Summary & Overview
HCPCS M1044: Oswestry Disability Index Pre- and Postoperative Assessment
HCPCS Level II code M1044 denotes measurement of functional status with the Oswestry Disability Index (ODI version 2.1a) within three months preoperatively and again at one year (9 to 15 months) postoperatively. The code captures a standardized patient-reported outcome for spine patients and supports documentation of longitudinal functional improvement or decline after surgical intervention. Nationally, standardized outcome measurement is increasingly important for quality programs, value-based payment models, and comparative effectiveness research.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context for M1044, the typical service setting (preoperative and postoperative outpatient visits in orthopedic or spine surgery practices), and the relevance of capturing 9–15 month postoperative outcomes. The publication outlines available benchmarks where provided, notes common documentation and timing expectations for this outcome measure, and highlights policy implications for claims coding and quality reporting.
This summary serves clinicians, coding professionals, and policy analysts seeking a concise national overview of the code’s purpose, typical use cases, and payer relevance. Data not available in the input is noted where specific details (modifiers, taxonomies, ICD-10 linkage) are absent.
Billing Code Overview
HCPCS Level II code M1044 documents that functional status was measured using the Oswestry Disability Index (ODI version 2.1a) patient-reported outcome tool within three months before surgery and again at one year (9 to 15 months) after surgery. This code represents a perioperative functional outcome assessment tied to spine-related interventions.
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Service type: Patient-reported outcome functional status assessment
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Typical site of service: Preoperative clinic visit and postoperative follow-up clinic visit (outpatient orthopedic or spine surgery practice)
Data not available in the input for common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with chronic lumbar degenerative disc disease and radiculopathy is scheduled for elective lumbar fusion. Preoperative evaluation includes a standardized patient-reported outcome assessment using the Oswestry Disability Index (ODI) version 2.1a completed within three months before surgery. Clinical workflow: at the preoperative clinic visit, nursing staff or clinical coordinator provides the ODI questionnaire (paper or electronic), documents the date completed, and uploads scores to the electronic health record. Perioperative care includes routine surgical consent and operative planning. At follow-up, between 9 and 15 months postoperatively (commonly at the one-year visit), the patient completes the ODI again to assess change in functional status and to support outcome reporting. The service is typically provided in an outpatient specialty spine clinic or multidisciplinary surgical practice and may be performed by spine surgeons (orthopedic spine or neurosurgery), physiatry, or trained clinic staff under clinician oversight.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | When an unrelated E/M is performed the same day as documentation of functional status measurement and billing requires an E/M modifier |