2026 MIPS Measure #351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation

Percentage of patients regardless of age undergoing a total knee or total hip replacement who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., History of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), Myocardial Infarction (MI), Arrhythmia and Stroke).

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

All patients regardless of age undergoing a total knee or total hip replacement

All patients, regardless of age

AND

Patient procedure during the performance period (CPT): 27438, 27442, 27446, 27447, 27130

Patients who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke)

Performance Met: Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke) (G9298)

OR

Performance Not Met: Patients who are not evaluated for venous thromboembolic and cardiovascular risk factorswithin 30 days prior to the procedure (e.g., history of DVT, PE, MI, arrhythmia and stroke, reason not given) (G9299)

Prior to a total knee or total hip replacement, the patient’s venous thromboembolic and cardiovascular risk should be evaluated. A population-based study of all Olmstead County, Minnesota, patients undergoing a total hip or knee arthroplasty from 1994 - 2008, reported that patients undergoing a total hip or total knee arthroplasty with a previous history of a cardiac event or a thromboembolic event were associated with an increased risk of a 90-day cardiac or thromboembolic event following surgery (Singh JA, Jensen MR, Harmsen WS, Gabriel SE, Lewallen DG, 2011).

A study using the Danish national resident registries compared all patients undergoing a primary total hip replacement and total knee replacement from 1998 – 2007 to control groups not undergoing one of the procedures and found that the MI rate 2 weeks after total knee replacement was increased 31-fold compared to the control group. The MI rate 2 weeks after total hip replacement was increased 25-fold compared to the control group. (Lalmohamed A, Vestergaard P, Klop C, Grove EL, 2012).

Any preoperative disease state should be identified and managed prior to surgery to minimize the risk of the surgical procedure.

This measure is designed for use by physicians and eligible health care professionals managing ongoing care for all patients undergoing a total knee or hip replacement. This measure addresses the preoperative period.