Next year, the CMS’ Physician Quality Reporting Initiative will feature an increased bonus and three new quality measures.
The bonus incentive will increase from 1.5 to 2 percent. Furthermore, it will not have a cap. As in the past, this bonus is contingent on achieving 80 percent success for three quality measures (or fewer, if fewer apply).
Three New Measures
Cataracts: Comprehensive Preoperative Assessment for Cataract Surgery With IOL Placement. Description: Percentage of patients aged 18 years and older who undergo cataract surgery with IOL placement and received a comprehensive preop assessment of 1) Dilated fundus exam; 2) Axial length, corneal keratometry measurement and method of IOL power calculation; and 3) Functional or medical indications(s) for surgery prior to the cataract surgery with IOL placement within 12 months prior to cataract surgery. Numerator/CPT II Code: Submit 0014F or, to indicate a nonspecified reason why the preop assessment wasn’t performed, 0014F–8P. CPT Codes: 66982, 66983 and 66984. ICD-9 Code: No diagnosis codes are associated with this measure.
AMD: Counseling on Antioxidant Supplement. Description: Percentage of patients aged 50 years and older with a diagnosis of AMD and/or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for preventing progression of AMD. Numerator/CPT II Code: Submit 4177F; or, to report a system reason(s) why the counseling didn’t happen, 4177F-3P; or to report a nonspecified reason why it didn’t happen, 4177F-8P. CPT Codes: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336 and 99337. ICD-9 Codes: 362.50, 362.51 and 362.52.
POAG: Reduction of IOP by 15 Percent or Documentation of a Plan of Care. Description: Percentage of patients aged 18 years and older with a diagnosis of POAG whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15 percent from the pre-intervention level) or if the most recent IOP was not reduced by at least 15 percent from the previous level, a plan of care was documented within 12 months. Numerator/CPT II Code: Submit 3284F to indicate the IOP is reduced greater than or equal to 15 percent from the pre-intervention level; or 0517F to document a plan of care plus 3285F to indicate the IOP is reduced less than 15 percent from pre-intervention level; or 0517F–3P to indicate there was a system reason(s) why a glaucoma plan of care was not documented plus 3285F (only append –3P to the first of those two codes); or 0517F–8P to indicate there was a nonspecified reason(s) why a glaucoma plan of care was not documented plus 3285F (only append –8P to the first of those two codes); or 3284F–8P to indicate there was a nonspecified reason(s) why IOP measurement was not documented. CPT Codes: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336 and 99337. ICD-9 Codes: 365.01, 365.10, 365.11, 365.12 and 365.15.
To find out more, visit www.aao.org/pqri. Questions? E-mail pqri@aao.org.
