URSA-PHF-045: Post-Op Clinician Office Visit within 14 Days

  • Published on Aug 21, 2025
  • 7 minute(s) read
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Measure Description

Among surgery encounters for patients with active plan membership where the patient was discharge home or home with home health, the percentage with a clinician office visit within 14 days of discharge

Metadata

  • Measure Type: Rate Measure
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Denominator Case Field: Surgery Encounter ID
  • Target Direction: Up

Denominator Description

Surgery encounters for patients with active plan membership across all settings. Excludes encounters with discharge status indicating the patient; expired, was transferred to inpatient status at another hospital or facility, or had a planned readmission.

Numerator Description

Clinician office visits occurring within 14 days of the surgery encounter end date.

Published Fields

  • Data Model Keys

    • Surgery Encounter ID
    • Surgery Patient ID
    • Surgery Encounter Primary Payor ID
    • Surgery Encounter Primary Plan ID
    • Surgery Facility Provider ID
    • Surgery Attending Provider ID
    • Surgery Primary HCPCS Procedure Provider ID
    • Patient ID
    • Primary Plan Attributee Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID
    • Primary Payor ID
    • Primary Plan ID

  • Date Fields

    • Surgery Encounter Start Date
    • Surgery Encounter End Date
    • Period Start Date
    • Period End Date
    • Current Continuous Primary Payor Membership Episode Start Date
    • Current Continuous Primary Payor Membership Episode End Date
    • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
    • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)

  • Encounter Fields

    • Is Surgery Observation Stay Parent Encounter
    • Surgery Encounter LOS in Elapsed Midnights
    • Is Surgery Same Day Discharge
    • Surgery Surgery Encounter Setting Category
    • Is Surgery Patient Discharged Home or Home with Home Health
    • Is Surgery Hospital Inpatient Admission Encounter
    • Is Surgery Ambulatory Surgical Center Encounter
    • Is Surgery Hospital Outpatient Surgery Encounter
    • Is Surgery Emergency Department Parent Encounter
    • Is Surgery MSK Related Encounter

  • Patient Fields

    • Is Patient Alive
    • Is Hospice in Last 12 Months
    • Patient Last Name
    • Patient Date of Birth
    • Patient Age Integer
    • Patient Age Category Tier 1
    • Patient Age Category Tier 2
    • Patient Sex Category
    • Is Patient Sex Female
    • Is Patient Sex Male
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months
    • PCP Attribution Category
    • Primary Care Engagement Category
    • Count Primary Care Visits in Last 36 Months
    • Specialty Care Engagement Category
    • Count Specialty Care Office Visits in Last 36 Months
    • Primary or Specialty Care Engagement Category
    • Count Clinician Office Visits in Last 3 Years
    • Patient ZIP Code 5-Digit

  • Numerator Fields

    • Clinician Visit Encounter ID
    • Clinician Visit Service Provider ID
    • Clinician Visit Provider Group Provider ID
    • Clinician Visit Facility Provider ID
    • Clinician Visit Encounter Date
    • Clinician Visit Qualifying Preventive Primary Care HCPCS Code
    • Elapsed Days from Surgery Discharge to Visit
    • Is Clinician Visit Primary Care Clinician Office Visit
    • Is Clinician Visit Specialist Clinician Office Visit
    • Is Clinician Visit Preventive Care Visit from Non-Primary Care Specialist
    • Is Clinician Visit Urgent Care Visit
    • Clinician Visit Service Provider NPI
    • Clinician Visit Service Provider Description
    • Clinician Visit Service Provider Primary NUCC Provider Taxonomy Description
    • Clinician Visit Ursa Physician Specialty Type Description
    • Clinician Visit Principal Discharge Diagnosis ICD-10-CM Code
    • Clinician Visit Principal Discharge Diagnosis ICD-10-CM Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
    • Clinician Visit Principal Discharge Diagnosis WHO ICD-10 Chapter Description
    • Clinician Visit Principal Discharge Diagnosis WHO ICD-10 Block Description
    • Clinician Visit Qualifying Preventive Primary Care HCPCS Code Description
    • Clinician Visit CMS Place of Service Code
    • Clinician Visit Primary Plan Allowed Amount
    • Clinician Visit Primary Plan Paid Amount
    • Clinician Visit Total Plan Paid Amount from All Plans
    • Clinician Visit Patient Paid Amount

  • Provider Fields

    • Surgery Facility Provider Description
    • Surgery Facility Provider Primary NUCC Provider Taxonomy Code
    • Surgery Facility Provider Primary NUCC Provider Taxonomy Description
    • Surgery Facility Provider Practice Address State Abbreviation
    • Surgery Facility Provider Practice Address ZIP Code 5-Digit
    • Primary Plan Attributee Provider Description
    • Primary Plan Attributee Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Individual Provider Description
    • Empirical Attributee Primary Care Individual Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Provider Group Provider Description
    • Empirical Attributee Primary Care Provider Group Primary NUCC Provider Taxonomy Description
    • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
    • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

  • Location Fields

    • Patient State Abbreviation
    • Patient County Description
    • UW HIP ADI Quintile Category
    • CDC SVI Overall Quintile Category
    • CDC SVI Socioeconomic Quintile Category
    • CDC SVI Household / Disability Quintile Category
    • CDC SVI Minority / Language Quintile Category
    • CDC SVI Housing / Transportation Quintile Category

  • Insurance Fields

    • Surgery Encounter Primary Payor Description
    • Surgery Encounter Primary Plan Description
    • Surgery Encounter Primary Plan Financial Class Description
    • Primary Payor Description
    • Primary Plan Description

  • Diagnosis Fields

    • Surgery Principal Discharge Diagnosis ICD-10-CM Code
    • Surgery Principal Discharge Diagnosis ICD-10-CM Description
    • Surgery Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Surgery Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Surgery Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Surgery Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • CCW Count Category
    • Count CCW Conditions
    • Is CCW Acquired Hypothyroidism
    • Is CCW Acute Myocardial Infarction
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
    • Is CCW Alzheimers Disease
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
    • Is CCW Anemia
    • Is CCW Anxiety Disorders
    • Is CCW Asthma
    • Is CCW Atrial Fibrillation
    • Is CCW Autism Spectrum Disorder
    • Is CCW Benign Prostatic Hyperplasia
    • Is CCW Bipolar Disorder
    • Is CCW Blindness and Visual Impairment
    • Is CCW Breast Cancer
    • Is CCW Cataract
    • Is CCW Cerebral Palsy
    • Is CCW CKD
    • Is CCW Colorectal Cancer
    • Is CCW COPD and Bronchiectasis
    • Is CCW Cystic Fibrosis and Other Metabolic Disorder
    • Is CCW Deafness and Hearing Impairment
    • Is CCW Depression
    • Is CCW Depressive Disorders
    • Is CCW Diabetes
    • Is CCW Endometrial Cancer
    • Is CCW Epilepsy
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue
    • Is CCW Glaucoma
    • Is CCW Heart Failure
    • Is CCW Hip or Pelvic Fracture
    • Is CCW Hyperlipidemia
    • Is CCW Hypertension
    • Is CCW Intellectual Disability
    • Is CCW Ischemic Heart Disease
    • Is CCW Learning Disability
    • Is CCW Leukemia
    • Is CCW Lung Cancer
    • Is CCW Migraine and Chronic Headache
    • Is CCW Mobility Impairment
    • Is CCW Multiple Sclerosis
    • Is CCW Muscular Dystrophy
    • Is CCW Obesity
    • Is CCW Osteoporosis
    • Is CCW Other Developmental Delay
    • Is CCW Personality Disorder
    • Is CCW Pressure or Chronic Ulcer
    • Is CCW Prostate Cancer
    • Is CCW PTSD
    • Is CCW PVD
    • Is CCW Rheumatoid Arthritis or Osteoarthritis
    • Is CCW Schizophrenia
    • Is CCW Schizophrenia or Other Psychotic Disorders
    • Is CCW Stroke or Transient Ischemic Attack
    • CCW Systems Category
    • Count CCW Systems
    • Is CCW System Behavioral Health
    • Is CCW System Cardiovascular
    • Is CCW System Congenital
    • Is CCW System Endocrine/Metabolic
    • Is CCW System Genitourinary
    • Is CCW System Hematologic
    • Is CCW System Musculoskeletal
    • Is CCW System Neurological
    • Is CCW System Oncologic
    • Is CCW System Ophthalmologic
    • Is CCW System Pulmonary
    • Is CCW System Other

  • Financial Fields

    • Surgery Primary Plan Allowed Amount
    • Surgery Primary Plan Paid Amount
    • Surgery Total Plan Paid Amount from All Plans
    • Surgery Patient Paid Amount

  • Billing and Claims Fields

    • Surgery MS-DRG Code
    • Surgery MS-DRG Description
    • Surgery MS-DRG MDC Code
    • Surgery MS-DRG MDC Description
    • Is Surgery MS-DRG MDC Code Musculoskeletal System
    • Surgery APR-DRG Code
    • Surgery CMS Admit Type Code
    • Surgery CMS Admit Type Description
    • Surgery CMS Admit Source Code
    • Surgery CMS Admit Source Description
    • Surgery CMS Place of Service Description
    • Surgery CMS Place of Service Code
    • Surgery CMS Patient Discharge Status Code
    • Surgery CMS Patient Discharge Status Description
    • Clinician Visit CMS Place of Service Description

  • Clinical Services Fields

    • Surgery Primary HCPCS Procedure HCPCS Code
    • Surgery Primary HCPCS Short Description
    • Is Surgery Primary HCPCS Procedure Surgical
    • Surgery Primary Surgical Procedure HCPCS Category
    • Is Surgery Primary HCPCS Surgical Procedure of Musculoskeletal System
    • Surgery Primary HCPCS MSK Surgical Procedure Category
    • Surgery Primary HCPCS AHRQ CCS Single-Level Procedure Category Code
    • Surgery Primary HCPCS AHRQ CCS Single-Level Procedure Category Description
    • Surgery Principal ICD Procedure ICD-10-PCS Code
    • Surgery Principal ICD Procedure ICD-10-PCS Description
    • Is Surgery Principal ICD-10-PCS Operation of Musculoskeletal System
    • Surgery Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Code
    • Surgery Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Description
    • Surgery Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Code
    • Surgery Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Description

  • Validation Only Fields

    • Is Surgery Any Total Hip or Knee Replacement
    • Is Surgery MSDRG for Hip or Knee Replacement
    • Is Surgery Principal ICD-10 PCS AHRQ CCS Single Level Category Total Knee
    • Is Surgery Principal ICD-10 PCS AHRQ CCS Single Level Category Total Hip
    • Is Surgery Primary HCPCS AHRQ CCS Single Level Category Total Knee
    • Is Surgery Primary HCPCS AHRQ CCS Single Level Category Total Hip

  • Measure Fields

    • Is Visit Service Provider the Plan Attributed Provider
    • Is Visit Service Provider the Empirical Attributee Individual Provider
    • Denominator