Specifications Manual for Joint Commission National Quality Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

Measure Information Form

Measure Set: Total Hip and Total Knee Replacement Outpatient (THKR-OP)

Set Measure ID: THKR-OP-3

Set Measure ID Performance Measure Name
THKR-OP-3a viewtopic Discharged to Home - Hip and Knee Overall
THKR-OP-3b viewtopic Discharged to Home - Hip
THKR-OP-3c viewtopic Discharged to Home - Knee

Performance Measure Name: Discharged to Home

Description: Patients discharged to home following total hip or total knee replacement.

Rationale: High-quality care for total hip and total knee replacement procedures is designed to promote early functional recovery and enable safe discharge to the patient’s home. The 2020 Enhanced Recovery After Surgery (ERAS®) Society consensus statement on perioperative care for total hip and knee replacement recommends the use of objective discharge criteria to facilitate direct discharge to home (Wainwright et al., 2020).

Home-based rehabilitation is increasingly used following total hip and knee replacement procedures. The American Academy of Orthopaedic Surgeons (AAOS) 2022 Surgical Management of Osteoarthritis of the Knee Evidence Based Clinical Practice Guideline reports that discharge to home, with or without home services, is associated with fewer adverse events compared to discharge to an acute rehabilitation facility or skilled nursing facility (American Academy of Orthopaedic Surgeons, 2022). Additionally, the 2023 Management of Osteoarthritis of the Hip Evidence Based Clinical Practice Guideline reports high-quality evidence supporting either formal physical therapy or unsupervised home exercise following total hip arthroplasty (American Academy of Orthopaedic Surgeons, 2023).

Analyses of large national datasets indicate that rates of discharge to home following total hip and knee arthroplasty have notably increased over the past decade (American Joint Replacement Registry, 2025; DeMik et al., 2021), although meaningful variation in discharge practices persist (DeMik et al., 2021).

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who were discharged to home following total hip or total knee replacement.
Included Populations: Patients discharged to home with or without home health services, in-home physical therapy or outpatient physical therapy.

Excluded Populations: None

Data Elements:

Denominator Statement: Patients undergoing a total hip or total knee replacement.
Included Populations:
  • Patient with a CPT® Code with Modifier as defined in Appendix A, Table 14.01b (Total Hip Replacement-OP), or Table 14.02b (Total Knee Replacement-OP), or Table 14.03b (Bilateral Hip Replacements-OP), or Table 14.04b (Bilateral Knee Replacements-OP).

Excluded Populations:
  • Patients less than 18 years of age
  • Residents of Other Health Care Facility:
    • Extended or Intermediate Care Facility (ECF/ICF)
    • Long Term Acute Care Hospital (LTACH)
    • Nursing Home or Facility including Veteran’s Administration Nursing Facility
    • Psychiatric Hospital or Psychiatric Unit of a Hospital
    • Skilled Nursing Facility (SNF), Sub-Acute Care or Swing Bed
    • Veterans Home
  • Patients with a CPT® Code with Modifier as defined in Appendix A: Table 14.05b (partial hip and partial knee replacements-OP), or Table 14.06b (revision and resurfacing procedures-OP), or Table 14.07b (removal of implanted devices/prostheses-OP)
  • Patients with an ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Code as defined in Appendix A: Table 14.08 (Complication of Internal Fixation Device/Prosthesis), or Table 14.09 (malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm), or Table 14.10 (Fractures)
  • Patient expired
  • Patient left AMA
  • Physician/APN/PA/nurse/social worker/care manager/discharge planner/physical therapist/occupational therapist documentation of medical/social reason why patient cannot be discharged to home.

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and CPT procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 and CPT codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Proportion for hip replacements, proportion for knee replacements and aggregated proportion for hip & knee replacements.

Selected References:

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step. Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

THKR-OP-3: Algorithm Narrative

THKR-OP-3: Outpatient Discharged to Home

Numerator: Patients who were discharged to home following total hip or total knee replacement.
Denominator: Patients undergoing a total hip or total knee replacement.

Stratification Table:
Measure ID Stratified Measure Name
THKR-OP-3a Overall Rate
THKR-OP-3b Hip
THKR-OP-3c Knee

1. Run cases, which are included in the THKR Outpatient Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check CPT® Codes with Modifier.
  1. If at least one of the CPT® Codes with Modifier is on Table 14.01b or Table 14.02b or Table 14.03b or Table 14.04b, continue processing and proceed to check ICD-10-CM Principal or Other Diagnosis Codes.
3. Check ICD-10-CM Principal or Other Diagnosis codes.
  1. If at least one of the ICD-10-CM Principal or Other Diagnosis codes is on Table 14.10, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 7.
  2. If none of the ICD-10-CM Principal or Other Diagnosis codes are on Table 14.10, continue processing and proceed to check Resident of Other Health Care Facility.
4. Check Resident of Other Health Care Facility.
  1. If Resident of Other Health Care Facility is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 7.
  2. If Resident of Other Health Care Facility equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 7.
  3. If Resident of Other Health Care Facility equals N, continue processing and proceed to check Discharge Disposition.
5. Check Discharge Disposition.
  1. If Discharge Disposition is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 7.
  2. If Discharge Disposition equals 6 or 7, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 7.
  3. If Discharge Disposition equals 1 or 2, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Proceed to Step 7.
  4. If Discharge Disposition equals 3, 4a, 4b, 4c, 4d, 5 or 8, continue processing and proceed to check Reason for Not Discharging Patient to Home.
6. Check Reason for Not Discharging Patient to Home.
  1. If Reason for Not Discharging Patient to Home is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 7.
  2. If Reason for Not Discharging Patient to Home equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 7.
  3. If Reason for Not Discharging Patient to Home equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 7.
7. Initialize the Measure Category Assignment for each strata measure (b-c) equals to B. Do not change the Measure Category Assignment that was already calculated for the overall rate (THKR-OP-3a). Proceed to check Overall Rate Category Assignment.

8. Check Overall Rate Category Assignment.
  1. If Measure Category Assignment equals B, assign B to Measure Category Assignment for measures THKR-0P-03b and THKR-0P-03c. Stop Processing.
  2. If Measure Category Assignment equals D,E or X, continue processing and proceed to check CPT® Codes with Modifier.
9. Check CPT® Codes with Modifier.
  1. If CPT® Codes with Modifier is on Table 14.01b or Table 14.03b, set Measure Category Assignment for measure THKR-OP-03b equal to Measure Category Assignment of THKR-OP-03a. Stop processing.
  2. If CPT® Codes with Modifier is on Table 14.02b or Table 14.04b, set Measure Category Assignment for measure THKR-OP-03c equal to Measure Category Assignment of THKR-OP-03a. Stop processing.

Measure Information Form THKR-OP-3
CPT® only copyright 2026 American Medical Association. All rights reserved.
Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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