DATA COLLECTION GUIDE Direct Data Submission. Spinal Surgery: Functional Status and Quality of Life Outcome Measures 2015

Transcription

1 DATA COLLECTION GUIDE Direct Data Submission Spinal Surgery: Functional Status and Quality of Life Outcome Measures 2015 () Data Submission: 04/13/2015 to 05/15/2015 Changes from Draft Data Collection Guide: 1. Terminology change from Denominator Certification to Pre-Submission Data Certification throughout guide.

2 Table of Contents Process and Timeline Overview... 3 Measure Specifications... 4 Summary of Changes...5 Codes used to Identify Patients who Underwent Lumbar Discectomy/Laminotomy Procedure...8 Table 1: CPT Codes for Identifying Lumbar Discectomy/Laminotomy Procedure... 8 Table 2: ICD-9 Codes for Identifying Lumbar Discectomy/Laminotomy Procedure... 9 Codes used to Identify Patients who Underwent Lumbar Spinal Fusion Procedure...9 Table 3: CPT Codes for Identifying Lumbar Spinal Fusion Procedure... 9 Codes used to Identify Patients who Meet Exclusion Criteria...9 Table 4: ICD-9 Codes for Identifying Patients who had Cancer Related to the Spine... 9 Table 5: ICD-9 Codes for Identifying Patients who had Fracture Related to the Spine Table 6: ICD-9 Codes for Identifying Patients who had Infection Related to the Spine Table 7: ICD-9 Codes for Identifying Patients who had Idiopathic or Congenital Scoliosis Measure Logic/Flow Charts Data Collection and Submission Preparations and Considerations Section A: Identifying the Initial Patient Population Section B: Data Collection Data Elements and Field Specification for Patient Population 1 (Lumbar Discectomy/Laminotomy Procedure) Summary of Changes Data Elements and Field Specification for Patient Population 2 (Lumbar Spinal Fusion Procedure) Section C: Data File Creation Section D: Data File Submission Section E: Data Validation Appendices Appendix A: Patient Reported Outcome (PRO) Tools Appendix B: Prior Back Surgery Determination Table 8: CPT Codes for Identifying Spinal Fusion Procedures with Instrumentation Table 9: CPT Codes for Identifying Lumbar Region without Fusion Appendix C: Facility Codes Table 10: Hospital Facility Codes Table 11: Freestanding Outpatient Surgical Centers Appendix D: Diagnosis Codes to Identify Clinical Condition/Reason for Procedure Table 12: ICD-9 Codes for Clinical Condition/Reason for Lumbar Spinal Fusion Appendix E: Measure Description Appendix F: MNCM Data Portal Registration Appendix G: Resources to Help You Get Started Appendix H: About Direct Data Submission Appendix I: About MNCM and Measure Development Page 2

3 Process and Timeline Overview Process Step Registration Medical groups register clinics and providers on the MNCM Data Portal and electronically sign a Site Terms of Use Agreement and Business Associate Agreement. Resources: Download Clinic & Provider Registration Instructions under RESOURCES on the MNCM Data Portal or Medical groups must register prior to submitting data. NOTE: Medical groups only need to register once for each report year. If changes occur within a medical group (e.g., clinics closures) after registration and during the report year, contact MNCM Support. Pre- Submission Data Certification (formerly Denominator Certification) Medical groups submit a pre-submission data certification form outlining their method for identifying the Initial Patient Population on the MNCM Data Portal. MNCM reviews and approves the method. MNCM must approve the pre-submission data certification form prior to data collection. Plan accordingly. Resources: Download Spinal Surgery Measures 2015 Pre-Submission Data Certification Template under RESOURCES on the MNCM Data Portal. Data Collection and Submission Data collection begins after the billing cycle for the measurement period is completed. Medical groups prepare and submit CSV files via MNCM Data Portal. Resources: Download Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Data Collection Guide, Spinal Surgery Measure Lumbar Discectomy/Laminotomy 2015 Data Collection Spreadsheet Template and Spinal Surgery Measure Lumbar Fusion 2015 Data Collection Spreadsheet Template under RESOURCES on the MNCM Data Portal. Preliminary Results Review, Quality Checks Medical groups review preliminary results internally to verify rates and provide comments. MNCM reviews preliminary results/comments. Resources: On MNCM Data Portal home page, under Data Submission. Data Validation MNCM conducts audit to validate submitted data matches source data in patient medical records. Resources: MNCM will instructions and post list of randomly-selected patients for audit on the MNCM Data Portal. Two-Week Medical Group Review Period Medical groups review preliminary statewide results prior to final statewide results being publicly reported. Resources: MNCM will information and instructions to appropriate medical groups. Data Results After the successful submission and validation of the clinical data, MNCM may publish the results on and in other publications. Important Dates Registration begins December 15, Registration deadline is February 6, Submit presubmission data certification document in March- April MNCM will respond within 3 business days after receiving the document. MNCM Data Portal opens April 13, MNCM Data Portal closes May 15, Completed after data submission and prior to validation audit. MNCM auditor will contact medical groups to schedule validation audit after data file is submitted. July Late Page 3

4 Spinal Surgery: Functional Status and Quality of Life Outcome Measures 2015 () Measure Specifications Page 4

5 Summary of Changes Measure Specifications Plan for Transition to PROMIS Global-10 PROMIS-10 is replacing the EQ5D-5L patient reported outcome tool for assessing pre-operative and post-operative quality of life. This change is effective for patients undergoing a procedure as of 1/1/2015. For patients who had a pre-op assessment with EQ5D and a post-op assessment with PROMIS Global-10, conversion of values will occur within the MNCM data portal. Please refer to Appendix A and the Data and Field Specifications for more details; Appendix I for measure development work group rationale. Clinical Condition Reason for Procedure (Lumbar Fusion) Following pilot testing, in an effort to reduce burden, the measure development work group revised the number of categories for this field from 6 to 4. This resulted in categories that are fully definable by ICD diagnosis codes. Please refer to the Data and Field Specifications. Description For patients ages 18 years and older who undergo a lumbar discectomy/laminotomy or lumbar spinal fusion procedure during the measurement year, the following measures will be calculated: 1. Average change between pre-operative and three months (6 to 20 weeks) post-operative functional status as measured with the Oswestry Disability Index, version 2.1a. 2. Average change between pre-operative and three months (6 to 20 weeks) post-operative health related quality of life as measured with the EQ5D-5L tool. 3. Average change between pre-operative and three months (6 to 20 weeks) post-operative back pain as measured with the visual analog scale (VAS) for pain. 4. Average change between pre-operative and three months (6 to 20 weeks) post-operative leg pain as measured with the visual analog scale (VAS) for pain. 5. Average change between pre-operative and one year (9 to 15 months) postoperative functional status as measured with the Oswestry Disability Index, version 2.1a. 6. Average change between pre-operative and one year (9 to 15 months) postoperative health related quality of life as measured with the EQ5D-5L. 7. Average change between pre-operative and one year (9 to 15 months) postoperative back pain as measured with the visual analog scale (VAS) for pain. 8. Average change between pre-operative and one year (9 to 15 months) postoperative leg pain as measured with the visual analog scale (VAS) for pain. Page 5

6 Methodology Rationale Measure Specifications Population identification is accomplished via a query of a practice management system or Electronic Medical Record (EMR) to identify the population of eligible patients (denominator). Data elements are either extracted from an EMR system or abstracted through medical record review. Full population data is required. Overall, spine surgery rates have declined slightly from 2002 to 2007, but the rate of complex spinal fusion procedures has increased 15-fold, from 1.3 to 19.9 per 100,000 Medicare beneficiaries. Complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex spinal fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex spinal fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50 to 3.49). 1 Minnesota, as compared to national Medicare statistics, 2 demonstrates a lumbar spinal fusion rate that is four times the national average [0.84 per 1000 enrollees as compared to 0.2 per 1000]. Spinal fusion has become one of medicine s most controversial procedures. Some surgeons argue that spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or severe curvature of the spine and that the financial incentives have caused the procedure to become overused. Others say that it is a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail. 3 Procedure Measurement Period For consumers, there is a lack of publicly reported information that would provide patients with an understanding of potentially how well they will function after having lumbar spinal surgery. These measures will provide outcome data for patients that currently do not exist. Measurement period will be for patients undergoing a procedure between 01/01/2013 and 12/31/ Trends, Major Medical Complications and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults Deyo. 2 Dartmouth Atlas of Health Care: Studies of Surgical Variation- Spine Surgery 3 Top Spine Surgeons Reap Royalties, Medicare Bounty- Wall Street Journal December 2010 Page 6

7 Denominator Patient Population 1 Lumbar Discectomy/ Laminotomy Measure Specifications Patients who meet each of the following criteria are included in the population: Patients age 18 years and older at the start of the procedure measurement period (date of birth was on or prior to 01/01/1995; no upper age limit). Patients who underwent a lumbar discectomy/laminotomy procedure for a diagnosis of disc herniation with the date of procedure between 01/01/2013 and 12/31/2013. Patient had following CPT Code: See Table 1. Include the patient in the lumbar discectomy/laminotomy population only if CPT diagnosis code is the only spine procedure code used. Do not include the patient if they have an additional spinal procedure (CPT) performed. Patient had following ICD-9 Diagnosis Code: See Table 2. This diagnosis code can be in any position Eligible specialties: Orthopedic surgery, Neurosurgery Exclusions Population 1 Denominator Patient Population 2 Lumbar Spinal Fusion Eligible providers: Orthopedic surgeons and Neurosurgeons who perform lumbar discectomy/laminotomy procedures. None Patients who meet each of the following criteria are included in the population: Patients age 18 years and older at the start of the procedure measurement period (date of birth was on or prior to 01/01/1995; no upper age limit). Patients who underwent a lumbar spinal fusion procedure with the date of procedure between 01/01/2013 and 12/31/2013. If any portion of the lumbar spine is fused (L1 to L5), the patient is to be included If the fusion of the lumbar spine also incorporates thoracic vertebrae, the patient is to be included Patient had following CPT Codes: 22533, 22534, 22558, , 22630, See Table 3. Eligible specialties: Orthopedic surgery, Neurosurgery Eligible providers: Orthopedic surgeons and Neurosurgeons who perform lumbar spinal fusion procedures. Page 7

8 Exclusions Population 2 Measures Patient Population 1 Lumbar Discectomy/ Laminotomy Patient Population 2 Lumbar Spinal Fusion Measure Specifications The following are exclusions: Cancer, fracture, and infection related to the spine. See Table 4, Table 5 and Table 6. Idiopathic and congenital scoliosis. See Table 7. Measures for the lumbar discectomy/laminotomy population three months (6 weeks to 20 weeks) postoperatively include: 1. Average change between pre-operative and three months (6 to 20 weeks) postoperative functional status as measured with the Oswestry Disability Index, version 2.1a. 2. Average change between pre-operative and three months (6 to 20 weeks) postoperative health related quality of life as measured with the EQ5D-5L tool. 3. Average change between pre-operative and three months (6 to 20 weeks) postoperative back pain as measured with the visual analog scale (VAS) for pain. 4. Average change between pre-operative and three months (6 to 20 weeks) postoperative leg pain as measured with the visual analog scale (VAS) for pain. Measures for the lumbar spinal fusion population one year (9 to 15 months) postoperatively include: 1. Average change between pre-operative and one year (9 to 15 months) postoperative functional status as measured with the Oswestry Disability Index, version 2.1a. 2. Average change between pre-operative and one year (9 to 15 months) postoperative health related quality of life as measured with the EQ5D-5L. 3. Average change between pre-operative and one year (9 to 15 months) postoperative back pain as measured with the visual analog scale (VAS) for pain. 4. Average change between pre-operative and one year (9 to 15 months) postoperative leg pain as measured with the visual analog scale (VAS) for pain. Codes used to Identify Patients who Underwent Lumbar Discectomy/Laminotomy Procedure Table 1: CPT Codes for Identifying Lumbar Discectomy/Laminotomy Procedure CPT Procedure Code CPT Procedure Code Description Laminotomy (hemilaminectomy), with decompression of the nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted procedures, 1 interspace, lumbar. Page 8

9 Measure Specifications Table 2: ICD-9 Codes for Identifying Lumbar Discectomy/Laminotomy Procedure ICD-9 Diagnosis Code ICD-9 Diagnosis Code Description Displacement of lumbar intervertebral disc without myelopathy Codes used to Identify Patients who Underwent Lumbar Spinal Fusion Procedure Table 3: CPT Codes for Identifying Lumbar Spinal Fusion Procedure CPT Procedure Codes CPT Procedure Code Description Arthrodesis, lateral extracavitary tech including minimal discectomy to prepare interspace, lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace thoracic or lumbar, each add segment Arthrodesis, anterior interbody tech including minimal discectomy to prepare interspace, lumbar Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace Arthrodesis, posterior technique, with or without lateral transverse technique, lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy, lumbar Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment, lumbar Codes used to Identify Patients who Meet Exclusion Criteria Table 4: ICD-9 Codes for Identifying Patients who had Cancer Related to the Spine ICD-9 Diagnosis Codes ICD-9 Diagnosis Code Description Malignant neoplasm bone & cartilage vertebral column Malignant neoplasm bone & cartilage pelvic, sacrum, coccyx Secondary malignant neoplasm ; bone and bone marrow Benign neoplasm bone & cartilage vertebral column Benign neoplasm bone & cartilage pelvic, sacrum, coccyx Neoplasm uncertain behavior bone & cartilage Neoplasm unspecified nature bone & cartilage Page 9

10 Measure Specifications Table 5: ICD-9 Codes for Identifying Patients who had Fracture Related to the Spine ICD-9 Diagnosis Codes ICD-9 Diagnosis Code Description Fracture, lumbar closed Fracture, lumbar open Fracture, sacrum & coccyx closed Fracture, sacrum & coccyx open Fracture w/spinal cord injury, lumbar closed Fracture w/spinal cord injury, lumbar open Fracture w/spinal cord injury, sacrum, coccyx closed unspecified Fracture w/spinal cord inj, sac/cocc closed cauda equina lesion Fracture w/spinal cord inj, sac/cocc closed cauda equina other Fracture w/spinal cord inj, sac/cocc closed other spinal cord inj Fracture w/spinal cord injury, sacrum, coccyx open unspecified Fracture w/spinal cord inj, sac/coccyx open cauda equina lesion Fracture w/spinal cord inj, sac/coccyx open cauda equina other Fracture w/spinal cord inj, sac/coccyx open other spinal cord inj Pathologic fracture of vertebrae Non-union of fracture (pseudoarthrosis) Late effect fracture of the spine and trunk without mention of spinal cord lesion Table 6: ICD-9 Codes for Identifying Patients who had Infection Related to the Spine ICD-9 Diagnosis Codes ICD-9 Diagnosis Code Description Acute osteomyelitis; pelvic region and thigh Acute osteomyelitis; other specified sites Acute osteomyelitis; multiple sites Chronic osteomyelitis; pelvic region and thigh Chronic osteomyelitis; other specified sites Chronic osteomyelitis; multiple sites Unspecified osteomyelitis; pelvic region and thigh Unspecified osteomyelitis; other specified sites Unspecified osteomyelitis; multiple sites Periostitis without mention of osteomyelitis; pelvic region and thigh Periostitis without mention of osteomyelitis; other specified sites Periostitis without mention of osteomyelitis; multiple sites Osteopathy resulting from poliomyelitis; pelvic region and thigh Osteopathy resulting from poliomyelitis; other specified sites Osteopathy resulting from poliomyelitis; multiple sites Other infections involving bone in diseases classified elsewhere; pelvic region and thigh Page 10

11 Measure Specifications ICD-9 Diagnosis Codes ICD-9 Diagnosis Code Description Other infections involving bone in diseases classified elsewhere; other specified sites Other infections involving bone in diseases classified elsewhere; multiple sites Unspecified infection of bone; pelvic region and thigh Unspecified infection of bone; other specified sites Unspecified infection of bone; multiple sites Table 7: ICD-9 Codes for Identifying Patients who had Idiopathic or Congenital Scoliosis ICD-9 Diagnosis Codes ICD-9 Diagnosis Code Description Scoliosis and kyphoscoliosis, idiopathic Resolving infantile idiopathic scoliosis Progressive infantile idiopathic scoliosis Scoliosis due to radiation Thoracogenic scoliosis Scoliosis and kyphoscoliosis, other Congenital deformity of the spine, postural lordosis or scoliosis Page 11

12 Measure Logic/Flow Charts Measure Specifications Was the patient born on or prior to 01/01/1995? Yes No Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Measure Flow Chart Determines clinic should include patient in data submission Did the patient undergo a lumbar discectomy/ laminotomy procedure between 01/01/2013 to 12/31/2013? No PATIENT NOT INCLUDED IN MEASURE Lumbar Discectomy/Laminotomy Yes Does the patient have the CPT code 63030? No Yes Does the patient have any other spine procedure CPT codes? YES NO No Does the patient have the ICD-9 code in any position? Yes SUBMIT ALL PATIENT DATA Submit ALL available pre-op and post-op functional status tools assessments Page 12

13 Measure Specifications Was the patient born on or prior to 01/01/1995? Yes Did the patient undergo a lumbar fusion (any portion of the lumbar spine) procedure between 01/01/2013 to 12/31/ 2013? Patients who had fusion of the lumbar spine which incorporate the thoracic vertebrae are also included. No No PATIENT NOT INCLUDED IN MEASURE Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Measure Flow Chart Determines clinic should include patient in data submission Lumbar Fusion Yes Does the patient have one of the following CPT codes? No Yes SUBMIT ALL PATIENT DATA Submit ALL available pre-op and post-op functional status tools assessments Page 13

14 Spinal Surgery: Functional Status and Quality of Life Outcome Measures 2015 Direct Data Submission () Page 14

15 Data Collection and Submission Preparations and Considerations Before collecting and submitting data to MNCM, the following items should be reviewed. Data submission preparations Medical group and clinics MUST BE REGISTERED in the MNCM Data Portal. Please see Appendix F for more information about registration. Many resources can be found on the MNCM websites. MNCM recommends saving their location as favorites or bookmarks for easy future reference. o MNCM Data Portal: o MNCM Corporate Website: o MN HealthScores: A dedicated folder location on the computer or network for all data submission documents may be useful. Name versions of documents clearly, including version numbers and/or dates, to ensure use of the most recent files. o Login to the MNCM Data Portal. See Appendix C for step-by-step instructions. Under RESOURCES, access Direct Data Submission (DDS) documents. Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Data Collection Guide; Spinal Surgery Measures 2015 Pre-Submission Data Certification Template; Spinal Surgery Lumbar Discectomy/Laminotomy (Population 1) 2015 Data Collection Form; Spinal Surgery Lumbar Spinal Fusion (Population 2) 2015 Data Collection Form Spinal Surgery Lumbar Discectomy/Laminotomy (Population 1) 2015 Data Collection Spreadsheet Template and Spinal Surgery Lumbar Spinal Fusion (Population 2) 2015 Data Collection Spreadsheet Template. Data submission considerations Patient Attribution The patient is attributed to the surgeon who performs the procedure. Page 15

16 Total Population Submission This measure requires submission of all patients undergoing lumbar spine procedures as defined below in populations 1 and 2. Patient Populations There are two patient populations for this measure; each population should be submitted in a separate data file during data submission. Each population has its own set of data elements and field specifications on pages The two populations are: 1. Lumbar Discectomy/Laminotomy 2. Lumbar Spinal Fusion All patients who meet the Initial Patient Population criteria are included in the submission for calculation of measures. Patients who may have missing assessment scores are included in the Initial Patient Population with the fields for scores and dates left blank in the submission file. The MNCM data portal assesses the presence of valid tools, values and pre-operative and post-operative time frames and calculates the Measure Denominator. The Measure Denominator, which is used to calculate the average change in functional status, pain or quality of life, only includes patients who have valid pre-operative and post-operative assessments. Process measures will be calculated to determine the rate of success in obtaining functional status assessments. Using multiple data collectors Use of one data collector or data collection process is preferred as it ensures consistent methods for data collection and results in improved reliability. However, if more than one person must collect data, steps to maximize inter-rater reliability (IRR) are strongly recommended, including but not limited to training for all persons involved in data collection regarding the process and methods to be applied. Training could include a review of this guide and all related data collection forms, as well as instructions for locating information in the medical record. MNCM also recommends referring to data collection errors made in previous submissions, making plans to improve the data collection process, and performing quality checks on the data. This ensures that measurement specifications are interpreted consistently and data is collected uniformly across multiple data collectors. Page 16

17 Section A: Identifying the Initial Patient Population The first stage in the process to calculate performance scores is to identify the Initial Patient Population; the total number of patients eligible for calculation of the outcome and process measures. Patients in the Initial Patient Population who have valid pre-operative and post-operative assessments comprise the Measure Denominator used to calculate rates for the outcome measures. The denominator is the bottom number in a fraction. There is no traditional numerator or target for the outcome measures; they are calculated as an average change in the functional status, quality of life or pain score. The detailed criteria used to identify the Initial Patient Population are included in the Measure Specifications on pages 5-8. Patient Population 1 - Lumbar Discectomy/Laminotomy Patients meet the Initial Patient Population criteria if ALL of the following are met: Patients age 18 years and older at the start of the procedure measurement period (date of birth was on or prior to 01/01/1995; no upper age limit). Patients who underwent a lumbar discectomy/laminotomy procedure for a diagnosis of disc herniation with the date of procedure between 01/01/2013 and 12/31/2013. Patient had following CPT Code: See Table 1. Include patients in this population only if CPT Code is the only spine procedure code used. Do not include patients who had an additional spinal procedure(s) (CPT) performed. Patient had following ICD-9 Diagnosis Code: See Table 2. This diagnosis code can be in any position There are NO up-front exclusions for Patient Population 1; all patients who meet all of the above criteria must be included. Calculated exclusions following data submission: patients without a valid pre-operative and/or post-operative assessment are removed from the Measure Denominator. Patient Population 2 - Lumbar Spinal Fusion Patients meet the Initial Patient Population criteria if ALL of the following are met: Patients age 18 years and older at the start of the procedure measurement period (date of birth was on or prior to 01/01/1995; no upper age limit). Patients who underwent a lumbar spinal fusion procedure with the date of procedure between 01/01/2013 and 12/31/2013. If any portion of the lumbar spine is fused (L1 to L5), the patient is to be included If the fusion of the lumbar spine also incorporates thoracic vertebrae, the patient is to be included Patient had following CPT Codes: 22533, 22534, 22558, , 22630, See Table 3. Page 17

18 There are exclusions for Patient Population 2. Patients who have any of the following conditions must be removed UPFRONT from the patient data file: Cancer, fracture, and infection related to the spine. See Table 4, Table 5 and Table 6. Idiopathic and congenital scoliosis. See Table 7. Calculated exclusions following data submission: patients without a valid pre-operative and/or post-operative assessment are removed from the Measure Denominator. Step 1: Pre-Submission Data Certification (formerly Denominator Certification) This must be done prior to identifying your population and collecting data. To aid medical groups identification of the correct Initial Patient Population, MNCM will review each medical group s source code and/or methodology for producing the patient population upfront. This process is intended to identify potential issues prior to data submission, thus avoiding rework for medical groups. However, the responsibility to submit an accurate patient population rests with the medical group. Please contact support@mncm.org with any questions. NOTE: MNCM s pre-submission data certification process may include a comprehensive review of the steps used by the medical group to identify the Initial Patient Population, including a final listing of the identified patients. MNCM recommends saving all original queries, spreadsheets and/or other documentation of the process used to identify the Initial Patient Population for potential review. Initial Patient Population Identification Methodology Details The following elements are included on the pre-submission data certifications forms. Medical groups will need to indicate on the form how they will identify each element. Date of birth range. ICD-9-CM and CPT codes included in query. o CPT codes are used to identify the Initial Patient Population o ICD-9 codes are used for exclusions for Population 2 (Lumbar Spinal Fusion) and may be used to identify the Clinical Condition Reason for Procedure o When querying the system for codes, use the appropriate sets of code ranges; do NOT use one single code range to query. Procedure date range. Board certified specialties of providers who will be included in the query. How exclusions for the lumbar spinal fusion patients will be identified. The query code that you used from your billing system The pre-submission data certification step is considered complete when your medical group receives approval from MNCM. Page 18

19 Pre-Submission Data Certification Template Form A template is provided to ensure all medical groups are using the same set of criteria to identify Initial Patient Population. Forms must be updated on an annual basis to ensure the most up-to-date information is collected. The pre-submission data certification form requires source code or screen shots, which are helpful for the certification process. Medical groups need to complete this form and submit it through the MNCM Data Portal. To download the form and submit it for certification: 1. Login to the MNCM Data Portal ( 2. Under RESOURCES, select Cycle B - Spinal Surgery from the drop-down menu. Download the Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Pre-Submission Data Certification Form. 3. Complete the form and save it in your network directory. 4. Login to the MNCM Data Portal and select Denominator Certification under the Spinal Surgery Lumbar Discectomy/Laminotomy 2015 Report (2013 Dates of Procedure) section. Follow the instructions to upload the form. 5. Login to the MNCM Data Portal and select Denominator Certification under the Spinal Surgery Lumbar Spinal Fusion 2015 Report (2013 Dates of Procedure) section. Follow the instructions to upload the form. 6. MNCM will review the information and respond within 3 business days. MNCM will either (1) contact the medical group if more clarification is needed, in which case the medical group will need to make the necessary revisions and re-upload the form; or (2) certify the Initial Patient Population identification methodology. This certification will be indicated in the MNCM Data Portal and an automatic notification will be sent to the medical group. Step 2: Initial Patient Population Identification After completing Step 1, and the pre-submission data certification form has been approved by MNCM, medical groups will be able to query their system to determine the patient population for this measure. NOTE: Medical groups that implemented a new practice management system during 2013 will need to generate the patient population list using both systems. Two queries or patient lists may be necessary; if so, the lists should be combined and a common identifier selected to de-duplicate the list. Please contact support@mncm.org with any questions. Page 19

20 System Query If any of the following data elements are available electronically, it is helpful to include them as part of the initial data extraction from your system during population identification. Refer to the Data Elements and Field Specifications Tables found on pages for details on formatting the data elements that must be submitted to MNCM. They include: MNCM Clinic ID Facility ID (see Table 10 and Table 11) Patient ID number: If you substitute this number with a unique encrypted number, keep a crosswalk of this information for the validation audit. Do not submit Social Security Numbers. Patient date of birth (DOB) Surgeon NPI Provider type and specialty code CPT Codes Diagnosis Code: May be helpful in determining the reason why the patient is having the procedure which is needed for the Clinical Condition Reason for Procedure field. Keep a Crosswalk : It is very important to keep a crosswalk between the unique identifier and the patient s name and DOB, so that records can be located by clinic staff at the time of validation by MNCM. Insurance payer: This information must be substituted with the MNCM-assigned insurance code in the data file that is submitted to MNCM. This should be the patient s most recent insurance on or prior to the end of the measurement period which includes the follow-up time period 15 months post procedure. Insurance member ID: Do not submit Social Security Numbers. Other demographic data: Race/ethnicity, language, country of origin, gender, and zip code. Other clinical data: Height, weight, history of prior back surgery, tobacco status. Exclusions In general, exclusions are kept to a minimum. They are supported by evidence that must show frequency of occurrence in which the results would be distorted without the exclusion or is clinically appropriate. A complete list of exclusions for the lumbar fusion population is included under Exclusions in the Measure Specifications on pages 5-8. Also see Tables 4-7 on pages 9-11 for all applicable exclusion codes. Patients with exclusions must be removed upfront and not included in the Initial Patient Population data file. If a patient meets the patient criteria for the Initial Patient Population and none of the exclusions apply, the patient must be included. Page 20

21 Patient Population 1 (Lumbar Discectomy/Laminotomy) There are NO upfront exclusions for Patient Population 1. All patients must be included. Calculated exclusions following data submission: patients without a valid pre-operative and/or post-operative assessment are removed from the Measure Denominator. Patient Population 2 (Lumbar Spinal Fusion) The following are exclusions for Patient Population 2. Patients who have any of these exclusions must be removed UPFRONT from the patient data file: Cancer, fracture and/or infection related to the spine (See Table 4, Table 5 and Table 6) Idiopathic and congenital scoliosis (See Table 7) Calculated exclusions following data submission: patients without a valid pre-operative and/or post-operative assessment are removed from the Measure Denominator. Finalizing the patient population list Once the query is completed, the file should be finalized using the following process: 1. Sort the list by clinic sites where patients are attributed. 2. Review the number of patients/procedures in the population. Is the total number of patients/procedures realistic and does it make sense? If not, does a correction in the methodology or query need to be made? 3. Make sure inactive patients are included. Patients designated as inactive in a practice management system, billing system or electronic medical record must be included in the patient population if they meet the criteria. Excel Pivot Table Tip The Excel pivot table function can show counts of patients. Use the patient medical record number, account number or other unique ID as common identifiers. Page 21

22 Patient Registry Caution Patient registries are important tools for clinics to track patient progress and to support quality improvement. However, MNCM cautions the use of patient registries to identify patients in the population or for collection of clinical data. Using a registry is acceptable only if the following conditions are met: 1. The clinic s entire population of patients undergoing Lumbar Discectomy/Laminotomy OR Lumbar Spinal Fusion are included AND 2. The information in the registry is as up-to-date as the medical record. Many registries give a snapshot of patients at a given time; thus they may not include all patients, according to patient inclusion criteria, or reflect the most recent clinical data (e.g., blood pressure or labs). If your medical group utilizes a registry that is programmed to update the patient population and clinical results on a continual basis (24/7), or was built using measure specifications, contact support@mncm.org to discuss its possible use. During the validation audit, MNCM auditors will review patient records for validation and not patient registries. Thus, if a clinic uses data from a patient registry, the auditor may find more validation errors. Page 22

23 Section B: Data Collection The second stage in the process to calculate performance rates is to collect the data elements. Specific information can be found in the Data Elements and Field Specifications Tables on pages Medical groups can collect clinical data from medical records by extracting it from an EMR through a data query or abstracting it from the medical record (paper record or EMR). Data collection should occur after: 1. The clinic s billing and medical record updates are complete for the measurement period; 2. The Initial Patient Population identification method is certified by MNCM; and 3. The Initial Patient Population is pulled according to the measure specifications. Data Collection Tips When manually collecting data from an EMR, highlight the row, column or cell that contains the data needed. This reduces the chance of looking at the wrong one. Watch for typos when entering data (number transpositions, etc.). Step 1: Collect the Data Data must be submitted using the provided Excel template. It contains all of the necessary fields and column formatting to submit data according to the measure specifications. Download the 2015 Lumbar Discectomy/Laminotomy (Population 1) Data Collection Spreadsheet Template and the 2015 Lumbar Spinal Fusion (Population 2) Data Collection Spreadsheet Template from the MNCM Data Portal. It is under RESOURCES by selecting Cycle B - Spinal Surgery from the drop-down menu. Locating Data Elements in the Patient Record The primary source of data should be the clinic s documentation in the medical record (e.g., flow sheets, progress notes). For these functional status and quality of life measures, it is unlikely the source of information will be anywhere beside the orthopedic or neurosurgery office s records. However, in the case of missing demographic or clinical information, some data can be obtained from correspondence that is included in the clinic record. If outside correspondence is used, it must be documented in the patient s medical record for validation audit purposes. Examples include height, weight, or smoking status. Please refer to the field specifications for instruction about the data collection for each field in addition to the tips below. Demographic and Clinical Information Demographic information could be obtained from account/billing system. Clinical information could be obtained from the pre-operative assessment or pre-operative history and physical, if this is contained in your record. Page 23

24 Oswestry Disability Index (ODI), EQ5D-5L/PROMIS-10 and VAS Scores. Patient Reported Outcome (PRO) assessments given to patients should become a permanent part of their medical record. Electronic Health Records: o Recommend storing values as discrete fields at allow easier extraction o Scanned assessments are an option, but may require manual abstraction to retrieve data Paper Records: o Store the assessment tools within your medical record file Medical groups may elect to obtain information via a scannable form that the patient completes. This could then be used to create the data file for submission. Results from PRO Tools o For the ODI, it is acceptable to submit the summary score or each individual score. If the summary score is submitted; this will be used for calculating average functional change If desired, the summary score field can be left blank and the individual values may be submitted for the MNCM Data Portal to calculate the summary ODI score. If a group elects the option to submit both the summary and individual values; calculations will be based on the summary score only (will not be re-calculated in the MNCM Data Portal) o For the EQ5D-5L and PROMIS-10 EQ5D-5L and PROMIS-10 calculations are very complex and require individual responses to be submitted in the MNCM Data Portal for score calculation or conversion if appropriate. All of the individual scores must be submitted for these tools. The MNCM Data Portal will only accept and calculate EQ5D-5L and PROMIS-10 indexes for patients that have all questions answered. The MNCM Data Portal will convert PROMIS-10 values to an EQ5D index for all patients with a date of procedure prior to 01/01/2015. Tracking Data Location in the Patient Record It is helpful during the audit process to know where data is located in the patient s medical record. If information is kept in a place in the medical record that is not typical for the practice, document the location on the data collection form or directly in the Excel spreadsheet by adding a Notes column. Save a copy of the Excel file with the Notes column (for internal records) and without (for submission to MNCM). Page 24

25 Data Elements and Field Specification for Patient Population 1 (Lumbar Discectomy/Laminotomy Procedure) Summary of Changes Plan for Transition to PROMIS Global-10 PROMIS-10 is replacing the EQ5D-5L patient reported outcome tool for assessing pre-operative and post-operative quality of life. This change is effective for patients undergoing a procedure as of 1/1/2015. For patients who had a preop assessment with EQ5D and a post-op assessment with PROMIS Global-10, conversion of values will occur within the MNCM data portal. Please refer to Appendix A and the Data and Field Specifications for more details; Appendix I for measure development work group rationale. Clinical Condition Reason for Procedure (Lumbar Fusion) Following pilot testing, in an effort to reduce burden, the measure development work group revised the number of categories for this field from 6 to 4. This resulted in categories that are fully definable by ICD diagnosis codes. Please refer to the Data and Field Specifications. Note: Prior Back Surgery Field For dates of procedure starting 1/1/2014 (2016 report year) the option to submit code # 4 = Prior back surgery history unknown/not documented in the record will no longer be a valid code. Its use was temporary to allow medical groups time to implement this field which is planned for evaluation for use in a risk adjustment model. Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example A Clinic ID Enter the MNCM Clinic ID for every patient/row submitted. MNCM assigns the clinic ID at the time of registration. Use the MNCM ID listed in the MNCM Data Portal. Do NOT use the Medical Group ID. Blank values will create ERRORs upon submission. Quality Check: Verify ID in each cell matches the clinic ID in the MNCM Data Portal. Page 25 Text 905

26 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example B Patient ID Enter a unique patient ID to identify each patient. C Patient Date of Birth Keep a crosswalk between patient IDs and the patient names/dobs to help clinic staff locate records during validation audits. Enter clinic-assigned ID (e.g., MRN, account number). Do NOT enter Social Security Numbers. Blank values will create ERRORs upon submission. Quality Check: Verify patient s procedure was not duplicated. If a duplicate is found, make sure the patient has undergone two separate lumbar discectomy/laminotomy procedures during the measurement period. Enter patient s date of birth. Patient must be 18 years or older on the date of procedure. BLANK or dates after 01/01/1995 will create a file ERROR upon submission. Text Date (mm/dd/yyyy) 05/08/1985 Quality Check: Verify each date of birth is within the accepted range. D Patient Gender Enter patient s gender. Female = F Male = M Unknown = U Text F Blank values will create ERRORs upon submission. Quality Check: Verify each cell has one of the accepted codes. E Patient Zip Code Enter the five-digit zip code of patient s primary residence at the most recent encounter on or prior to 12/31/2014. Text If EMR query extracts a nine-digit number, submit the nine-digit number. The MNCM Data Portal will remove the last four digits automatically. Blank values will create ERRORs upon submission. Quality Check: Verify the zip code is at least five digits and each cell has data. Page 26

27 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example F Race/Ethnici Please refer to a separate document entitled 2015 REL Data Field Specifications and ty1 Codes for the field specifications in Columns F-N. It can be found via the link above, G Race/Ethnici under RESOURCES on the MNCM Data Portal in the Race/Ethnicity/Language Data ty2 (REL) section, or on MNCM.org under Submitting Data > Training & Guidance > Data H Race/Ethnici ty3 Collection. I Race/Ethnici ty4 These are optional fields. J Race/Ethnici ty5 For more information about collecting this data from patients, refer to the Handbook K Country of Origin Code on the Collection of Race Ethnicity and Language Data available at under Data Collection. L Country of Origin Quality Check: Verify each cell has one of the accepted codes. Blank cells (if there is no Other data is available) are acceptable. Description M Preferred Language Code N Preferred Language Other Description O Surgeon NPI Number Enter the 10 digit NPI number of the surgeon who performed the lumbar discectomy/laminotomy procedure. Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data. Text Page 27

28 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example P Provider Enter the code for the specialty of the surgeon performing the lumbar Number 22 Specialty discectomy/laminotomy procedure. Code 22 = Orthopedic Medicine/Surgery 18 = Neurosurgery Q R S Insurance Coverage Code Insurance Coverage Other Description Insurance Plan Member ID Blank values will create ERRORs upon submission. Quality check: Verify each cell has an accepted code. Please refer to a separate document entitled 2015 Insurance Coverage Data Field Specifications and Codes for these field specifications. This document can be found via the link above, under RESOURCES on the MNCM Data Portal in the Insurance Coverage Info section, or on MNCM.org under Submitting Data > Training & Guidance > Data Collection. This should be the patient s most recent insurance on or prior to 05/14/2014. Quality Check: Verify each cell has an accepted code and that all 99 codes have a name entered in Column R. Verify Social Security Numbers are NOT submitted. Number 1 Text Text Assurant Health FBOXZ7969 T Height Inches Enter the patient s height in inches. One decimal place is allowed to reflect one-half inch (e.g., 62.5). Rounding up or down as appropriate to the next whole number is acceptable as well, depends on system capability. Must be collected (measured) in a clinical setting and not a patient reported value. Field is used with weight to calculate the patient s BMI. One decimal or may round up or down to whole inches 62.5 (inches) Leave BLANK if patient s height was not assessed. Quality Check: If data is entered, verify a whole number or only one decimal point is used. Page 28

29 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example U V W Weight Pounds Tobacco Status Prior Back Surgery Enter the patient s pre-operative weight in pounds. Do not use decimals. Round up or down to the nearest pound. Use the most recent weight within six months prior to the procedure; do not include weights that are more than 6 months prior to the procedure. Must be collected (measured) in a clinical setting and not a patient reported value. Field is used with height to calculate the patient s BMI. Leave BLANK if the patient s weight was not assessed. Quality Check: If data is entered, verify a whole number and no decimal places are used. Enter the patient s pre-operative tobacco status. Tobacco includes any amount of cigarettes, cigars, pipes, or chew. Do NOT count e-cigarettes as tobacco products. 1 = Tobacco Free (patient does not use tobacco) 2 = No Documentation 3 = Current Tobacco User Leave BLANK if unknown/not submitting data. Quality Check: Verify each cell has an accepted code if data is entered. History of prior lumbar back surgery. Time frame of prior lumbar surgery is unlimited; intent is to capture any history of prior back surgery. Medical groups are encouraged to build this question into their patient assessment work flow and incorporate into EMR systems as a discrete reportable field. A table of suggested CPT codes can be used to identify lumbar spine surgery; however there are cautions in using this approach. In particular, the patient may have a history of prior back surgery at another medical group and using the procedure code history alone would not capture this. Enter the appropriate code to indicate if the patient had prior lumbar surgery: 1 = No prior back surgery in the lumbar region 2 = Prior back surgery in the lumbar region with fusion (with or without instrumentation) 3 = Prior back surgery in the lumbar region without fusion (no instrumentation or bone graft that fuses vertebrae) Page 29 whole number (round up or down) Number 1 Number 1 62 (pounds)

30 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example W 4 = Prior back surgery history unknown/not documented in the record. (cont.) Prior Back Surgery (cont.) Note: Code # 4 only available for procedures completed prior to 01/01/2014 to allow medical groups time to create structured data. For procedures completed after 01/01/2014 this option will no longer be available. X Date of Procedure Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data. Enter the date of the lumbar discectomy/laminotomy procedure. Blank values or values outside the measurement period will create ERRORs upon submission. Quality Check: Verify all dates are between 01/01/2013 to 12/31/2013. Y Facility ID Enter the code for the hospital where the lumbar discectomy/laminotomy procedure was performed. Please refer to Table 10 and Table 11. This data element is required for reporting outcome information by hospital. Please search the tables thoroughly for the code as facility names may not match exactly as you expect. Blank values will create ERRORs upon submission. Quality Check: Verify each cell has an accepted code. If 999 is entered into cell, verify text is entered in Column Z for this row. Z Facility Other Description If the facility (and subsequent code) where the procedure was performed is not listed in Table 10 and Table 11 and the Facility ID = 999 Other, enter the description of the location where the lumbar discectomy/laminotomy procedure was performed. Date (mm/dd/yyyy) Text 41 Text 9/10/2013 Elk Ridge Surgery Center Quality Check: Verify that in each row that has text entered in this cell if 999 is entered into Column Y. Page 30

31 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AA Facility Type Enter the type of facility in which the procedure was performed. 1 = Hospital 2 = Free Standing Outpatient Ambulatory Surgery Center Blank values will create ERRORs upon submission. Quality check: Verify each cell has an accepted code. Number 1 For all Oswestry Disability Index (ODI) Fields including Pre-operative and Post-operative; refer to Appendix A for more information about how to implement and score the ODI. If a patient selects more than one response to a question, submit the highest (worst) response. If submitting a summary score only, use the highest (worst) response in creating the summary score. Do not fill blanks with a zero as this is a valid response in the tool. There are three options for submitting ODI assessment information. Option One: Submit only the summary ODI score only. Medical groups must attest to following the rules if they select this option. Rules for submitting summary score only: 1. Patient must complete at least eight of the 10 questions asked for a valid submission. You cannot submit the summary ODI score if the patient answers seven or fewer questions. 2. Review Appendix A for calculating the ODI Summary Score. Option Two: Submitting each individual value so the MNCM Data Portal can calculate the ODI score. The MNCM Data Portal will evaluate all incoming responses, if at least 8 of the 10 questions are completed by the patient, the assessment tool can be used and the portal will score appropriately. Option Three: Submit both the summary score and the individual values. If desired and available, medical groups can choose to submit both the summary score they calculated according to the scoring rules and the individual answers to each question. If medical groups chose this option, the MNCM data portal will use the summary score submitted by the medical group for rate calculations. Page 31

32 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AB AC AD Preop ODI Date Target = Preoperative assessment within three months prior to procedure Preop ODI Summary Score Preop ODI Pain Enter the date when the pre-operative Oswestry Disability Index (ODI) was completed by the patient. If more than one pre-operative ODI was obtained, use the ODI that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative ODI date was three months prior to the date of procedure. Leave BLANK if a pre-operative ODI evaluation was not obtained. If submitting the individual values and allowing the MNCM Data Portal to determine the completeness of the ODI, enter the date of the ODI and all of the subsequent values. Quality Checks: Verify date is valid. Enter the value of the patient s pre-operative summary ODI score. Leave BLANK if the patient answers seven or fewer questions, OR if submitting individual values and not the summary score (Option Two). Use the ODI scoring guide available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s pre-operative selection for ODI Section 1- Pain intensity. 0 = I have no pain at the moment. 1 = The pain is very mild at the moment. 2 = The pain is moderate at the moment. 3 = The pain is fairly severe at the moment. 4 = The pain is very severe at the moment. 5 = The pain is the worst imaginable at the moment. If patient selects more than one response to a question, submit the highest (worst) response. Date (mm/dd/yyyy) whole 7/27/ Page 32

33 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AD Preop ODI Leave BLANK if the patient does not answer or if there is no documentation. (cont.) Pain (cont.) Quality Check: Verify each cell has a value between zero and five. AE Preop ODI Care Enter the value that corresponds with the patient s pre-operative selection for ODI Section 2- Personal Care (washing, dressing, etc.). 0 = I can look after myself normally without causing additional pain. 1 = I can look after myself normally but it is very painful. 2 = It is painful to look after myself and I am slow and careful. 3 = I need some help but manage most of my personal care. 4 = I need help every day in most aspects of my personal care. 5 = I do not get dressed, I wash with difficulty and stay in bed. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 1 Page 33

34 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AF Preop ODI Lifting Enter the value that corresponds with the patient s pre-operative selection for ODI Section 3- Lifting. 0 = I can lift heavy weights without additional pain. 1 = I can lift heavy weights but it give me additional pain. 2 = Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned, e.g. on a table. 3 = Pain prevents me from lifting heavy weights, but I can manage light to medium weights if off they are conveniently positioned. 4 = I can lift only very light weights. 5 = I cannot lift ot carry anything at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 4 AG Preop ODI Walking Enter the value that corresponds with the patient s pre-operative selection for ODI Section 4- Walking. 0 = Pain does not prevent me from walking any distance. 1 = Pain prevents me from walking more than one mile. 2 = Pain prevents me from walking more than a quarter of a mile. 3 = Pain prevents me from walking more than 100 yards. 4 = I can only walk using a cane or crutches. 5 = I am in bed most of the time and have to crawl to the toilet. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 2 Page 34

35 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AH Preop ODI Sitting Enter the value that corresponds with the patient s pre-operative selection for ODI Section 5- Sitting. 0 = I can sit in any chair as long as I like. 1 = I can sit in my favorite chair as long as I like. 2 = Pain prevents me from sitting more than one hour. 3 = Pain prevents me from sitting more than half an hour. 4 = Pain prevents me from sitting more than 10 minutes. 5 = Pain prevents me from sitting at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 1 AI Preop ODI Standing Enter the value that corresponds with the patient s pre-operative selection for ODI Section 6- Standing. 0 = I can stand as long as I want without additional pain. 1 = I can stand as long as I want but it gives me additional pain. 2 = Pain prevents me from standing more than one hour. 3 = Pain prevents me from standing more than half an hour. 4 = Pain prevents me from standing more than 10 minutes. 5 = Pain prevents me from standing at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 3 Page 35

36 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AJ Preop ODI Sleeping Enter the value that corresponds with the patient s pre-operative selection for ODI Section 7- Sleeping. 0 = My sleep is never interrupted by pain. 1 = My sleep is occassionally interrupted by pain. 2 = Because of pain I have less than 6 hours of sleep. 3 = Because of pain I have less than 4 hours of sleep. 4 = Because of pain I have less than 2 hours of sleep. 5 = Pain prevents me from sleeping at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 1 AK Preop ODI Sex Enter the value that corresponds with the patient s pre-operative selection for ODI Section 8- Sex life. 0 = My sex life is normal and causes no additional pain. 1 = My sex life is normal but causes some additional pain. 2 = My sex life is nearly normal but is very painful. 3 = My sex life is severly restricted by pain. 4 = My sex life is nearly nonexistant because of pain. 5 = Pain prevents me from having any sex life at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 2 Page 36

37 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AL Preop ODI Social Enter the value that corresponds with the patient s pre-operative selection for ODI Section 9- Social Life. 0 = My social life is normal and causes no additional pain. 1 = My social life is normal but increases the degree of pain. 2 = Pain has no significant effect on my social life apart from limiting my more energetic interests. 3 = Pain has restricted my social life and I do not go out as often. 4 = Pain has restricted my social life to home. 5 = I have no social life becasue of pain. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 0 AM Preop ODI Travelling Enter the value that corresponds with the patient s pre-operative selection for ODI Section 10- Travelling. 0 = I can travel anywhere without pain. 1 = I can travel anywhere but it gives me additional pain. 2 = Pain is bad but I m able to manage trips over two hours. 3 = Pain restricts me to trips on less than one hour. 4 = Pain restricts me to short necessary trips of under 30 minutes. 5 = Pain prevents me from travelling except to receive treatment. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 0 Page 37

38 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example For All EQ5D-5L Fields: If a pre-operative or post-operative EQ5D-5L assessment was not obtained, the patient record should still be submitted; however, the EQ5D-5L fields should be left blank. If a patient skips one of the five domain questions, submit values for the questions that the patient did answer. Values have merit individually for understanding the patient population and use for potential risk adjustment. However, the health index score can only be calculated when all five questions are completed. If a patient selects more than one response to a question, submit response as a blank (no value). Do not attempt to select a value (unlike ODI and VAS). According to EuroQol, the tool developer, two responses to a question invalidates the tool. For EQ5D Health State field - If there is a discrepancy between where the patient has placed the X and the number the patient has written in the box, use the numeric value written in the box. If a pre-operative or post-operative EQ5D-5L evaluation was obtained, but an answer was skipped, leave that answer blank. The MNCM Data Portal will evaluate all incoming responses, and if a valid response is submitted for each of the five domain questions, will calculate the EQ5D-5L health index. Please refer to the MNCM Data Portal RESOURCES tab after selecting Spinal Surgery from the drop-down menu and Appendix A in this guide for more details. Plan for Transition EQ5D-5L to PROMIS Global-10: Measuring the patient s quality of life following the procedure is transitioning to a new tool- PROMIS Global-10 for patients with procedure dates starting 1/1/2015. For patients who had a pre-op assessment with EQ5D and a post-op assessment with PROMIS Global-10, conversion of values will occur within the MNCM data portal. Please refer to Appendix A for more information. AN Preop EQ5D Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative EQ5D-5L was completed by the patient. If more than one pre-operative EQ5D-5L was obtained, use the EQ5D-5L that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative EQ5D date was three months prior to the date of procedure. Leave BLANK if pre-operative EQ5D-5L evaluation was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) Page 38 10/27/2011

39 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AO Preop EQ5D 2 Mobility AP AQ Preop EQ5D Self Care Preop EQ5D Usual Activities Enter the value of the patient s pre-operative response to the EQ5D-5L Mobility Statement. 1 = I have no problems in walking. 2 = I have slight problems walking. 3 = I have moderate problems walking. 4 = I have severe problems walking. 5 = I am unable to walk. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s pre-operative response to the EQ5D-5L Self Care Statement. 1 = I have no problems with washing or dressing myself. 2 = I have slight problems washing or dressing myself. 3 = I have moderate problems washing or dressing myself. 4 = I have severe problems washing or dressing myself. 5 = I am unable to wash or dress myself. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s pre-operative response to the EQ5D-5L Usual Activities Statement. 1 = I have no problems doing my usual activities. 2 = I have slight problems doing my usual activities. 3 = I have moderate problems doing my usual activities. 4 = I have severe problems doing my usual activities. 5 = I am unable to do my usual activities. Page

40 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AQ Preop EQ5D Leave BLANK if patient does not answer, if there is no documentation or if the patient (cont.) Usual selected more than one response. Activities Quality Check: Verify each cell has a value between one and five. (cont.) AR Preop EQ5D Pain Enter the value of the patient s pre-operative response to the EQ5D-5L Pain/Discomfort Statement. 1 = I have no pain or discomfort. 2 = I have slight pain or discomfort. 3 = I have moderate pain or discomfort. 4 = I have severe pain or discomfort. 5 = I have extreme pain or discomfort. 2 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. AS Preop EQ5D Anxiety Depression Enter the value of the patient s pre-operative response to the EQ5D-5L Anxiety/Depression Statement. 1 = I am not anxious or depressed. 2 = I am slightly anxious or depressed. 3 = I am moderately anxious or depressed. 4 = I am severely anxious or depressed. 5 = I am extremely anxious or depressed. 1 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Page 40

41 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AT Preop EQ5D Health State Enter the value of the patient s pre-operative response to the EQ5D-5L Best Imaginable Health Statement. This value corresponds with a scale that the patient points to, ranging from 0 (worst imaginable health status) to 100 (best imaginable health status). If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. Leave BLANK if patient does not answer or if there is no documentation. Quality Check: If data is entered, verify it is a whole number between 0 and AU Preop VAS Pain Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative VAS Visual Analog Pain Scale rating was completed by the patient. If more than one pre-operative VAS Pain score was obtained, use the VAS Pain score that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the preoperative VAS pain date was three months prior to the date of procedure. Leave BLANK if a pre-operative VAS Visual Analog Pain Scale rating was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 10/27/2011 AV Preop VAS Pain Value- Back Enter the value corresponding to the patient s pre-operative selection on the VAS pain scale continuum related to back pain. The VAS pain scale is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 in 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the 10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if patient did not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and 10. One decimal point 7.5 Page 41

42 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AW Preop VAS Pain Value- Leg Enter the value corresponding to the patient s pre-operative selection on the VAS pain scale continuum related to leg pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the 10 end of the scale is described as Intolerable. If a patient selects more than one response to a question,submit the highest (worst) response. Leave BLANK if patient did not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and 10. One decimal point For All PROMIS Global-10 Fields: The PROMIS Global 10 tool is going to be used for ALL patients undergoing spine surgery procedures starting 01/01/2015. It will replace the EQ5D-5L. If your medical group has the ability to collect and report PROMIS-10 for patients who underwent procedures prior to 01/01/2015, you can submit the PROMIS-10 data. If the patient selects more than one response for a PROMIS-10 question, submit a blank for the value for that question. After your medical group has implemented the PROMIS-10 tool, there is no need to use the EQ5D for follow-up assessments of patients who were assessed pre-operatively with the EQ5D prior to 01/01/2015.The MNCM Data Portal will convert PROMIS-10 values to an EQ5D health index score for all patients with a date of procedure before 01/01/2015. This will allow for consistency of measurement within each calendar year based measurement period. 7.5 Page 42

43 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AX Preop PGH Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative PROMIS Global Health 10 was completed by the patient. If more than one pre-operative PROMIS Global Health 10 was obtained, use the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative PROMIS Global Health 10 date was three months prior to the date of procedure. Leave BLANK if a pre-operative PROMIS Global Health 10 evaluation was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 03/01/2013 AY Preop PGH 1 Health Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general health rating. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 1 Page 43

44 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example AZ Preop PGH 2 Quality Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general quality of life. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 2 BA Preop PGH 3 Physical Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general physical health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 3 Page 44

45 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BB Preop PGH 4 Mental Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general mental health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 4 BC Preop PGH 5 Satis Social Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general satisfaction with social activities and relationships. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 5 Page 45

46 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BD Preop PGH 9 Soc Activities Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding ability to carry out social activities and roles. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 1 BE Preop PGH 6 Phys Activities Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding ability to carry out physical activities. 1 = Not at all 2 = A little 3 = Moderately 4 = Mostly 5 = Completely Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 2 Page 46

47 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BF Preop PGH 10 Emotional Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding emotional problems in the past 7 days. 1 = Always 2 = Often 3 = Sometimes 4 = Rarely 5 = Never Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 3 BG Preop PGH 8 Fatigue Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding fatigue on average in the past 7 days. 1 = Very severe 2 = Severe 3 = Moderate 4 = Mild 5 = None Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 4 BH Preop PGH 7 Pain Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding pain rating in the past 7 days using a scale of 0 (No Pain) to 10 (Worst imaginable pain). Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 5 Page 47

48 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BI 3 Mon Postop ODI Date Target = Postoperative assessment between six and 20 weeks after procedure Enter the date when the three month Oswestry Disability Index (ODI) was completed by the patient. If more than one post-operative ODI was obtained, use the ODI that is the most recent and prior to 20 weeks after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the three month post-operative ODI date was between six and 20 weeks after the date of procedure. Leave BLANK if a three month post-operative ODI evaluation was not obtained. Quality Check: Verify date is valid. Date (mm/dd/yyyy) 11/12/2013 BJ 3 Mon Postop ODI Summary Score Enter the value of the patient s three month post-operative summary ODI score. Leave BLANK if the patient answers seven or fewer questions OR if submitting individual values and not the summary score (Option Two). Use the ODI scoring guide available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu. Quality Check: Verify each cell has a value between zero and five. whole 67 BK 3 Mon Postop ODI Pain Enter the value of the patient s post-operative selection for ODI Section 1- Pain intensity. 0 = I have no pain at the moment. 1 = The pain is very mild at the moment. 2 = The pain is moderate at the moment. 3 = The pain is fairly severe at the moment. 4 = The pain is very severe at the moment. 5 = The pain is the worst imaginable at the moment. If patient selects more than one response to a question, submit the highest (worst) 2 Page 48

49 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BK 3 Mon response. Leave BLANK if the patient does not answer or if there is no documentation. (cont.) Postop ODI Pain (cont.) Quality Check: Verify each cell has a value between zero and five. BL BM 3 Mon Postop ODI Care 3 Mon Postop ODI Lifting Enter the value of the patient s post-operative selection for ODI Section 2- Personal Care (washing, dressing, etc.). 0 = I can look after myself normally without causing additional pain. 1 = I can look after myself normally but it is very painful. 2 = It is painful to look after myself and I am slow and careful. 3 = I need some help but manage most of my personal care. 4 = I need help every day in most aspects of my personal care. 5 = I do not get dressed, I wash with difficulty and stay in bed. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 3- Lifting. 0 = I can lift heavy weights without additional pain. 1 = I can lift heavy weights but it give me additional pain. 2 = Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned, e.g. on a table. 3 = Pain prevents me from lifting heavy weights, but I can manage light to medium weights if off they are conveniently positioned. 4 = I can lift only very light weights. 5 = I cannot lift ot carry anything at all. If patient selects more than one response to a question, submit the highest (worst) Page

50 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BM 3 Mon response. (cont.) Postop ODI Leave BLANK if the patient does not answer or if there is no documentation. Lifting (cont.) Quality Check: Verify each cell has a value between zero and five. BN BO 3 Mon Postop ODI Walking 3 Mon Postop ODI Sitting Enter the value that corresponds with the patient s post-operative selection for ODI Section 4- Walking. 0 = Pain does not prevent me from walking any distance. 1 = Pain prevents me from walking more than one mile. 2 = Pain prevents me from walking more than a quarter of a mile. 3 = Pain prevents me from walking more than 100 yards. 4 = I can only walk using a cane or crutches. 5 = I am in bed most of the time and have to crawl to the toilet. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 5- Sitting. 0 = I can sit in any chair as long as I like. 1 = I can sit in my favorite chair as long as I like. 2 = Pain prevents me from sitting more than one hour. 3 = Pain prevents me from sitting more than half an hour. 4 = Pain prevents me from sitting more than 10 minutes. 5 = Pain prevents me from sitting at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Page

51 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example Quality Check: Verify each cell has a value between zero and five. BP 3 Mon Postop ODI Standing Enter the value that corresponds with the patient s post-operative selection for ODI Section 6- Standing. 0 = I can stand as long as I want without additional pain. 1 = I can stand as long as I want but it gives me additional pain. 2 = Pain prevents me from standing more than one hour. 3 = Pain prevents me from standing more than half an hour. 4 = Pain prevents me from standing more than 10 minutes. 5 = Pain prevents me from standing at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 3 BQ 3 Mon Postop ODI Sleeping Enter the value that corresponds with the patient s post-operative selection for ODI Section 7- Sleeping. 0 = My sleep is never interrupted by pain. 1 = My sleep is occassionally interrupted by pain. 2 = Because of pain I have less than 6 hours of sleep. 3 = Because of pain I have less than 4 hours of sleep. 4 = Because of pain I have less than 2 hours of sleep. 5 = Pain prevents me from sleeping at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 1 Page 51

52 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BR 3 Mon Postop ODI Sex Enter the value that corresponds with the patient s post-operative selection for ODI Section 8- Sex life. 0 = My sex life is normal and causes no additional pain. 1 = My sex life is normal but causes some additional pain. 2 = My sex life is nearly normal but is very painful. 3 = My sex life is severly restricted by pain. 4 = My sex life is nearly nonexistant because of pain. 5 = Pain prevents me from having any sex life at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 2 BS 3 Mon Postop ODI Social Enter the value that corresponds with the patient s post-operative selection for ODI Section 9- Social Life. 0 = My social life is normal and causes no additional pain. 1 = My social life is normal but increases the degree of pain. 2 = Pain has no significant effect on my social life apart from limiting my more energetic interests. 3 = Pain has restricted my social life and I do not go out as often. 4 = Pain has restricted my social life to home. 5 = I have no social life becasue of pain. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 0 Page 52

53 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BT 3 Mon Enter the value that corresponds with the patient s post-operative selection for ODI 0 Postop ODI Section 10- Travelling. Travelling 0 = I can travel anywhere without pain. 1 = I can travel anywhere but it gives me additional pain. 2 = Pain is bad but I m able to manage trips over two hours. 3 = Pain restricts me to trips on less than one hour. 4 = Pain restricts me to short necessary trips of under 30 minutes. 5 = Pain prevents me from travelling except to receive treatment. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. BU BV 3 Mon Postop EQ5D Date Target = Postoperative assessment between six and 20 after procedure 3 Mon Postop EQ5D Mobility Enter the date when the post-operative EQ5D-5L was completed by the patient. If more than one post-operative EQ5D-5L was obtained, use the Q5D-5L that is the most recent and prior to 20 weeks after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days since the date of procedure (calendar date math) to determine if the three month post-operative EQ5D date was between six and 20 weeks after the date of procedure. Leave BLANK if a three month post-operative EQ5D-5L evaluation was not obtained. Quality Check: Verify dates are valid. Enter the value of the patient s post-operative response to the EQ5D-5L Mobility Statement. 1 = I have no problems in walking. 2 = I have slight problems walking. 3 = I have moderate problems walking. 4 = I have severe problems walking. Date (mm/dd/yyyy) Page 53 10/27/2011 2

54 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BV (cont.) BW BX BY 3 Mon Postop EQ5D Mobility (cont.) 3 Mon Postop EQ5D Self Care 3 Mon Postop EQ5D Usual Activities 3 Mon Postop EQ5D Pain 5 = I am unable to walk. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Self Care Statement. 1 = I have no problems with washing or dressing myself. 2 = I have slight problems washing or dressing myself. 3 = I have moderate problems washing or dressing myself. 4 = I have severe problems washing or dressing myself. 5 = I am unable to wash or dress myself. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Usual Activities Statement. 1 = I have no problems doing my usual activities. 2 = I have slight problems doing my usual activities. 3 = I have moderate problems doing my usual activities. 4 = I have severe problems doing my usual activities. 5 = I am unable to do my usual activities. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Pain/Discomfort Statement. 1 = I have no pain or discomfort. 2 = I have slight pain or discomfort. 3 = I have moderate pain or discomfort. Page

55 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example BY 4 = I have severe pain or discomfort. (cont.) 5 = I have extreme pain or discomfort. BZ 3 Mon Postop EQ5D Pain (cont.) 3 Mon Postop EQ5D Anxiety Depression Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Anxiety/Depression Statement. 1 = I am not anxious or depressed. 2 = I am slightly anxious or depressed. 3 = I am moderately anxious or depressed. 4 = I am severely anxious or depressed. 5 = I am extremely anxious or depressed. 1 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. CA 3 Mon Postop EQ5D Health State Enter the value of the patient s post-operative response to the EQ5D-5L Best Imaginable Health Statement. This value corresponds with a thermometer scale that the patient points to, ranging from 0 (worst imaginable health status) to 100 (best imaginable health status). If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. 76 Leave BLANK if a post-operative answer was not obtained. Quality Check: If data is entered, verify it is a whole number between 0 and 100. Page 55

56 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example CB 3 Mon Postop VAS Pain Date Target = Postoperative assessment between six and 20 weeks after procedure Enter the date when the post-operative VAS Visual Analog Pain Scale rating was completed by the patient. If more than one post-operative VAS Pain Scale was obtained, use the VAS Pain Scale that is the most recent and prior to 20 weeks after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (date math) to determine if the three month post-operative VAS Pain date was between six and 20 weeks after the date of procedure. Leave BLANK if a post-operative VAS pain a VAS Visual Analog Pain Scale rating was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 10/27/2011 CC 3 Mon Postop VAS Pain Value- Back Enter the value corresponding to the patient s post-operative selection on the VAS pain scale continuum related to back pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the 10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between one and 10. One decimal point 7.5 CD 3 Mon Postop VAS Pain Value- Leg Enter the value corresponding to the patient s post-operative selection on the VAS pain scale continuum related to leg pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the far10 end of the scale is described as Intolerable. One decimal point 7.5 Page 56

57 CD (cont.) 3 Mon Postop VAS Pain Value- Leg (cont.) 3 Mon Postop PGH Date Target = Postoperative assessment between six and 20 weeks after procedure 3 Mon Postop PGH 1 Health Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example If a patient selects more than one response to a question, submit the highest (worst) response. CE CF Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between one and 10. Enter the date when the post-operative PROMIS Global Health 10 was completed by the patient. If more than one post-operative PROMIS Global Health 10 was obtained, use the PROMIS Global Health 10 that is the most recent and prior to 20 weeks after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the three month post-operative PROMIS Global Health 10 date was between six and 20 weeks after the date of procedure. Leave BLANK if a post-operative PROMIS Global Health 10 was not obtained. Quality Check: Verify dates are valid. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general health rating. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Date (mm/dd/yyyy) whole 03/12/ Page 57

58 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example CG 3 Mon Postop PGH 2 Quality Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general quality of life. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 2 CH 3 Mon Postop PGH 3 Physical Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general physical health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent whole 3 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. CI 3 Mon Postop PGH 4 Mental Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general mental health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good whole 4 Page 58

59 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example CI 5 = Excellent (cont.) CJ CK 3 Mon Postop PGH 4 Mental (cont.) 3 Mon Postop PGH 5 Satis Social 3 Mon Postop PGH 9 Soc Activities Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general satisfaction with social activities and relationships. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding ability to carry out social activities and roles. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole whole 5 1 Page 59

60 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example CL 3 Mon Postop PGH 6 Phys Activities Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding ability to carry out physical activities. 1 = Not at all 2 = A little 3 = Moderately 4 = Mostly 5 = Completely Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 2 CM 3 Mon Postop PGH 10 Emotional Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding emotional problems in the past 7 days. 1 = Always 2 = Often 3 = Sometimes 4 = Rarely 5 = Never Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 3 Page 60

61 Column Field Name Notes: Population 1 Lumbar Discectomy/ Laminotomy Excel Format Example CN 3 Mon Postop PGH 8 Fatigue Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding fatigue on average in the past 7 days. 1 = Very severe 2 = Severe 3 = Moderate 4 = Mild 5 = None Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. whole 4 CO 3 Mon Postop PGH 7 Pain Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding pain rating in the last 7 days using a scale of 0 (No Pain) to 10 (Worst imaginable pain). Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and 10. whole 5 Page 61

62 Data Elements and Field Specification for Patient Population 2 (Lumbar Spinal Fusion Procedure) Use this data elements and field specifications section to develop your data submission. The specifications contain detailed information on each column that you will need to submit for the measure including column order, definitions, examples, and appropriate formatting. Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example A Clinic ID Enter the MNCM Clinic ID for every patient/row submitted. MNCM assigns the clinic ID at the time of registration. Use the MNCM ID listed in the MNCM Data Portal. Do NOT use the Medical Group ID. Blank values will create ERRORs upon submission. Quality Check: Verify ID in each cell matches the clinic ID in the MNCM Data Portal. B Patient ID Enter a unique patient ID to identify each patient. Keep a crosswalk between patient IDs and the patient name/dob to help clinic staff locate records during validation audits. Enter clinic-assigned ID (e.g., MRN, account number). Do NOT enter Social Security Numbers. Blank values will create ERRORs upon submission. Quality Check: Verify patient s procedure was not duplicated. If a duplicate is found, make sure that the patient has undergone two separate lumbar spinal fusion procedures during the measurement period. C Patient Date of Enter patient s date of birth. Patient must be 18 year or older on date of procedure. Birth Blank values or values prior to 01/01/1995 will create ERRORs upon submission. Quality Check: Verify each date of birth is within the accepted range. Text 905 Text Date (mm/dd/yyyy) 05/08/1985 D Patient Gender Enter patient s gender: Female = F Male = M Unknown = U Text F Blank values will create ERRORs upon submission. Quality Check: Verify each cell has one of the accepted codes. Page 62

63 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example E F G H I J K L M N Patient Zip Code Race/Ethnicity 1 Race/Ethnicity 2 Race/Ethnicity 3 Race/Ethnicity 4 Race/Ethnicity 5 Country of Origin Code Country of Origin Other Description Preferred Language Code Preferred Language Other Description Enter the five-digit zip code of patient s primary residence at the most recent encounter on or prior to 12/31/2014. If EMR query extracts a nine-digit number, submit the nine-digit number. The MNCM Data Portal will remove the last four digits automatically. Blank values will create ERRORs upon submission. Quality Check: Verify the zip code is at least five digits and each cell has data. Please refer to a separate document entitled 2015 REL Data Field Specifications and Codes for the field specifications in Columns F-N. It can be found via the link above, under RESOURCES on the MNCM Data Portal in the Race/Ethnicity/Language Data (REL) section, or on MNCM.org under Submitting Data > Training & Guidance > Data Collection. These are optional fields. For more information about collecting this data from patients, refer to the Handbook on the Collection of Race Ethnicity and Language Data available at under Data Collection. Quality Check: Verify each cell has one of the accepted codes. Blank cells (if there is no data is available) are acceptable. Text Page 63

64 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example O P Q R S Surgeon NPI Number Provider Specialty Code Insurance Coverage Code Insurance Coverage Other Description Insurance Plan Member ID Enter the 10 digit NPI number of the surgeon who performed the lumbar spinal fusion procedure. Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data. Enter the code for the specialty of the surgeon performing the lumbar spinal fusion procedure. 22 = Orthopedic Medicine/Surgery 18 = Neurosurgery Blank values will create ERRORs upon submission. Quality check: Verify each cell has an accepted code. Please refer to a separate document entitled 2015 Insurance Coverage Data Field Specifications and Codes for these field specifications. This document can be found via the link above, under RESOURCES on the MNCM Data Portal in the Insurance Coverage Info section, or on MNCM.org under Submitting Data > Training & Guidance > Data Collection. This should be the patient s most recent insurance on or prior to 03/31/2015 Quality Check: Verify each cell has an accepted code and that all 99 codes have a name entered in Column R. Verify Social Security Numbers are NOT submitted. T Height Inches Enter the patient s height in inches. One decimal place is allowed to reflect one-half inch (e.g., 62.5). Rounding up or down as appropriate to the next whole number is acceptable as well, depends on system capability. Must be collected (measured) in a clinical setting and not a patient reported value. Field is used with weight to calculate the patient s BMI. Leave BLANK if patient s height was not assessed. Quality Check: If data is entered, verify a whole number or only one decimal point is used. Page 64 Text Number 22 Number 1 Text Text Number One decimal or may round up or down to whole inches Assurant Health FBOXZ (inches)

65 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example U Weight Pounds Enter the patient s pre-operative weight in pounds. Do not use decimals. Round up or down to the nearest pound. Use the most recent weight within six months prior to the procedure; do not include weights that are more than 6 months prior to the procedure. Must be collected (measured) in a clinical setting and not a patient reported value. Field is used with height to calculate the patient s BMI. Leave BLANK if the patient s weight was not assessed. Quality Check: If data is entered, verify a whole number and no decimal places are used. whole number (round up or down) 130 (pounds) V Tobacco Status Enter the patient s pre-operative tobacco status. Tobacco includes any amount of cigarettes, cigars, pipes, or chew. Do NOT count e-cigarettes as tobacco products. 1 = Tobacco Free (patient does not use tobacco) 2 = No Documentation 3 = Current Tobacco User Leave BLANK if unknown/not submitting data. Quality Check: Verify each cell has an accepted code if data is entered. Number 1 W Prior Back Surgery History of prior lumbar back surgery. Time frame of prior lumbar surgery is unlimited; intent is to capture any history of prior back surgery. Medical groups are encouraged to build this question into their patient assessment work flow and incorporate into EMR systems as a discrete reportable field. A table of suggested CPT codes can be used to identify lumbar spine surgery; however there are some cautions in using this approach. In particular, the patient may have a history of prior back surgery at another medical group and using the procedure code history alone would not capture this. Enter the appropriate code to indicate if the patient had prior lumbar surgery: 1 = No prior back surgery in the lumbar region 2 = Prior back surgery in the lumbar region with fusion (with or without instrumentation) Number 1 Page 65

66 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example W (cont.) Prior Back Surgery (cont.) 3 = Prior back surgery in the lumbar region without fusion (no instrumentation or bone graft that fuses vertebrae) 4 = Prior back surgery history unknown/not documented in the record. Note: Code # 4 only available for procedures completed prior to 01/01/2014 to allow medical groups time to create structured data. For procedures completed after 01/01/2014 this option will no longer be available. Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data. X Clinical Condition Reason for Procedure Enter the code that represents the primary clinical condition for which the patient underwent the lumbar spinal fusion procedure. If the patient has two or more conditions involved, the surgeon can select which is the clinical condition reason for the procedure. If not identified by the surgeon then the primary diagnosis can be used as the clinical condition reason for the procedure. See Appendix C for more information. 1 = Degenerative Disc Disease 2 = Disc Herniation 3 = Spinal Stenosis 4 = Spondylolisthesis Blank values will create ERRORs upon submission. Quality Check: Verify each cell has data. Number 3 Y Date of Procedure Enter the date of the lumbar spinal fusion procedure. Blank values or values outside the measurement period will create ERRORs upon submission. Date (mm/dd/yyyy) 9/10/2013 Quality Check: Verify all dates are between 01/01/2013 to 12/31/2013. Page 66

67 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example Z Facility ID Enter the code for the hospital where the lumbar spinal fusion procedure was performed. Please refer to Table 10 and Table 11. Text 41 Blank values will create ERRORs upon submission. Quality Check: Verify each cell has an accepted code. If 999 is entered into cell, verify text is entered in Column AA for this row. AA Facility Other Description If the facility (and subsequent code) where the procedure was performed is not listed in Table 10 and Table 11 and the Facility ID = 999 Other, enter the description of the location where the lumbar spinal fusion procedure was performed. Text Elk Ridge Surgery Center Quality Check: Verify that in each row that has text entered in this cell if 999 is entered into Column Z. AB Facility Type Enter the type of facility in which the procedure was performed. 1 = Hospital 2 = Free Standing Outpatient Ambulatory Surgery Center Number 1 Blank values will create ERRORs upon submission. Quality check: Verify each cell has an accepted code. For all Oswestry Disability Index (ODI) Fields including Pre-operative and Post-operative; refer to Appendix A for more information about how to implement and score the ODI. If a patient selects more than one response to a question, submit the highest (worst) response. If submitting a summary score only, use the highest (worst) response in creating the summary score. Do not fill blanks with a zero as this is a valid response in the tool. There are three options for submitting ODI assessment information. Page 67

68 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example Option One: Submit only the summary ODI score only. Medical groups must attest to following the rules if they select this option. Rules for submitting summary score only: 1. Patient must complete at least eight of the 10 questions asked for a valid submission. You cannot submit the summary ODI score if the patient answers seven or fewer questions. 2. Review Appendix A for calculating the ODI Summary Score. Option Two: Submitting each individual value so the MNCM Data Portal can calculate the ODI score. The MNCM Data Portal will evaluate all incoming responses, if at least 8 of the 10 questions are completed by the patient, the assessment tool can be used and the portal will score appropriately. Option Three: Submit both the summary score and the individual values. If desired and available, medical groups can choose to submit both the summary score they calculated according to the scoring rules and the individual answers to each question. If medical groups chose this option, the MNCM data portal will use the summary score submitted by the medical group for rate calculations. AC Preop ODI Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative Oswestry Disability Index (ODI) was completed by the patient. If more than one pre-operative ODI was obtained, use the ODI that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative ODI date was three months prior to the date of procedure. Leave BLANK if a pre-operative ODI evaluation was not obtained. If submitting the individual values and allowing the MNCM Data Portal to determine the completeness of the ODI, enter the date of the ODI and all of the subsequent values. Quality Checks: Verify date is valid. Date (mm/dd/yyyy) 8/27/2013 AD Preop ODI Summary Score Enter the value that corresponds with the patient s pre-operative summary ODI score. Leave BLANK if the patient answers seven or fewer questions OR if submitting individual values and not the summary score (Option Two). Use the ODI scoring guide available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu. Quality Check: Verify each cell has a value between zero and five. whole 67 Page 68

69 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AE Preop ODI Pain Enter the value that corresponds with the patient s pre-operative selection for ODI Section 1- Pain intensity. 0 = I have no pain at the moment. 1 = The pain is very mild at the moment. 2 = The pain is moderate at the moment. 3 = The pain is fairly severe at the moment. 4 = The pain is very severe at the moment. 5 = The pain is the worst imaginable at the moment. 2 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. AF Preop ODI Care Enter the value that corresponds with the patient s pre-operative selection for ODI Section 2- Personal Care (washing, dressing, etc.). 0 = I can look after myself normally without causing additional pain. 1 = I can look after myself normally but it is very painful. 2 = It is painful to look after myself and I am slow and careful. 3 = I need some help but manage most of my personal care. 4 = I need help every day in most aspects of my personal care. 5 = I do not get dressed, I wash with difficulty and stay in bed. 1 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Page 69

70 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AG Preop ODI Lifting Enter the value that corresponds with the patient s pre-operative selection for ODI Section 3- Lifting. 0 = I can lift heavy weights without additional pain. 1 = I can lift heavy weights but it give me additional pain. 2 = Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned, e.g. on a table. 3 = Pain prevents me from lifting heavy weights, but I can manage light to medium weights if off they are conveniently positioned. 4 = I can lift only very light weights. 5 = I cannot lift ot carry anything at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 4 AH Preop ODI Walking Enter the value that corresponds with the patient s pre-operative selection for ODI Section 4- Walking. 0 = Pain does not prevent me from walking any distance. 1 = Pain prevents me from walking more than one mile. 2 = Pain prevents me from walking more than a quarter of a mile. 3 = Pain prevents me from walking more than 100 yards. 4 = I can only walk using a cane or crutches. 5 = I am in bed most of the time and have to crawl to the toilet. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. 2 Page 70

71 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AI Preop ODI Sitting Enter the value that corresponds with the patient s pre-operative selection for ODI Section 5- Sitting. 0 = I can sit in any chair as long as I like. 1 = I can sit in my favorite chair as long as I like. 2 = Pain prevents me from sitting more than one hour. 3 = Pain prevents me from sitting more than half an hour. 4 = Pain prevents me from sitting more than 10 minutes. 5 = Pain prevents me from sitting at all. 1 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. AJ Preop ODI Standing Enter the value that corresponds with the patient s pre-operative selection for ODI Section 6- Standing. 0 = I can stand as long as I want without additional pain. 1 = I can stand as long as I want but it gives me additional pain. 2 = Pain prevents me from standing more than one hour. 3 = Pain prevents me from standing more than half an hour. 4 = Pain prevents me from standing more than 10 minutes. 5 = Pain prevents me from standing at all. 3 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Page 71

72 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AK Preop ODI Sleeping Enter the value that corresponds with the patient s pre-operative selection for ODI Section 7- Sleeping. 0 = My sleep is never interrupted by pain. 1 = My sleep is occassionally interrupted by pain. 2 = Because of pain I have less than 6 hours of sleep. 3 = Because of pain I have less than 4 hours of sleep. 4 = Because of pain I have less than 2 hours of sleep. 5 = Pain prevents me from sleeping at all. 1 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. AL Preop ODI Sex Enter the value that corresponds with the patient s pre-operative selection for ODI Section 8- Sex life. 0 = My sex life is normal and causes no additional pain. 1 = My sex life is normal but causes some additional pain. 2 = My sex life is nearly normal but is very painful. 3 = My sex life is severly restricted by pain. 4 = My sex life is nearly nonexistant because of pain. 5 = Pain prevents me from having any sex life at all. 2 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Page 72

73 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AM Preop ODI Social Enter the value that corresponds with the patient s pre-operative selection for ODI Section 9- Social Life. 0 = My social life is normal and causes no additional pain. 1 = My social life is normal but increases the degree of pain. 2 = Pain has no significant effect on my social life apart from limiting my more energetic interests. 3 = Pain has restricted my social life and I do not go out as often. 4 = Pain has restricted my social life to home. 5 = I have no social life becasue of pain. 0 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s pre-operative selection for ODI Section 10- Travelling. 0 = I can travel anywhere without pain. 1 = I can travel anywhere but it gives me additional pain. 2 = Pain is bad but I m able to manage trips over two hours. 3 = Pain restricts me to trips on less than one hour. 4 = Pain restricts me to short necessary trips of under 30 minutes. 5 = Pain prevents me from travelling except to receive treatment. AN Preop ODI Travelling 0 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Page 73

74 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example For All EQ5D-5L Fields: If a pre-operative or post-operative EQ5D-5L assessment was not obtained, the patient record should still be submitted; however, the EQ5D-5L fields should be left blank. If a patient skips one of the five domain questions, submit values for the questions that the patient did answer. Values have merit individually for understanding the patient population and use for potential risk adjustment. However, the health index score can only be calculated when all five questions are completed. If a patient selects more than one response to a question, submit response as a blank (no value). Do not attempt to select a value (unlike ODI and VAS). According to EuroQol, the tool developer, two responses to a question invalidates the tool. For EQ5D Health State field - If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. If a pre-operative or post-operative EQ5D-5L evaluation was obtained, but an answer was skipped, leave that answer blank. The MNCM Data Portal will evaluate all incoming responses, and if a valid response is submitted for each of the five domain questions, will calculate the EQ5D-5L health index. Please refer to the MNCM Data Portal RESOURCES tab after selecting Spinal Surgery from the drop-down menu and Appendix A in this guide for more details. Plan for Transition EQ5D-5L to PROMIS Global-10: Measuring the patient s quality of life following the procedure is transitioning to a new tool- PROMIS Global-10 for patients with procedure dates starting 1/1/2015. For patients who had a pre-op assessment with EQ5D and a post-op assessment with PROMIS Global-10, conversion of values will occur within the MNCM data portal. Please refer to Appendix A for more information. AO Preop EQ5D Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative EQ5D-5L was completed by the patient. If more than one pre-operative EQ5D-5L was obtained, use the EQ5D-5L that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative EQ5D date was three months prior to the date of procedure. Leave BLANK if a pre-operative EQ5D-5L evaluation was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 10/27/2011 Page 74

75 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AP Preop EQ5D Mobility Enter the value of the patient s pre-operative response to the EQ5D-5L Mobility Statement. 1 = I have no problems in walking. 2 = I have slight problems walking. 3 = I have moderate problems walking. 4 = I have severe problems walking. 5 = I am unable to walk. 2 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. AQ Preop EQ5D Self Care Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s pre-operative response to the EQ5D-5L Self Care Statement. 1 = I have no problems with washing or dressing myself. 2 = I have slight problems washing or dressing myself. 3 = I have moderate problems washing or dressing myself. 4 = I have severe problems washing or dressing myself. 5 = I am unable to wash or dress myself. 2 AR Preop EQ5D Usual Activities Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s pre-operative response to the EQ5D-5L Usual Activities Statement. 1 = I have no problems doing my usual activities. 2 = I have slight problems doing my usual activities. 3 = I have moderate problems doing my usual activities. 4 = I have severe problems doing my usual activities. Page 75 3

76 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AR (cont.) AS Preop EQ5D Usual Activities (cont.) Preop EQ5D Pain 5 = I am unable to do my usual activities. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s pre-operative response to the EQ5D-5L Pain/Discomfort Statement. 1 = I have no pain or discomfort. 2 = I have slight pain or discomfort. 3 = I have moderate pain or discomfort. 4 = I have severe pain or discomfort. 5 = I have extreme pain or discomfort. 2 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. AT Preop EQ5D Anxiety Depression Enter the value of the patient s pre-operative response to the EQ5D-5L Anxiety/Depression Statement. 1 = I am not anxious or depressed. 2 = I am slightly anxious or depressed. 3 = I am moderately anxious or depressed. 4 = I am severely anxious or depressed. 5 = I am extremely anxious or depressed. 1 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Page 76

77 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AU Preop EQ5D Health State Enter the value of the patient s pre-operative response to the EQ5D-5L Best Imaginable Health Statement. This value corresponds with a scale that the patient points to, ranging from 0 (worst imaginable health status) to 100 (best imaginable health status). If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. Leave BLANK if patient does not answer or if there is no documentation. Quality Check: If data is entered, verify it is a whole number between 0 and AV Preop VAS Pain Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative VAS Visual Analog Pain Scale rating was completed by the patient. If more than one pre-operative VAS Pain score was obtained, use the VAS Pain score that is the most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the preoperative VAS Pain date was three months prior to the date of procedure. Leave BLANK if a pre-operative VAS Visual Analog Pain Scale rating was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 10/27/2011 AW Preop VAS Pain Value- Back Enter the value corresponding to the patient s pre-operative selection on the VAS pain scale continuum related to back pain. The VAS pain scale is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the 10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient did not answer or if there is no documentation. Quality Check: Verify each cell has a value between one and 10. One decimal point 7.5 Page 77

78 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AX Preop VAS Pain Value- Leg Enter the value corresponding to the patient s pre-operative selection on the VAS pain scale continuum related to leg pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and 10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient did not answer or if there is no documentation. Quality Check: Verify each cell has a value between one and 10. One decimal point For All PROMIS Global-10Fields: The PROMIS Global 10 tool is going to be used for ALL patients undergoing spine surgery procedures starting 01/01/2015. It will replace the EQ5D-5L. If your medical group has the ability to collect and report PROMIS-10 for patients who underwent procedures prior to 01/01/2015, you can submit the PROMIS-10 data. If the patient selects more than one response for a PROMIS-10 question; submit a blank for the value for that question. After your medical group has implemented the PROMIS-10 tool, there is no need to use the EQ5D for follow-up assessments of patients who were assessed pre-operatively with the EQ5D prior to 01/01/2015.The MNCM Data Portal will convert PROMIS-10 values to an EQ5D health index score for all patients with a date of procedure before 01/01/2015. This will allow for consistency of measurement within each calendar year based measurement period. 7.5 Page 78

79 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example AY Preop PGH Date Target = Preoperative assessment within three months prior to procedure Enter the date when the pre-operative PROMIS Global Health 10 was completed by the patient. If more than one pre-operative PROMIS Global Health 10 was obtained, use most recent and prior to the procedure. Data Portal logic will use month functionality (calendar date math) to determine if the pre-operative PROMIS Global Health 10 date was three months prior to the date of procedure. Leave BLANK if a pre-operative PROMIS Global Health 10 evaluation was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 10/27/2011 AZ Preop PGH 1 Health Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general health rating. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if the patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 Page 79

80 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BA Preop PGH 2 Quality Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general quality of life. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 BB Preop PGH 3 Physical Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general physical health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 Page 80

81 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BC Preop PGH 4 Mental Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general mental health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 BD Preop PGH 5 Satis Social Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding general satisfaction with social activities and relationships. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 Page 81

82 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BE Preop PGH 9 Soc Activities Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding ability to carry out social activities and roles. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 BF Preop PGH 6 Phys Activities Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding ability to carry out physical activities. 1 = Not at all 2 = A little 3 = Moderately 4 = Mostly 5 = Completely Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 Page 82

83 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BG Preop PGH 10 Emotional Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding emotional problems in the past 7 days. 1 = Always 2 = Often 3 = Sometimes 4 = Rarely 5 = Never Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 BH Preop PGH 8 Fatigue Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding fatigue on average in the past 7 days. 1 = Very severe 2 = Severe 3 = Moderate 4 = Mild 5 = None Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 BI Preop PGH 7 Pain Enter the value of the patient s pre-operative response to the PROMIS Global Health 10 question regarding pain rating using a scale of 0 (No Pain) to 10 (Worst imaginable pain). Leave BLANK if the patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and Page 83

84 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BJ 1 Yr Postop ODI Date Target = Postoperative assessment between nine and 15 months after procedure Enter the date when the one year post-operative Oswestry Disability Index (ODI) was completed by the patient. If more than one post-operative ODI was obtained, use the ODI that is the most recent and prior to 15 months after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the one year post-operative ODI date was between nine and 15 months after the date of procedure. Leave BLANK if a one year post-operative ODI evaluation was not obtained. Quality Check: Verify date is valid. Date (mm/dd/yyyy) 11/12/2013 BK 1 Yr Postop ODI Summary Score Enter the value that corresponds with the patient s three month post-operative summary ODI score. Leave BLANK if the patient answers seven or fewer questions OR if submitting individual values and not the summary score (Option Two). Use the ODI scoring guide available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu. whole 67 Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 1- Pain intensity. 0 = I have no pain at the moment. 1 = The pain is very mild at the moment. 2 = The pain is moderate at the moment. 3 = The pain is fairly severe at the moment. 4 = The pain is very severe at the moment. 5 = The pain is the worst imaginable at the moment. BL 1 Yr Postop ODI Pain 2 Page 84

85 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BL (cont.) BM BN 1 Yr Postop ODI Pain (cont.) 1 Yr Postop ODI Care 1 Yr Postop ODI Lifting If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 2- Personal Care (washing, dressing, etc.). 0 = I can look after myself normally without causing additional pain. 1 = I can look after myself normally but it is very painful. 2 = It is painful to look after myself and I am slow and careful. 3 = I need some help but manage most of my personal care. 4 = I need help every day in most aspects of my personal care. 5 = I do not get dressed, I wash with difficulty and stay in bed. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 3- Lifting. 0 = I can lift heavy weights without additional pain. 1 = I can lift heavy weights but it give me additional pain. 2 = Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned, e.g. on a table. 3 = Pain prevents me from lifting heavy weights, but I can manage light to medium weights if off they are conveniently positioned. 4 = I can lift only very light weights. 5 = I cannot lift ot carry anything at all. If patient selects more than one response to a question, submit the highest (worst) Page

86 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BN 1 Yr Postop response. Leave BLANK if the patient does not answer or if there is no documentation. (cont.) ODI Lifting (cont.) Quality Check: Verify each cell has a value between zero and five. BO BP 1 Yr Postop ODI Walking 1 Yr Postop ODI Sitting Enter the value that corresponds with the patient s post-operative selection for ODI Section 4- Walking. 0 = Pain does not prevent me from walking any distance. 1 = Pain prevents me from walking more than one mile. 2 = Pain prevents me from walking more than a quarter of a mile. 3 = Pain prevents me from walking more than 100 yards. 4 = I can only walk using a cane or crutches. 5 = I am in bed most of the time and have to crawl to the toilet. If patient selects more than one response to a question, submit the highest (worst) response. I Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 5- Sitting. 0 = I can sit in any chair as long as I like. 1 = I can sit in my favorite chair as long as I like. 2 = Pain prevents me from sitting more than one hour. 3 = Pain prevents me from sitting more than half an hour. 4 = Pain prevents me from sitting more than 10 minutes. 5 = Pain prevents me from sitting at all. If patient selects more than one response to a question, submit the highest (worst) response. 2 1 Page 86

87 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BP 1 Yr Postop Leave BLANK if the patient does not answer or if there is no documentation. (cont.) ODI Sitting (cont.) Quality Check: Verify each cell has a value between zero and five. BQ 1 Yr Postop ODI Standing Enter the value that corresponds with the patient s post-operative selection for ODI Section 6- Standing. 0 = I can stand as long as I want without additional pain. 1 = I can stand as long as I want but it gives me additional pain. 2 = Pain prevents me from standing more than one hour. 3 = Pain prevents me from standing more than half an hour. 4 = Pain prevents me from standing more than 10 minutes. 5 = Pain prevents me from standing at all. 3 If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. BR 1 Yr Postop ODI Sleeping Enter the value that corresponds with the patient s post-operative selection for ODI Section 7- Sleeping. 0 = My sleep is never interrupted by pain. 1 = My sleep is occassionally interrupted by pain. 2 = Because of pain I have less than 6 hours of sleep. 3 = Because of pain I have less than 4 hours of sleep. 4 = Because of pain I have less than 2 hours of sleep. 5 = Pain prevents me from sleeping at all. 1 If patient selects more than one response to a question, submit the highest (worst) response. Page 87

88 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BR 1 Yr Postop Leave BLANK if the patient does not answer or if there is no documentation. (cont.) ODI Sleeping (cont.) Quality Check: Verify each cell has a value between zero and five. BS BT 1 Yr Postop ODI Sex 1 Yr Postop ODI Social Enter the value that corresponds with the patient s post-operative selection for ODI Section 8- Sex life. 0 = My sex life is normal and causes no additional pain. 1 = My sex life is normal but causes some additional pain. 2 = My sex life is nearly normal but is very painful. 3 = My sex life is severly restricted by pain. 4 = My sex life is nearly nonexistant because of pain. 5 = Pain prevents me from having any sex life at all. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the value that corresponds with the patient s post-operative selection for ODI Section 9- Social Life. 0 = My social life is normal and causes no additional pain. 1 = My social life is normal but increases the degree of pain. 2 = Pain has no significant effect on my social life apart from limiting my more energetic interests. 3 = Pain has restricted my social life and I do not go out as often. 4 = Pain has restricted my social life to home. 5 = I have no social life becasue of pain. If patient selects more than one response to a question, submit the highest (worst) response. 2 0 Page 88

89 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BT 1 Yr Postop Leave BLANK if the patient does not answer or if there is no documentation. (cont.) ODI Social (cont.) Quality Check: Verify each cell has a value between zero and five. BU BV 1 Yr Postop ODI Travelling 1 Yr Postop EQ5D Date Target = Postoperative assessment between nine and 15 months after procedure Enter the value that corresponds with the patient s post-operative selection for ODI Section 10- Travelling. 0 = I can travel anywhere without pain. 1 = I can travel anywhere but it gives me additional pain. 2 = Pain is bad but I m able to manage trips over two hours. 3 = Pain restricts me to trips on less than one hour. 4 = Pain restricts me to short necessary trips of under 30 minutes. 5 = Pain prevents me from travelling except to receive treatment. If patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between zero and five. Enter the date when the post-operative EQ5D-5L was completed by the patient. If more than one post-operative EQ5D-5L was obtained, use the Q5D-5L that is the most recent and prior to 15 months after the date of the procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the one year post-operative EQ5D date was between nine and 15 months after the date of procedure. Leave BLANK if a one year post-operative EQ5D-5L evaluation was not obtained. Quality Check: Verify dates are valid. Date (mm/dd/yyyy) 0 10/27/2011 Page 89

90 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BW BX BY 1 Yr Postop EQ5D Mobility 1 Yr Postop EQ5D Self Care 1 Yr Postop EQ5D Usual Activities Enter the value of the patient s post-operative response to the EQ5D-5L Mobility Statement. 1 = I have no problems in walking. 2 = I have slight problems walking. 3 = I have moderate problems walking. 4 = I have severe problems walking. 5 = I am unable to walk. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Self Care Statement. 1 = I have no problems with washing or dressing myself. 2 = I have slight problems washing or dressing myself. 3 = I have moderate problems washing or dressing myself. 4 = I have severe problems washing or dressing myself. 5 = I am unable to wash or dress myself. Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the EQ5D-5L Usual Activities Statement. 1 = I have no problems doing my usual activities. 2 = I have slight problems doing my usual activities. 3 = I have moderate problems doing my usual activities. 4 = I have severe problems doing my usual activities. 5 = I am unable to do my usual activities. Leave BLANK if patient does not answer, if there is no documentation or if the patient Page

91 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example BY (cont.) 1 Yr Postop EQ5D Usual Activities (cont.) selected more than one response. Quality Check: Verify each cell has a value between one and five. BZ 1 Yr Postop EQ5D Pain Enter the value of the patient s post-operative response to the EQ5D-5L Pain/Discomfort Statement. 1 = I have no pain or discomfort. 2 = I have slight pain or discomfort. 3 = I have moderate pain or discomfort. 4 = I have severe pain or discomfort. 5 = I have extreme pain or discomfort. 2 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. CA 1 Yr Postop EQ5D Anxiety Depression Enter the value of the patient s post-operative response to the EQ5D-5L Anxiety/Depression Statement. 1 = I am not anxious or depressed. 2 = I am slightly anxious or depressed. 3 = I am moderately anxious or depressed. 4 = I am severely anxious or depressed. 5 = I am extremely anxious or depressed. 1 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Page 91

92 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example CB 1 Yr Postop EQ5D Health State Enter the value of the patient s post-operative response to the EQ5D-5L Best Imaginable Health Statement. This value corresponds with a thermometer scale that the patient points to, ranging from 0 (worst imaginable health status) to 100 (best imaginable health status). If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. Leave BLANK if a post-operative answer was not obtained. Quality Check: If data is entered, verify it is a whole number between 0 and CC CD 1 Yr Postop VAS Pain Date Target = Postoperative assessment between nine and 15 months after procedure 1 Yr Postop VAS Pain Value- Back Enter the date when the one year post-operative VAS Visual Analog Pain Scale rating was completed by the patient. If more than one post-operative VAS Pain score was obtained, use the VAS Pain score that is the most recent and within 15 months after the date of procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the one year post-operative VAS Pain date was between nine and 15 months after the date of procedure. Leave BLANK if a post-operative VAS pain a VAS Visual Analog Pain Scale rating was not obtained. Quality Check: Verify dates are valid. Enter the value corresponding to the patient s post-operative selection on the VAS pain scale continuum related to back pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the far10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Date (mm/dd/yyyy) One decimal point Page 92 10/27/

93 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example Quality Check: Verify each cell has a value between one and 10. CE CF CG 1 Yr Postop VAS Pain Value- Leg 1 Yr Postop PGH Date Target = Postoperative assessment between nine and 15 months post procedure 1 Yr Postop PGH 1 Health Enter the value corresponding to the patient s post-operative selection on the VAS pain scale continuum related to leg pain. The VAS pain scale (available on the MNCM Data Portal under RESOURCES by selecting Spinal Surgery from the drop-down menu) is a continuous line with spaces below to mark an X on the continuum. Valid values range from 0 to 10 at 0.5 increments (e.g., 0, 0.5, 1.0, 1.5, 2.0, etc.). The zero end of the scale is described as No Pain and the far10 end of the scale is described as Intolerable. If a patient selects more than one response to a question, submit the highest (worst) response. Leave BLANK if the patient does not answer or if there is no documentation. Quality Check: Verify each cell has a value between one and 10. Enter the date when the post-operative PROMIS Global Health 10 was completed by the patient. If more than one post-operative PROMIS Global Health 10 was obtained, use the PROMIS Global Health 10 that is the most recent and within 15 months after the date of procedure. Data Portal logic will use a calculation for this time window based on the number of days elapsed since the date of procedure (calendar date math) to determine if the one year post-operative PROMIS Global Health 10 date was between nine and 15 months after the date of procedure. Leave BLANK if a post-operative PROMIS Global Health 10 was not obtained. Quality Check: Verify dates are valid. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general health rating. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient One decimal point Date (mm/dd/yyyy) Page /27/2011 3

94 CG (cont.) 1 Yr Postop PGH 1 Health (cont.) Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example selected more than one response. Quality Check: Verify each cell has a value between one and five. CH 1 Yr Postop PGH 2 Quality Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general quality of life. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent 3 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. CI 1 Yr Postop PGH 3 Physical Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general physical health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent 3 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Page 94

95 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example CJ 1 Yr Postop PGH 4 Mental Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general mental health. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 CK 1 Yr Postop PGH 5 Satis Social Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding general satisfaction with social activities and relationships. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Excellent 3 Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. CL 1 Yr Postop PGH 9 Soc Activities Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding ability to carry out social activities and roles. 1 = Poor 2 = Fair 3 = Good 4 = Very Good 3 Page 95

96 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example CL 5 = Excellent (cont.) CM CN 1 Yr Postop PGH 9 Soc Activities (cont.) 1 Yr Postop PGH 6 Phys Activities 1 Yr Postop PGH 10 Emotional Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding ability to carry out physical activities. 1 = Not at all 2 = A little 3 = Moderately 4 = Mostly 5 = Completely Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding emotional problems in the past 7 days. 1 = Always 2 = Often 3 = Sometimes 4 = Rarely 5 = Never Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 3 Page 96

97 Column Field Name Notes: Population 2 Lumbar Spinal Fusion Excel Format Example CO 1 Yr Postop PGH 8 Fatigue Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding fatigue on average in the past 7 days. 1 = Very severe 2 = Severe 3 = Moderate 4 = Mild 5 = None Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. Quality Check: Verify each cell has a value between one and five. 3 CP 1 Yr Postop PGH 7 Pain Enter the value of the patient s post-operative response to the PROMIS Global Health 10 question regarding pain rating using a scale of 0 (No Pain) to 10 (Worst imaginable pain). Leave BLANK if patient does not answer, if there is no documentation or if the patient selected more than one response. 3 Quality Check: Verify each cell has a value between one and 10. Page 97

98 Step 2: Quality Check the Data MNCM recommends completing several internal quality checks of the data prior to submission. Quality checks improve data accuracy, reduce the likelihood of errors, and ensure that the data can be validated upon audit. Quality Check Option 1 Use Excel s AutoFilter feature to complete data quality checks of specific data elements in the Excel file. To set the filter and review specific data elements, follow these instructions: 1. Click inside any data cell and activate the AutoFilter by: a. In Excel 2003, click the Data menu, point to Filter, and click AutoFilter. b. In Excel 2007 and Excel 2010, click the Data tab and, in the Sort & Filter area, click Filter. 2. The AutoFilter arrows should appear to the right of each column heading. 3. Click on the arrow of any column to display drop-down boxes and scan for key entry errors and out-ofrange or missing data (e.g., a date of procedure outside the date of procedure range 01/01/2013 to 12/31/2013). Determine if the data needs to be corrected. 4. To display all data again, click on the same drop-down box and select All. 5. Remove the AutoFilter by: a. In Excel 2003, click Data, Filter, and then AutoFilter again. b. In Excel 2007 and Excel 2010, click Filter again in the Sort & Filter area. Example Quality Check: Verify that every patient with a VAS Pain assessment date has an associated VAS Pain Value entered by clicking the VAS Pain Value drop-down menu to see a list of values and other selections; scroll through the values to verify that the scores entered are valid scores from the tool which include a range of zero to ten in 0.5 increments; values above 10 may indicate a math error or typo. Quality Check Option 2 Complete an internal audit of clinical data by reviewing a random sample of records (we recommend 8 to 10 records) or a full sample (30 records) to see if the data matches the patient records. If errors are found, make corrections in the Excel file. Quality Check Option 3 Complete these general quality checks: 1. Conduct the quality checks listed in the Notes column of each data element in the Data Elements and Field Specifications Table on pages Verify excluded records are removed. See Tables 4-7 on pages 9-11 for all codes applicable to exclusions. 3. Confirm there are no hyphens or zeroes (0s). If the data field is supposed to be blank, do NOT enter hyphens or zero; instead leave it blank. Page 98

99 4. Confirm there are no blank rows at the end of the spreadsheet. Blank rows at the bottom of the Excel file can slow the data submission process. a. To check for blank rows, press Ctrl/End at the same time to go to the bottom-most cell in the spreadsheet. Remove any by highlighting the blank rows, right-clicking in the left margin, and selecting Delete. Considerations during Quality Checks If errors are found during quality checks, consider if they are isolated cases or indicative of a larger data collection problem. (e.g., there are no patients with a height listed in Column T (Height Inches) and your clinic consistently measures patient s height). It is important to complete quality checks before submitting data to MNCM. This can help avoid delays in file submission and ensure submission of the most accurate data. All changes, additions or corrections must be made in the Excel file before submitting data to MNCM. Page 99

100 Section C: Data File Creation The third stage in the process to calculate performance scores is to create the data file for submission in the MNCM Data Portal. Before proceeding with the file submission, be sure to: Complete all data collection and data entry. Complete data quality checks. Combine all clinic files onto one spreadsheet. All clinics in a medical group must be uploaded in one, single file. The clinic identifier is the Clinic ID. Verify each column is formatted according to measure specifications (TEXT, NUMBER, or DATE formatting). Columns can remain at any width. Verify all original columns remain in the spreadsheet even if there is no data in column. Do NOT delete any columns. Once these steps are completed, save the Excel template and then save the file as a CSV file, which will be uploaded to the MNCM Data Portal. CSV stands for comma separated values. A CSV file is a common and simple format used to import or transport data between systems or software applications that are not directly related. If at any point in the process it is discovered that corrections to the data are needed, do NOT open the CSV file in Excel. Doing so destroys the formatting and alters the data. Instead, to view or make corrections to the data, open your original Excel file. Then save the changes as a new CSV file. If the CSV file is mistakenly opened in Excel, simply re-save a new CSV file from the original Excel file. Rename the old CSV file or delete it entirely. Create CSV File for Data Submission The steps for creating a CSV file using Excel 2003, 2007 or 2010 are below. If multiple tabs were created in the Excel spreadsheet, select the correct tab and proceed with the following steps. If only one tab was created, start with step 6. For Excel 2003 Users For Excel 2007 Users For Excel 2010 Users 1. Open the original Excel file (.xls). 2. Click Edit or right-click the tab of the spreadsheet you wish to save (near bottom of screen). 3. Select Move or Copy Sheet To book (new book) this is a drop-down selection. 4. Select Create Copy. 5. In this new book, click File, Save As. 2. Right-click the tab of the spreadsheet you wish to save (near bottom of screen). 3. Select Move or Copy Sheet To book (new book) this is a dropdown selection. 4. Select Create a Copy; click OK. 5. In this new book, click the Office Button (upper left-hand corner of screen); select Save As. 2. Right-click the tab of the spreadsheet you wish to save (near bottom of screen). 3. Select Move or Copy Sheet To book (new book) this is a dropdown selection. 4. Select Create a Copy; click OK. 5. In this new book, click the File tab (upper left-hand corner of screen); select Save As. 6. Select the folder and file name of your choice. 7. At the very bottom, you will see Save as type; choose from the drop-down menu, CSV (comma delimited). 8. Click Save. When you save the CSV file, the following warning will appear: may contain features that are not compatible with CSV. Do you want to keep the workbook in this format? Click Yes. 9. Now you can close the file; a message will appear: Do you want to save this file...? Click Yes or No. Your CSV file is now ready for upload to the MNCM Data Portal. Do NOT open the CSV file in Excel. If the file is mistakenly opened, simply resave a new CSV file. Page 100

101 Section D: Data File Submission The fourth stage in the process to calculate performance scores is to submit the data file to MNCM through the MNCM Data Portal. These steps must be completed for both the Spinal Surgery Lumbar Discectomy/Laminotomy 2015 Report (2013 Dates of Procedure) measure and the Spinal Surgery Lumbar Spinal Fusion 2015 Report (2013 Dates of Procedure) measure. Data File Transfer Selection Beginning 2014, the Minnesota Department of Health (MDH) is requesting the receipt of patient level data for the uses described below. MDH has assured us that your organization is permitted to disclose this patient level data to MDH under applicable law (including Minnesota law and HIPAA) because it will be used by MDH only for public health activities, health oversight activities, or other activities required or authorized by state or federal law. Please indicate your selection on the MNCM Data Portal to indicate if you choose to have MNCM share patient-level data with MDH. A list of the data elements for each measure that will be shared with MDH is available in the MNCM Data Portal by going to the RESOURCES tab and selecting Minnesota Statewide Quality Reporting and Measurement System from the drop-down menu. MDH will use patient level data to: Validate quality measure results Publicly report medical group results Research risk adjustment methodologies Design and evaluate public health interventions Research and analyze health disparities MDH will not use patient level data to pursue investigatory or regulatory activities. When you are ready to make this selection: 1. Click on the Data Files Transfer step on the HOME tab of the MNCM Data Portal under the Spinal Surgery Lumbar Discectomy/Laminotomy 2015 Report (2013 Dates of Procedure) section or the Spinal Surgery Lumbar Spinal Fusion 2015 Report (2013 Dates of Procedure) section measure heading. 2. Choose one of the two data sharing options: YES My organization agrees to have MNCM share our patient-level data with MDH for specified measures. NO My organization does not agree to have MNCM share our patient-level data with MDH. 3. Click Save. Page 101

102 Data Submission Click on Data Submission on HOME in the MNCM Data Portal, under the Spinal Surgery Lumbar Discectomy/Laminotomy 2015 Report (2013 Dates of Procedure) section or the Spinal Surgery Lumbar Spinal Fusion 2015 Report (2013 Dates of Procedure) section. Use the following steps to submit data to MNCM. Step 1: Enter Denominator Medical groups can manually enter denominator counts and information or enter the information into an Excel sheet and upload the Excel file. Use the instructions below. Manual Entry To manually enter denominator counts and information, enter the following information for each clinic row. Once entered, click Save and Continue. Method Used for Data Collection: Select one of the methods from the drop-down box o EMR: All data pulled via query o EMR: Some data looked up manually o EMR: All data looked up manually o Manual: Paper records only o Manual: EMR and paper record REL Data Collection: Indicate if collection of race, Hispanic ethnicity, preferred language and country of birth occurred using best practice methods. Best practice methods include: o Hispanic Ethnicity and Race: Allowing patient to self-report race AND not using a multiracial category AND system allows the collection and reporting of more than one race. o Preferred Language and Country of Birth: Allowing patient to self-report these demographic data. Not Reporting: Check this box if a clinic is not reporting for this cycle of data collection. o Be advised that MNCM s policy requires that ALL clinic sites within a medical group submit their data through the DDS process. Likewise, this is a condition of participation for Minnesota Bridges to Excellence (BTE) and other pay-for-performance programs. o Provide a reason the clinic is not reporting. (e.g., the clinic has no patients meeting eligibility criteria.) Excel Upload To enter the denominator counts and information into an Excel sheet that will then be uploaded to the MNCM Data Portal, use the following instructions. 1. Click on Download the Denominator Worksheet. The clinic names will be displayed in Column A and the clinic IDs will be displayed in Column B. 2. Complete the worksheet by entering the following information for each clinic: Page 102

103 Method Used for Data Collection (Column C): Enter the appropriate code for each clinic ID. 1 = EMR: All data pulled via query 2 = Manual: Paper records only 3 = Manual: EMR and paper record 4 = EMR: Some data looked up manually 5 = EMR: All data looked up manually REL Data Collection (Columns D G): Indicate if collection of race, Hispanic ethnicity, preferred language and country of birth occurred using best practice methods. Best practice methods include: o Race and Hispanic Ethnicity: Allowing patient to self-report race AND not using a multi-racial category AND system allows the collection and reporting of more than one race. o Preferred Language and Country of Birth: Allowing patient to self-report these demographic data. For each clinic ID, indicate if best practices are used by using the following codes and instructions: 1 = Yes, we follow the best practice 0 = No, we do not follow the best practice o Column D: Enter the appropriate code (1 or 0) to indicate if patients are allowed to self-report race and Hispanic Ethnicity o Column E: Enter the appropriate code (1 or 0) to indicate if clinic is NOT using a multi-racial category AND system allows the collection and reporting of more than one race o Column F: Enter the appropriate code (1 or 0) to indicate if patients are allowed to self-report preferred language o Column G: Enter the appropriate code (1 or 0) to indicate if patients are allowed to self-report race and Hispanic Ethnicity Not Reporting (Column H): Indicate if a clinic is not reporting for this cycle of data collection by entering the following code. Leave as 0 if a clinic is reporting data. 1 = Clinic is NOT reporting o Be advised that MNCM s policy requires ALL clinic sites within a medical group submit their data through the DDS process. Likewise, that is a condition of participation for Minnesota Bridges to Excellence (BTE and other pay-forperformance programs. Reason not reporting (Column I): Provide a reason the clinic is not reporting. (e.g., the clinic has no patients meeting eligibility criteria.) 3. Save the Excel file as a CSV file (see page 100for more information). Click Browse to search and find the CSV file and then click Submit File. Page 103

104 Step 2: Review & Save Verify the numbers entered by reviewing all of the clinic site s information for accuracy (no typos or duplicate patients). Click Save and Continue, or click Back to Step 1 to re-enter the counts. Step 3: Upload Data Click Browse to search for the CSV file; then click Upload CSV and Continue. The MNCM Data Portal will scan the CSV file to identify possible errors. It will then provide an Upload Status that indicates any errors or warnings in the data file. You may have to click Refresh. To view errors and warnings, click View Errors & Warnings. 1. Errors: For example, date of birth is out-of-range. If found, corrections must be made and a new file uploaded. 2. Warnings: For example, provider code other than one of the listed specialties is in data file. Review warnings and determine if corrections are needed. If corrections are not necessary, click Continue to Step 4. Data file corrections If errors are found, the data file must be corrected and resubmitted in the MNCM Data Portal. Refer to the Data Elements and Field Specifications table (pages 26-97) to review the required data for each column. To start from Step 3: If corrections are only needed to the data file, make corrections in the original Excel file and save the corrected file with a new name. Then save as a new CSV file to upload. Do NOT make corrections in the original CSV file, as it will destroy the format and alter the data. Go back to the MNCM Data Portal submission page and click Re-Upload Data (csv) File. Begin again with Step 3 Upload Data. To start from Step 1: Click Clear & Start Over to start the process completely over from Step 1 Enter Denominator. In this case, all number entries and a new file upload will be necessary. Once the CSV File has been re-uploaded without any errors or warnings needing correction, click Continue to Step 4. Step 4: Review & Submit Review and check each box of the Pre-Submission Quality Checklist and contact MNCM at support@mncm.org if you have questions regarding any Pre-Submission Quality Checklist item. Review the quality checks for each item listed in the Data Elements and Field Specifications table on pages If you need to resubmit the data file only, click Re-Upload Data (CSV) File. If you need to resubmit the denominator counts and the data file, click Clear & Start Over at the bottom of the page. If you have checked all the boxes, click Continue. Page 104

105 Review this information and determine if the file is ready to submit to MNCM. You can click Save as Draft if you need to review it in more detail prior to submitting. To access your medical group s information, you can click on Data Submission under the Lumbar Spinal Surgery Discectomy/Laminotomy 2015 Report (2013 Dates of Procedure) section or the Spinal Surgery Lumbar Spinal Fusion 2015 Report (2013 Dates of Procedure) section. When the data file is ready to submit to MNCM, click Submit Data to MNCM. Step 5: Done! The data file has been successfully submitted. MNCM will send an saying that it has been received. Click Download Data near the top of the data comparison section to see which patients were included in the denominator (1) and which were not (0). This can be viewed by looking at the additional columns added to the right side of the file. Page 105

106 Section E: Data Validation After data is submitted, MNCM completes key validation steps to identify potential data errors. If errors are identified, the medical group must make corrections to the data and resubmit before MNCM approves the data. MNCM completes data validation in three steps: data quality checks, the validation audit, and the two-week medical group review. MNCM completes data quality checks of the demographic data, patient population and outcome results. Validation audits verify the submitted data matches source data in the medical record. And, prior to approving final results, medical groups are given an opportunity to review preliminary statewide results during what is called the two-week medical group review. Each step is critical to the validation process and ensures results are accurate and comparable. Preparing for the Validation Audit All medical groups are subject to a validation audit. If your medical group is selected for audit, MNCM will contact you to schedule the audit. MNCM will provide list of sample records that will be audited. Medical groups are expected to prepare for the audit as follows: The medical group or clinic site representative must be available to participate in the entire audit process. o For data that resides in an electronic record, the audit will be conducted via a HIPAA secure, online meeting service; the medical group or clinic representative will need to retrieve and display the selected records and screens necessary to complete the validation. o For data that resides in a paper record, the audit will take place onsite. Patient names or other personal information may be blinded. MNCM will verify the record is correct using the date of birth submitted. Clinics must have the following available at the time of the validation audit: o ALL requested patient records. o The crosswalk between the unique patient identifier and the patient s name and date of birth, as necessary. o Data collection forms and other notes describing where various data elements were located in the patient record. o List of patients that were excluded, if applicable. Validation Audit Process MNCM utilizes the National Committee for Quality Assurance (NCQA) 8 and 30 process for validation audits. MNCM randomly selects 33 records from each applicable clinic site for validation. At most, 30 records for each clinic site will be reviewed. The additional three records are oversamples to ensure 30 records will be available on the day of the review. Page 106

107 The MNCM auditor reviews records 1 to 8 in the sample to verify whether the submitted data matches the source data in the medical record. If all of the first eight records reviewed have no errors, the compliance rate is 100%, and the clinic site is determined to be in high compliance. The MNCM auditor may determine no further record review is necessary. The MNCM auditor communicates results to MNCM staff. If the auditor identifies one or more records with errors, he/she will continue auditing records 9 to 30 and a compliance rate is calculated (e.g., 27/30 records compliant, 90%). If the compliance rate is less than 90%, the MNCM auditor will communicate the results with MNCM staff who will contact the medical group to discuss a resubmission plan. Two-Week Medical Group Review The two-week medical group review is the official opportunity to review and comment on the statewide results before they are approved. Each medical group is responsible for reviewing its own results, investigating any concerns, and submitting evidence to MNCM if a change in results is requested. In that event, MNCM staff will review the evidence and determine whether the data will be included in the statewide results. After Validation Once MNCM validation processes are complete, MNCM will approve the data in the MNCM Data Portal. An automatic will be generated and sent to the medical group s data contact notifying them that the data is approved. After all statewide results are approved, MNCM may publish medical group level results on MN HealthScores ( You can also find the results on the MNCM Data Portal on the Results tab. Medical groups should maintain data submission files and other documents related to their data submission for two years. Page 107

108 Spinal Surgery: Functional Status and Quality of Life Outcome Measures 2015 Direct Data Submission () Appendices Page 108

109 Appendices Appendix A: Patient Reported Outcome (PRO) Tools The most important step in measuring the change in functional status and quality of life for patients is to implement the administration of the PRO tools into your clinic s processes and work flows. PRO tools need to be integrated into the pre-operative evaluation and post-operative follow-up at three months and one year. There are three PRO tools used to calculate the outcomes for the patient: Oswestry Disability Index (ODI), a low back pain specific assessment tool. EQ-5D-5L, a quality of life assessment tool. [Transition to PROMIS Global Health 10] VAS Visual Analog Pain scale. Additional Information about PRO Tools Ideally tools are completed by the patient at the time of the pre-operative and post-operative visits; however office visits are not required for tool completion. Any provider or office staff may administer the pre and postoperative assessment tools. PRO Patient Reported Outcome Tools- Modes of acceptable administration Administration Mode ODI VAS Pain EQ5D PROMIS-10 In person/during visit Acceptable Acceptable Acceptable Acceptable Via mail Acceptable Acceptable Acceptable Acceptable Via telephone Not Acceptable* Not Acceptable* Not Acceptable* Acceptable Administer electronically ** Acceptable Acceptable Prohibited Acceptable *Tools have not been validated for phone administration and/ or visual analog components would be difficult to replicate by phone interview. **When administering electronically, the tool must be kept intact including content, order and scoring. Electronic examples: , patient portal, ipad/tablet, patient kiosk. Other Activities ODI VAS Pain EQ5D PROMIS-10 Store results in EMR Acceptable Acceptable Acceptable Acceptable Must seek approval for other uses* Yes No Yes Yes * examples: research, publication, use of tool beyond measure population, etc. NOTE: All patients who meet the initial patient population criteria must be included in the data submission file, whether or not they completed the Patient Reported Outcome tools. Page 109

110 Appendices Oswestry Disability Index (ODI) version 2.1a This is a patient completed survey consisting of 10 structured questions asking the patient to describe the impact of their low back pain and function in the following areas: pain, personal care, lifting, walking, sitting, standing, sleeping, sex life (if applicable), social life, and ability to travel. More information can be found at There are three options for submitting ODI assessment information to MNCM. Option # 1: Submit the Summary ODI score only If the summary ODI score is submitted the patient must complete at least eight out of10 questions asked. The Summary ODI score CANNOT be submitted if the patient answers seven or less questions. Please refer to developer s scoring table page 112. The following is an example of calculating the percent score according to the following rules: 1. Score each section of the ODI (0 to 5). 2. If less than 8 questions are answered, DO NOT include the score. 3. Add up the score of section. 4. Double the score, for example 40. a. If all 10 questions answered in this example the patient s Summary ODI score would be 40. b. If 9 questions answered, patient s % ODI would be 44. c. If 8 questions answered, patient s % ODI would be Submit the correct summary score for this patient. Option # 2: Submit each individual value The MNCM Data Portal will evaluate all incoming responses, if eight of the10 questions are completed by the patient, the assessment tool can be used and the MNCM Data Portal will score appropriately. The MNCM Data Portal will score appropriately, recalculating the denominator as recommended by the developer, Jeremy Fairbank. If a pre-operative or post-operative ODI evaluation was obtained, but an answer was skipped, leave that answer blank. Do not fill blanks with a zero as this is a valid response in the tool. If a patient selects more than one response to a question, submit the highest (worst) response. If submitting a summary score only, use the highest (worst) response in creating the summary score. Do not fill blanks with a zero as this is a valid response in the tool. Option # 3: Submit both the summary score and the individual values If desired and available, medical groups can choose to submit both the summary score they calculated according to the scoring rules and the individual answers to each question. The MNCM Data Portal will default in using the Page 110

111 Appendices summary score that is submitted by the medical group and will not additionally calculate the summary score based on the individual values. It is understood that that there is value in 1) having the individual responses for potential use in a risk adjustment model and 2) having medical groups submit the data in one standard way for rate calculation, however feedback obtained during the pilot phase indicated that many medical groups had been calculating, collecting and storing the summary scores for years. The medical groups wanted the summary capability to be incorporated. The MNCM Data Portal will default in using the summary score that is submitted by the medical groups and will not additionally calculate the summary score based on the individual values. If a patient selects more than one response to a question, submit the highest (worst) response. If submitting a summary score only, use the highest (worst) response in creating the summary score. Do not fill blanks with a zero as this is a valid response in the tool. References ODI Jeremy Fairbank, All Rights Reserved. ODI - United States/English - Version of 29 Jul 11 - Mapi Institute. ID6287/ODI_AU2.1a_eng-US.doc Fairbank J, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): Baker DJ, Pynsent PB and Fairbank JCT (1989) The Oswestry Disability revisited. In Roland Jenner JR (eds) Back pain: New approaches to rehabilitation and education. Manchester University Press.pp Fairbank JCT, Couper J, Davies JB, O Brien JP. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980;66: Permissions Permission was granted to MNCM for the use of ODI version 2.1a and to post this tool on the MNCM Data Portal for use by individual clinical practices for the purposes of participating in the state-wide quality reporting and improvement effort. This tool is available in the public domain and is free of charge for individual clinician use in clinical practice. For medical groups who additionally intend to use the ODI for research, please refer to the MAPI Trust website for more direction: The tool developer, Dr. Jeremy Fairbank has stipulated that as a part of the user agreement that For all new studies, version 2.1a of the ODI must be used. Version 2.1a is available for medical groups to use and can be accessed on the MNCM Data Portal RESOURCES tab by selecting Spinal Surgery from the drop-down menu. Page 111

112 Appendices Interpreting the ODI Score 0 to 20% minimal disability 21 to 40% moderate disability 41 to 60% severe disability 61 to 80% crippled 81 to 100% bed bound or exaggerative Scandinavian Journal of Surgery 91: , 2002 Niskanen et al. The Oswestry Low Back Pain Disability Questionnaire a Two Year Follow-up of Spine Surgery Patients Page 112

113 EQ-5D-5L Appendices This is a tool developed by EuroQol and is a standardized instrument for use as a measure of health related quality of life. The EQ-5D-5L assessment of current health state consisting of six questions asking the patient to describe in general (not related to their low back function) mobility, self-care, usual activities, pain/discomfort and anxiety/depression and a visual analog 100 point scale where patient rates current health state today. Applicable to a wide range of health conditions and treatments, it provides a simple descriptive profile and a single index value for health status. The EQ-5D-5L is designed for self-completion by respondents and is ideally suited for use in postal surveys, in clinics and face-to-face interviews. It is cognitively simple, taking only a few minutes to complete. For more information on the EQ-5D visit the website at While relatively simple for the patient to take the test, the actual scoring of the tool is quite complicated and lends itself well to applying a program to calculate the index score. For this reason, medical groups must submit the corresponding number to each of the patient s response for the first five questions. If a patient selects more than one response to a question, submit response as a blank (no value). Do not attempt to select a value (unlike ODI and VAS). According to EuroQol, the tool developer, two responses to a question invalidates the tool. If there is a discrepancy between the where the patient as placed the X and the number the patient has written in the box, use the numeric value written in the box. Plan for Transition EQ5D-5L to PROMIS Global-10: Measuring the patient s quality of life following the procedure is transitioning to a new tool- PROMIS Global-10 for patients with procedure dates starting 1/1/2015. For patients who had a pre-op assessment with EQ5D and a post-op assessment with PROMIS Global-10, conversion of values will occur within the MNCM data portal. Please refer to measure development work group details in Appendix I. References The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3): Brooks R (1996). EuroQol: the current state of play. Health Policy 37(1): Permission Permission was granted to MNCM for the use of the EQ5D-5L in individual clinical practice for the purposes of participating in the state-wide quality reporting and improvement effort. If any medical group or practice plan to use results from the EQ5D-5L tool for other purposes (i.e., research study and publication), additional licensure will need to be obtained from EuroQol to avoid copyright infringement. Page 113

114 Visual Analog Pain Scale Appendices Visual Analog Pain scales are a method for assessing the patient s level using a line to assess where the patient is on the continuum of pain. There are numerous pain rating scales in use (public domain). Principles that the work group felt were important: 1. Do not display the numeric values of the scale on the line that the patient is using to mark where they are on the continuum, but selection needs to translate (behind the scenes) to a numeric value for measurement. 2. Use the scale wording, No Pain on the left-hand (zero) side to Intolerable on the right-hand (ten) side aligning with pain descriptions cited in research by Million et al. 3. Need to have two separate questions, one that asks about back pain and the second that asks about leg pain. Below is a depiction of the tool that is available on the MNCM Data Portal under the Resources tab by selecting- Spinal Surgery from the drop-down menu. If a patient selects more than one response to a question; submit the highest (worst) response. Page 114

115 Appendices Key for Numeric Translation Do not include this in the portion of the tool for the patient to complete References Million R, Hall W, Nilsen KH, Baker RD, Jayson MI. Assessment of the progress of the back-pain patient 1981 Volvo Award in Clinical Science. Spine May-Jun;7(3): PROMIS Global Health 10 PROMIS Global Health 10 a patient completed assessment of health related quality of life consisting of 10 structured questions reported on two subscales general physical health and general mental health. NIH sponsored tool publicly available, free of charge, with multiple modes of administration available. Recommended by the measure development work group to replace the EQ5D-5L in 2015 and conversion of PROMIS 10 to EQ5D-5L supports a transition plan without the loss of ability to measure health related quality of life in the interim. For more information, access the PROMIS website: Given the need to convert the PROMIS Global Health-10 score to the EQ5D-5L Index, medical groups must submit the corresponding number to each of the patient s response for all questions. If the patient selects more than one response for a PROMIS-10 question; submit a blank for the value for that question. References Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), Permissions Permission was granted to MNCM for the use of the PROMIS Global Health- 10 in individual clinical practice for the purposes of participating in the state-wide quality reporting and improvement effort. If any medical group or practice plan to use results from the PROMIS-10 tool for other purposes or other populations (i.e., research Page 115

116 Appendices study and publication), it is recommended that an additional user agreement with PROMIS Health Organization be obtained by the medical group that outlines its planned use. Request form for instruments can be obtained at Page 116

117 Appendices Appendix B: Prior Back Surgery Determination There are four categories of prior back surgery: 1. No prior back surgery in the lumbar region. 2. Prior back surgery in the lumbar region with fusion (with or without instrumentation). 3. Prior back surgery in the lumbar region without fusion (no instrumentation or bone graft that fuses vertebrae). 4. Prior back surgery history unknown/not documented in the record. Administrative claims data or CPT codes may or may not be useful in the identification of procedures to indicate prior back surgery. The utilization of billing codes to identify procedures or complete field specification elements requires consistent, accurate coding practices by the billing organization. The following information is provided for guidance purposes only. However, it may be more accurate to build this question into documentation practices as separate discrete data fields as the patient may have a had prior back surgery procedure performed by another medical group meaning the CPT codes may not be searchable within your system. Category 1: No prior back surgery in the lumbar region Option 1: Absence of historical CPT codes that reflect prior lumbar surgery. (only captures procedures the orthopedic clinic has performed within their billing history) Option 2: Absence of patient history via new patient history/intake. This is the preferred method for determining prior history of back pain Category 2: Prior back surgery in the lumbar region with fusion (with or without instrumentation) This category includes fusion both with and without instrumentation, so it is most important to capture the history of the lumbar arthrodesis. The range of instrumentation codes are not specific to the lumbar region and if used to identify patients should be used in conjunction with (AND) the arthrodesis codes. Use Table 3 on page 9 to identity prior back surgery in the lumbar region with fusion (with or without instrumentation). To identify those with instrumentation, use the above codes and the following range of codes that signify instrumentation (these codes are not specific to the lumbar region). Table 8: CPT Codes for Identifying Spinal Fusion Procedures with Instrumentation CPT Procedure Code CPT Procedure Code Description Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring, facet screw fixation.) Internal spinal fixation by wiring of spinous processes Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments Posterior segmental instrumentation ; 7 to 12 vertebral segments Posterior segmental instrumentation, 13 or more vertebral segments Anterior instrumentation; 2 to 3 vertebral segments Page 117

118 Appendices CPT Procedure Code CPT Procedure Code Description Anterior instrumentation; 4 to 7 vertebral segments Anterior instrumentation; 8 or more vertebral segments Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum Reinsertion of spinal fixation device Removal of posterior nonsegmental instrumentation Application of intervertebral biomechanical device(s) (e.g., synthetic cage(s), methylmethacrylate) to vertebral defect or interspace Category 3: Prior back surgery in the lumbar region without fusion (no instrumentation or bone graft that fuses vertebrae) Use the following CPT codes to identity prior back surgery in the lumbar region without fusion: Table 9: CPT Codes for Identifying Lumbar Region without Fusion CPT Procedure Code CPT Procedure Code Description Partial excision of posterior vertebral component (e.g., spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar Partial excision of posterior vertebral component for intrinsic bony lesion without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (e.g., pedicle/vertebral body subtraction); lumbar Osteotomy of spine, posterior or posterolateral approach1 vertebral; lumbar Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar Open treatment and/or reduction of vertebral fractures(s) and/or dislocation(s), posterior approach, 1 fractured vertebrae or dislocated segment; lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace lumbar Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace lumbar Removal of total disc arthroplasty (artificial disc), approach, single interspace lumbar Laminectomy with exploration and/or decompression of the spinal cord and/or cauda equine, without facetectomy, foraminotomy or discectomy 1 or 2 vertebral segments, lumbar except spondylolisthesis Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy, more than 2 vertebral segments; lumbar Page 118

119 CPT Procedure Code Appendices CPT Procedure Code Description Laminotomy (hemilaminectomy), with decompression of the nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar Laminotomy (hemilaminectomy), with decompression of the nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, re-exploration, lumbar Laminotomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s); single vertebral segment, lumbar Transpedicular approach with decompression of spinal cord, equina and/or nerve root; lumbar Vertebral corpoectomy (vertebral body restriction), partial or complete, combined thoracolumbar approach with decompression of spinal cord, causa equine or nerve roots(s), lower thoracic or lumbar; single segment Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of the spinal cord, cauda equina or nerve roots, lower thoracic, lumbar or sacral, single segment Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavity approach with decompression of the spinal cord or nerve roots for tumor or repulsed bone fragments, lumbar, single segment Laminectomy with release of tethered spins cord, lumbar Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar Laminectomy for biopsy/excision of intraspinal lesion neoplasm, extradural; lumbar Laminectomy for biopsy/excision of intraspinal lesion neoplasm, extramedullary; lumbar Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, extradural, lumbar or sacral by transperitoneal or retroperitoneal approach Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, intradural, lumbar or sacral by transperitoneal or retroperitoneal approach Category 4: There is no prior back surgery history documented in the record or it is unknown This is a temporary interim option for groups to plan to create structured data/reportable fields to collect this important variable related to the patient s history. For procedure dates 01/01/2014 and forward, Option 4 will no longer be available. Page 119

120 Appendices Appendix C: Facility Codes The tables below only include facilities within the state of Minnesota. The tables are not all inclusive. If the hospital or freestanding outpatient surgical center where the procedure was performed does not have an ID number assigned below, enter a code of 999 for Other and complete the free text field Facility Other Description. Table 10: Hospital Facility Codes 51 Abbott Northwestern Hospital 205 Albany Area Hospital and Medical Center 206 Appleton Area Health Services 172 Avera Marshall Regional Medical Center 104 Bigfork Valley Hospital 211 Buffalo Hospital 213 Cambridge Medical Center 276 CentraCare Health - Long Prairie 281 CentraCare Health - Melrose 294 CentraCare Health - Monticello 149 CentraCare Health - Sauk Centre 38 Children's Hospitals and Clinics of Minnesota - MPLS 27 Children's Hospitals and Clinics of Minnesota - STP 217 Chippewa County-Montevideo Hospital 224 Community Memorial Hospital 230 Cook County North Shore Hospital 229 Cook Hospital & C&NC 231 Cuyuna Regional Medical Center 117 District One Hospital 234 Douglas County Hospital 237 Ely-Bloomenson Community Hospital 203 Essentia Health - Ada 225 Essentia Health - Deer River 290 Essentia Health - Duluth 246 Essentia Health Fosston 261 Essentia Health - Graceville 175 Essentia Health - Northern Pines 124 Essentia Health - Sandstone 142 Essentia Health - St. Joseph's Medical Center 167 Essentia Health - Virginia 147 Essentia Health St. Mary's - Detroit Lakes 148 Essentia Health St. Mary's Medical Center 186 Fairview Lakes Health Services 241 Fairview Northland Medical Center 44 Fairview Ridges Hospital 41 Fairview Southdale Hospital 267 FirstLight Health System 42 Gillette Children's Specialty Healthcare 250 Glacial Ridge Health System 251 Glencoe Regional Health Services 264 Grand Itasca Clinic and Hospital 253 Granite Falls Municipal Hospital & Manor 258 Hendricks Community Hospital Association 22 Hennepin County Medical Center 262 Hutchinson Health 266 Johnson Memorial Health Services 269 Kittson Memorial Healthcare Center 271 Lake Region Healthcare 272 Lake View Memorial Hospital 3 Lakeview Hospital 159 LakeWood Health Center 161 Lakewood Health System 121 LifeCare Medical Center 277 Madelia Community Hospital 278 Madison Hospital 279 Mahnomen Health Center 32 Maple Grove Hospital 100 Mayo Clinic Health System - Albert Lea 150 Mayo Clinic Health System - Austin 215 Mayo Clinic Health System in Cannon Falls 239 Mayo Clinic Health System in Fairmont 270 Mayo Clinic Health System in Lake City 561 Mayo Clinic Health System in Mankato 114 Mayo Clinic Health System in New Prague 138 Mayo Clinic Health System in Red Wing 130 Mayo Clinic Health System in Springfield 171 Mayo Clinic Health System in St. James 170 Mayo Clinic Health System in Waseca 120 Mayo Clinic Rochester Hospital, Methodist Campus 145 Mayo Clinic Rochester Hospital, Saint Mary s Campus 280 Meeker Memorial Hospital 2 Mercy Hospital 283 Mercy Hospital 228 Mille Lacs Health System 24003F Minneapolis VA Medical Center 292 Minnesota Valley Health Center 299 Murray County Medical Center 127 New Ulm Medical Center 30 North Memorial Medical Center 169 North Valley Health Center 105 Northfield Hospital 107 Olmsted Medical Center 108 Ortonville Area Health Services 257 Owatonna Hospital 26 Park Nicollet Methodist Hospital 110 Paynesville Area Health Care System 112 Perham Health 33 Phillips Eye Institute 113 Pipestone County Medical Center 254 Prairie Ridge Hospital and Health Services 245 Rainy Lake Medical Center 285 Range Regional Health Services 116 RC Hospital & Clinics Red Lake Hospital 296 Redwood Area Hospital 12 Regina Medical Center 11 Regions Hospital 118 Rice Memorial Hospital 6 Ridgeview Medical Center 222 River's Edge Hospital & Clinic 119 RiverView Health 204 Riverwood Healthcare Center 133 Saint Elizabeth's Medical Center 219 Sanford Bagley Medical Center 102 Sanford Bemidji Medical Center 214 Sanford Canby Medical Center 265 Sanford Jackson Medical Center 221 Sanford Luverne Medical Center 106 Sanford Thief River Falls Medical Center 156 Sanford Tracy Medical Center 235 Sanford Westbrook Medical Center 174 Sanford Wheaton Medical Center 177 Sanford Worthington Medical Center 8 Shriners Hospitals for Children 207 Sibley Medical Center 129 Sleepy Eye Medical Center 367 St. Cloud Hospital 24002F St. Cloud VA Medical Center 134 St. Francis Healthcare Campus Page 120

121 7 St. Francis Regional Medical Center 136 St. Gabriel's Hospital 21 St. John's Hospital 140 St. Joseph's Area Health Services Inc. 13 St. Joseph's Hospital 143 St. Luke's Hospital 152 Stevens Community Medical Center Appendices 153 Swift County-Benson Hospital 157 Tri-County Health Care 201 Tyler Healthcare Center/Avera 565 U.S. PHS Indian Hospital- Cass Lake 567 U.S. PHS Indian Hospital- Red Lake 52 United Hospital 162 United Hospital District 4 Unity Hospital 19 University of Minnesota Medical Center, Fairview 176 Windom Area Hospital 227 Winona Health Services 14 Woodwinds Health Campus Table 11: Freestanding Outpatient Surgical Centers 64 Allina Health - Abbott Northwestern WestHealth 53 Allina Health - University Avenue Surgery Center 18 Brainerd Lakes Surgery Center 50 CDI Twin Cities ASC 11 Centennial Lakes Surgery Center 31 CentraCare Surgery Center, Saint Cloud 5 Central Minnesota Surgical Center 61 Chaska Plaza Surgery Center, LLC 21 Children's - Minnetonka 49 Chu Surgery Center 9 Crossroads Surgery Center 17 Crosstown Surgery Center 19 Edina Surgery Center, Inc 52 Fairview Maple Grove Surgery Center 54 Family Surgery Center LLC 69 Greenway Surgery Center 3 High Pointe Surgery Center 22 Institute for Low Back and Neck Care, Special Procedures 7 Lakewood Surgery Center 13 Landmark Surgery Center 10 Mankato Surgery Center 43 Maplewood Surgery Center 48 Midsota Surgical Suites 47 Midwest Surgery Center 42 Minnesota Orthopaedic Surgery Center LLC 41 Minnesota Surgery Center, Ltd - Edina 40 Minnesota Surgery Center, Ltd - Maple Grove 38 Minnesota Valley Surgery Center, LLC 4 North Memorial Ambulatory Surgery Center at Maple Grove 29 North Metro Surgery Center 67 Pain Centers of Minnesota-Mankato 39 Pavilion Surgery Center, LLC 62 Sanford Health Detroit Lakes Clinic Same Day Surgery Center 26 South Central Surgical Center 23 Southwest Minnesota Surgical Center, Inc. 32 Southwest Surgical Center dba Orthopaedic Institute Surgery Center 15 Saint Cloud Surgical Center 30 TRIA Orthopaedic Center, LLC 6 Willmar Surgery Center 14 Woodbury Ambulatory Surgery Center Page 121

122 Appendices Appendix D: Diagnosis Codes to Identify Clinical Condition/Reason for Procedure Diagnosis codes are provided as a guide, but do not need to be used exclusively to categorize each patient. If is expected that if a category is used to classify the condition, that the accepted clinical criteria are met. (see Stratification by Condition/Reason for Lumbar Spinal Fusion section). Table 12: ICD-9 Codes for Clinical Condition/Reason for Lumbar Spinal Fusion Condition ICD-9 Code ICD-9 Description Degnerative Disc Degeneration of lumbar or lumbosacral intervertebral disc Disease Disc Herniation Displacement of lumbar intervertebral disc without myelopathy Defined displacement of intervertebral disc due to lumbago, sciatica, neuritis or radiculitis Intervertebral disc disorder with myelopathy, lumbar region Spinal Stenosis Spinal stenosis, lumbar region without neurogenic claudication Spinal stenosis, lumbar region with neurogenic claudication Spondylolisthesis Acquired spondylolisthesis Defined as degenerative or acquired spondylolisthesis Congenital anomalies of spine, spondylolisthesis Page 122

123 Appendices Appendix E: Measure Description Outcome measures for the Population 1 (lumbar discectomy/laminotomy population) at three months (6 weeks to 20 weeks) post-operatively include: 1. Average change between pre-operative and three months (6 to 20 weeks) post-operative functional status as measured with the Oswestry Disability Index, version 2.1a. 2. Average change between pre-operative and three months (6 to 20 weeks) post-operative health related quality of life as measured with the EQ5D-5L tool. 3. Average change between pre-operative and three months (6 to 20 weeks) post-operative back pain as measured with the visual analog scale (VAS) for pain. 4. Average change between pre-operative and three months (6 to 20 weeks) post-operative leg pain as measured with the visual analog scale (VAS) for pain. Outcome measures are displayed with the total volume of procedures. Outcome Measures for the Population 2 (lumbar spinal fusion population) at one year (9 to 15 months) postoperatively include: 1. Average change between pre-operative and one year (9 to 15 months) post-operative functional status as measured with the Oswestry Disability Index, version 2.1a. 2. Average change between pre-operative and one year (9 to 15 months) post-operative health related quality of life as measured with the EQ5D-5L. 3. Average change between pre-operative and one year (9 to 15 months) post-operative back pain as measured with the visual analog scale (VAS) for pain. 4. Average change between pre-operative and one year (9 to 15 months) post-operative leg pain as measured with the visual analog scale (VAS) for pain. Outcome measures are displayed with the total volume of procedures. Process Measures for PRO Administration Rates Both Populations- Pre-Operative PRO (pre-op three months prior to procedures) % of patients (procedures) administered a pre-op ODI % of patients (procedures) administered a pre-op VAS for Back Pain % of patients (procedures) administered a pre-op VAS for Leg Pain % of patients (procedures) administered a pre-op EQ5D* Post-Operative PRO Administration by Population Population 1 (lumbar discectomy/laminotomy population) Three Month Postop Assessment (6 to 20 weeks) Population 2 (lumbar spinal fusion population) One Year Postop Assessment (9 to 15 months) % of patients (procedures) administered a post-op ODI Page 123

124 Appendices % of patients (procedures) administered a post-op VAS for Back Pain % of patients (procedures) administered a post-op VAS for Leg Pain % of patients (procedures) administered a post-op EQ5D* * Transition to PROMIS-10 Page 124

125 Appendices Appendix F: MNCM Data Portal Registration Registration must be completed prior to data submission and is completed once a year. Registration instructions can be found under RESOURCES on the MNCM Data Portal Contact MNCM at support@mncm.org if you did not register. If your medical group opened or closed clinics after the 2015 Clinic and Provider Registration ended in February 2015, contact MNCM to discuss updating registration and clinic information. If a medical group opened or acquired a new clinic in the last year, the new clinic must register and submit data with the medical group. Contact support@mncm.org to discuss submitting this data. Page 125

126 Appendices Appendix G: Resources to Help You Get Started MNCM offers a selection of resources and tools to identify your population, collect data, and get started in the data submission process: To access the resources and tools for Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Report (2013 Dates of Procedure) section, login to the MNCM Data Portal at and click on RESOURCES. Select Cycle B - Spinal Surgery from the dropdown menu. The Cycle B - Spinal Surgery RESOURCES screen contains Frequently Asked Questions, Resources and this Direct Data Submission Collection Guide. The documents you will need from that screen include: Spinal Surgery Functional Status and Quality of Life Outcome Measures 2015 Data Collection Guide; Spinal Surgery Measures 2015 Pre- Submission Data Certification Form; Spinal Surgery Lumbar Lumbar Discectomy/Laminotomy (Population 1) 2015 Data Collection Spreadsheet Template; Spinal Surgery Lumbar Spinal Fusion (Population 2) 2015 Data Collection Spreadsheet Template and Optional: Spinal Surgery Lumbar Discectomy/Laminotomy (Population 1) 2015 Data Collection Form and Spinal Surgery Lumbar Spinal Fusion (Population 2) 2015 Data Collection Form (This is a patient-level form that is most useful for medical groups and clinics using paper records.) Page 126