Patient’s primary diagnosis is osteoarthritis 715.xx)