Osteoporosis Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older This measure is to be reported for all female patients aged 65 years and older — a minimum of once per reporting period. Measure description What if this process or outcome of care is not
Percentage of female patients aged 65 years and older who have
appropriate for your patient?
a central dual-energy X-ray absorptiometry (DXA) measurement There may be times when it is not appropriate to order or
ordered or performed at least once since age 60 or pharmacologic perform a central DXA measurement at least once since age 60
OR prescribe pharmacologic therapy for osteoporosis, due to:n Medical reasons (eg, not indicated, contraindicated, other
What will you need to report for each female patient for this measure?
n Patient reasons (eg, patient declined, economic, social,
If you select this measure for reporting, you will report:
n System reasons (eg, resources to perform the services not
n Whether or not you ordered or performed a central dual-
energy X-ray absorptiometry (DXA) measurement at least
available, insurance coverage/payer-related limitations,
other reason attributable to health care delivery system)
In these cases, you will need to indicate which reason applies,
n Whether or not you prescribed pharmacologic therapy
specify the reason on the worksheet and in the medical chart.
(other than minerals/vitamins) for osteoporosis
The office/billing staff will then report a code with a modifier
that represents these valid reasons (also called exclusions).
1 Pharmacologic therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical
order: bisphosphonates (alendronate, ibandronate, and risedronate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modules or SERMs (raloxifene).
PQRI 2007 Measure 39, Effective Date 07/01/2007 2004-6 American Medical Association and National Committee for Quality Assurance. All rights reserved. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference)
Osteoporosis Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older PQRI Data Collection Sheet Clinical Information Billing Information Step 1 Is patient eligible for this measure? Code Required on Claim Form
There is a CPT E/M Service Code for this visit.
Refer to coding specifications document for list of applicable codes.
If No is checked for any of the above, STOP. Do not report a CPT category II code. Step 2 Does patient meet or have an acceptable reason for not meeting the measure? Central Dual-energy X-ray Absorptiometry (DXA) Code to be Reported on Line 24D of Paper Claim Form, Measurement OR Pharmacologic Therapy1 if Yes (or Service Line 24 of Electronic Claim Form)
Not prescribed for one of the following reasons:• Medical (eg, not indicated, contraindicated,
• Patient (eg, patient declined, economic,
• System (eg, resources to perform the
services not available, other reason attributable to health care delivery system)
Document reason here and in medical chart.
If No is checked for all of the above, report 3096F–8P OR 3095F–8P OR 4005F–8P (Central dual energy X-ray absorptiometry [DXA] measurement was not ordered or performed and a pharmacologic therapy for osteoporosis was not prescribed, reason not otherwise specified.)
1 Pharmacologic therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical
order: bisphosphonates (alendronate, ibandronate, and risedronate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modules or SERMs (raloxifene).
PQRI 2007 Measure 39, Effective Date 07/01/2007 2004-6 American Medical Association and National Committee for Quality Assurance. All rights reserved. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference) CPT® copyright 2006 American Medical Association
Osteoporosis Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older Coding Specifications
Quality codes for this measure (one of the following for every
Codes required to document a visit occurred:
A CPT E/M service code is required to identify patients to be
CPT II Code descriptors
(Data collection sheet should be used to determine appropriate
CPT E/M service codes
n CPT II 3096F: Central Dual-energy X-Ray Absorptiometry
n 99201, 99202, 99203, 99204, 99205 (office-new patient),
n 99212, 99213, 99214, 99215 (office-established patient),
n CPT II 3095F: Central Dual-energy X-Ray Absorptiometry
n 99387 (preventive medicine services — new patient),
n 99397 (preventive medicine services — established patient),
n CPT II 4005F: Pharmacologic therapy (other than minerals/
n 99401, 99402, 99403, 99404 (preventive medicine services —
n CPT II 3096F–1P OR 3095F–1P OR 4005F–1P:
Documentation of medical reason(s) for not ordering or
performing a central dual energy X-ray absorptiometry
(DXA) measurement or not prescribing pharmacologic
n CPT II 3096F–2P OR 3095F–2P OR 4005F–2P:
Documentation of patient reason(s) for not ordering or
performing central dual energy X-ray absorptiometry
(DXA) measurement or not prescribing pharmacologic
n CPT II 3096F–3P OR 3095F–3P OR 4005F–3P:
Documentation of system reason(s) for not ordering or
performing central dual energy X-ray absorptiometry
(DXA) measurement or not prescribing pharmacologic
n CPT II 3096F–8P OR 3095F–8P OR 4005F–8P: Central
dual energy X-ray absorptiometry (DXA) measurement
was not ordered or performed and a pharmacologic
therapy for osteoporosis was not prescribed, reason not
Physician Performance Measures (Measures) and related data specifications, developed by the American Medical Association (AMA) in col aboration with the Physician Consortium for Performance Improvement (the Consortium) and the National Committee for Quality Assurance (NCQA) pursuant to government sponsorship under subcontract 6205-05-054 with Mathematica Policy Research, Inc. under contract 500-00-0033 with Centers for Medicare & Medicaid Services.
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.
The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the Consortium) or NCQA. Neither the AMA, NCQA, Consortium nor its members shall be responsible for any use of the Measures.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
2004-6 American Medical Association and National Committee for Quality Assurance. All Rights Reserved.
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, NCQA, the Consortium and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.
CPT® contained in the Measures specifications is copyright 2006 American Medical Association
G codes and associated descriptions included in these Measure specifications are in the public domain.
PQRI 2007 Measure 39, Effective Date 07/01/2007 2004-6 American Medical Association and National Committee for Quality Assurance. All rights reserved. CPT® copyright 2006 American Medical Association
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