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Osteoporosis Management in Women: Measure Guidelines and Coding Tips

Date:
January 23, 2020

We know the Osteoporosis Management in Women Who Had a Fracture (OMW) HEDIS measure poses challenges, including coding, time frames and patient screening. Here are some tips on how to ensure proper coding of, and adherence to, the OMW measure.

About This Measure

OMW is based on the percentage of female Medicare patients 67-85 years old who suffered a fracture and who either had a bone mineral density (BMD) test, heel ultrasound scan or prescription for a drug to treat osteoporosis in the 6 months after a fracture.

If a patient over the age of 67 suffers a fracture and has not received a BMD test in the past two years, then that patient becomes included in the measure. We will let your practice know if you have a patient in the measure.

Please note:

  • Fractures of finger, toe, face, and skull are not included in this measure
  • The single X-ray absorptiometry (SEXA) test is no longer accepted

What You Should Do

If your patient is at risk for osteoporosis, a BMD test should be performed every 2 years ($0 copay as a Medicare preventive screening.) 

Female patients over the age of 67 should receive a bone density test within 6 months of a fracture.

Start medication for osteoporosis if clinically indicated.

In-home bone density tests are available to your BlueShield patients. Please contact your practice account manager or call Care Management at 1-877-878-8785 option 2.

Coding Tips for OMW

Bone Mineral Density

CPT 76977, 77078, 77080, 77081, 77082, 77085, 77086

Osteoporosis Medications

Description Prescription
Bisphosphonates
  • Alendronate
  • Alendronate-cholecalciferol
  • Ibandronate
  • Risedronate
  • Zoledronic acid
Other agents 
  • Abaloparatide
  • Denosumab
  • Raloxifene
  • Teriparatide

To prevent patients who don’t have a new fracture from being included in the OMW measure incorrectly, we’d like to clarify the following regarding coding for initial vs. subsequent fractures.

When billing an ICD-10CM fracture code (category M80), use the 7th character to specify if the office visit for a fracture is an initial or subsequent encounter (D,G,K,P).

Please note that an initial encounter is for a patient you are actively treating for the fracture. Otherwise, please use a subsequent encounter diagnosis code.

The appropriate 7th character is to be added to each code from category M80:
A Initial Encounter for fracture
D Subsequent encounter for fracture with routine healing
G Subsequent encounter for fracture with delayed healing
K Subsequent encounter for fracture with nonunion
P Subsequent encounter for fracture with malunion
S Sequela

Please call Care Management at 1-877-878-8785 option 2 for more information. 

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