Osteoporosis Management in Women M N and Preventing ......bone mineral density (BMD) test to screen...
Transcript of Osteoporosis Management in Women M N and Preventing ......bone mineral density (BMD) test to screen...
Osteoporosis Management in Women and Preventing Fractures (OMW)
Osteoporosis is commonly underdiagnosed and undertreated. Osteoporosis may present minor symptoms, or even be asymptomatic in the early stages. Many people are unaware they have this condition, which may become serious. A fracture may be an indicator of osteoporosis. Screening and subsequent medication treatment for osteoporosis can significantly improve health and prevent fractures.
When should I provide bone mineral density testing?The United States Preventive Services Task Force (USPSTF) recommends all women ages 65 and older routinely have a bone mineral density (BMD) test to screen for osteoporosis. A BMD test is also recommended when men and women ages 50 and older break a bone.
Make sure that all women ages 67—85 who have su�ered a fracture complete a BMD test or fill a medication for osteoporo-sis treatment within six months.
BMD tests are the most e�ective method for determining bone health, identifying osteoporosis, determining risk for fractures, and assessing response to osteoporosis treatment.
Does Meridian cover a BMD test?Meridian covers BMD testing. To find a hospital or radiology center, check the Provider Directory at www.mhplan.com.
Fax bone mineral density test resultsto 313-202-0006
For further questions, please call Meridian's Quality Improvement department at 888-437-0606
Visit the Provider Portal at hpprovider.atlascomplete.com to enter relevant Healthcare E�ectivness Data and Information Set (HEDIS®) information
FDA-Approved Osteoporosis Therapies*
Recommended pharmacologic options for osteoporosis treatment include:
*Not all medications may be covered. For a list of covered medications, refer to the Meridian Drug Formulary at www.mhplan.com
Contact Information:For questions regarding the Meridian Drug Formulary, please call MeridianRx at 855-323-4580.
EDPS39 MI CORP | www.mhplan.com
CPT ICD-10-CM Procedure
76977, 77078, 77080, 77081, 77085, 77086
Codes to bill for BMD testing:
BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1
M
ERIDIAN
PA S S P O RT
Codes listed are specific to the subject matter of this flyer. While Meridian encourages you to use these codes in association with the subject matter of this flyer, Meridian recognizes that the circumstances around the services provided may not always directly support/match the codes. It is crucial that the medical record documentation describes the services rendered in order to support the medical necessity and use of these codes.
Bisphosphonates Alendronate Risedronate Alendronate-cholecalciferol Zoledronic acid Ibandronate
Other agents Abaloparatide Raloxifene Denosumab Teriparatide
Janu
ary
2020
Elig
ible
Pop
ulat
ion
Key
Com
pone
nts
Freq
uenc
y
A
ge
Sex
Wei
ght (
kg)
H
eigh
t (cm
)
Pre
viou
s fra
ctur
e
Par
ent f
ract
ured
hip
C
urre
nt s
mok
ing
G
luco
corti
coid
s
Rhe
umat
oid
arth
ritis
S
econ
dary
ost
eopo
rosi
s [ty
pe 1
dia
bete
s, o
steo
gene
sis
impe
rfect
a in
adu
lts, u
ntre
ated
long
-sta
ndin
g hy
perth
yroi
dism
,
hy
pogo
nadi
sm o
r pre
mat
ure
men
opau
se (<
45 y
ears
), ch
roni
c
m
alnu
tritio
n, o
r mal
abso
rptio
n, a
nd c
hron
ic li
ver d
isea
se)
A
lcoh
ol 3
or m
ore
units
per
day
(see
FR
AX®)
Fe
mor
al n
eck
BM
D (g
/cm
2 )
Oth
er ri
sk fa
ctor
sV
itam
in D
def
icie
ncy
or lo
w d
ieta
ry c
alci
um in
take
Inad
equa
te p
hysi
cal a
ctiv
ityLo
ss o
f hei
ght (
1.5
inch
es)
Fam
ily h
isto
ry o
f ost
eopo
rosi
sD
epo-
Pro
vera
use
Aro
mat
ase
inhi
bito
r the
rapy
And
roge
n in
hibi
tor t
hera
pyLu
pron
ther
apy
Cor
e P
rinci
ples
of
Prim
ary
Pre
vent
ion
Ther
e is
insu
ffici
ent
evid
ence
on
the
optim
al
scre
enin
g in
terv
al in
a
wom
an w
ith p
revi
ous
norm
al B
MD
Pat
ient
Sel
ectio
n fo
r Pha
rmac
olog
ical
M
anag
emen
t B
ased
on
Ris
k
MQ
IC.O
RG
1 Use
cau
tion
in p
atie
nts
with
act
ive
uppe
r GI d
isor
ders
. Tak
e m
edic
atio
n on
an
empt
y st
omac
h w
ith w
ater
, rem
ain
uprig
ht, n
o fo
od o
r bev
erag
e fo
r 30
min
utes
, (60
min
utes
for I
band
rona
te).
Iden
tify
risk
fact
ors
Ass
ess
risk
fact
ors.
[C] C
alcu
late
FR
AX®
to a
sses
s fu
ture
frac
ture
risk
. Inc
lude
bon
e m
iner
al d
ensi
ty (B
MD
) whe
n av
aila
ble.
Rec
ord
resu
lt.A
dult
heig
ht
asse
ssm
ents
at
perio
dic
wel
l exa
ms
Opt
imiz
e di
etar
y ca
lciu
m (1
000-
1200
mg/
d) a
nd v
itam
in D
(≥ 1
000
IU/d
). O
nly
use
supp
lem
ents
if d
iet i
s in
suffi
cien
t.P
harm
acol
ogic
al
Man
agem
ent
M
ichi
gan
Qua
lity
Impr
ovem
ent
Con
sort
ium
Gui
delin
e
Man
agem
ent
and
Prev
enti
on o
f Ost
eopo
rosi
s
Appr
oved
by
MQ
IC M
edic
al D
irect
ors
2003
, 200
6, 2
008,
201
0, 2
012,
201
4, 2
016,
201
8, 2
020
The
follo
win
g gu
idel
ine
reco
mm
ends
ass
essm
ent a
nd m
anag
emen
t of p
atie
nts
to re
duce
frac
ture
risk
due
to o
steo
poro
sis.
2 J of
Bon
e M
etab
olis
m N
ov 2
015
Dru
g H
olid
ays
and
Prin
cipl
es o
f Mon
itorin
gLe
vels
of E
vide
nce
for t
he m
ost s
igni
fican
t rec
omm
enda
tions
: A =
rand
omiz
ed c
ontro
lled
trial
s; B
= c
ontro
lled
trial
s, n
o ra
ndom
izat
ion;
C =
obs
erva
tiona
l stu
dies
; D =
opi
nion
of e
xper
t pan
el
Rec
omm
enda
tion
and
Leve
l of E
vide
nce
This
gui
delin
e re
pres
ents
cor
e m
anag
emen
t ste
ps. I
t is
base
d on
Qas
eem
A, F
orci
ea M
A, M
cLea
n R
M, D
enbe
rg T
D, f
or th
e C
linic
al G
uide
lines
Com
mitt
ee o
f the
Am
eric
an C
olle
ge o
f Phy
sici
ans.
Tre
atm
ent o
f Low
Bon
e D
ensi
ty o
r Ost
eopo
rosi
s to
Pre
vent
Fra
ctur
es
in M
en a
nd W
omen
: A C
linic
al P
ract
ice
Gui
delin
e U
pdat
e Fr
om th
e Am
eric
an C
olle
ge o
f Phy
sici
ans.
Ann
Inte
rn M
ed. 2
017;
166:
818–
839.
doi
: 10.
7326
/M15
-136
1; F
inal
Rec
omm
enda
tion
Stat
emen
t: O
steo
poro
sis
to P
reve
nt F
ract
ures
: Scr
eeni
ng. U
.S. P
reve
ntiv
e S
ervi
ces
Task
For
ce. J
uly
2019
.. In
divi
dual
pat
ient
con
side
ratio
ns a
nd a
dvan
ces
in m
edic
al s
cien
ce m
ay s
uper
sede
or m
odify
thes
e re
com
men
datio
ns.
The
role
of c
alci
um a
nd v
itam
in D
sup
plem
enta
tion
is u
ncle
ar.
Sup
plem
enta
tion
is n
ot a
ssoc
iate
d w
ith re
duce
d fra
ctur
e ris
k an
d is
not
re
com
men
ded
for p
rimar
y pr
even
tion.
Wei
ght-b
earin
g ex
erci
se [A
]A
ddre
ss m
odifi
able
risk
fact
ors
abov
e, in
clud
ing
not s
mok
ing
or d
rinki
ng to
o m
uch
alco
hol
Fall
prev
entio
nTr
eat p
atie
nts
on c
ortic
oste
roid
ther
apy
with
a T
-sco
re ≤
-1.0
. [A]
Trea
t pat
ient
s w
ith a
his
tory
of a
n os
teop
orot
ic fr
actu
re o
r fra
ctur
e of
the
hip
or s
pine
. [A]
Trea
t pat
ient
s w
ithou
t a h
isto
ry o
f fra
ctur
es b
ut w
ith a
T-s
core
of -
2.5
or lo
wer
. [A]
Trea
t pat
ient
s w
ith a
T-s
core
bet
wee
n -1
.0 a
nd -2
.5 if
FR
AX®
maj
or o
steo
poro
tic fr
actu
re p
roba
bilit
y is
≥ 2
0% o
r hip
frac
ture
pro
babi
lity
is
≥ 3
%. [
D]
Per
form
BM
D te
stin
g us
ing
dual
-ene
rgy
x-ra
y ab
sorp
tiom
etry
(DXA
) for
:
Wom
en ≥
65
year
s re
gard
less
of r
isk
fact
ors
[D]
M
en/w
omen
with
frac
ture
risk
(10-
year
pro
babi
lity
of fr
actu
re u
sing
FR
AX® ≥
9.3%
)
On
corti
cost
eroi
ds
Tran
spla
nt
CT
scan
for s
cree
ning
is n
ot re
com
men
ded.
Con
side
r ora
l bis
phos
phon
ate
ther
apy1 . A
dru
g ho
liday
may
be
cons
ider
ed a
fter 3
-5 y
ears
2 in
low
-ris
k (6
-10
year
s in
hig
h-ris
k). I
f not
tole
rate
d
or in
effe
ctiv
e, c
onsi
der o
ther
age
nts.
Con
side
r ref
erra
l to
endo
crin
e or
bon
e an
d m
iner
al m
etab
olis
m s
peci
alis
t if p
atie
nt d
oes
not t
oler
ate
treat
men
t or s
how
s pr
ogre
ssio
n or
re
curr
ent f
ract
ure
afte
r 2 y
ears
on
treat
men
t.
Pat
ient
s re
quiri
ng
ther
apy
to re
duce
hig
h ris
k of
non
-trau
mat
ic
fract
ures
Pat
ient
s at
po
tent
ial r
isk
for
oste
opor
osis