• Measure 12: Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry for EHR: groups and individuals
    • IRIS Registry for manual data entry: groups and individuals
    • EHR through your vendor (if offered): groups and individuals
    • Claims-based reporting: individuals only

    Measure Type: Process

    Instructions: This measure is to be reported a minimum of once per performance period for patients, aged 18 years and older, with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during the performance period.

    It’s anticipated that clinicians who provide the primary management of patients with primary open-angle glaucoma (in either one or both eyes) will submit this measure.

    To Which Patients Does the Measure Apply?

    i) Denominator: All patients, aged 18 year and older, diagnosed with POAG. 

    There are three criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
    3. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.” 

    Diagnosis Codes

    CMS has stated that ICD-10 should be coded to the greatest specificity and unspecified codes may be denied. Therefore, the codes listed below with a strikethrough should not be included on your claim or submitted with this quality measure.

    Diagnosis for primary open-angle glaucoma: H40.10X0, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.1110, H40.1111, H40.1112, H40.1113, H40.1114, H40.1120, H40.1121, H40.1122, H40.1123, H40.1124, H40.1130, H40.1131, H40.1132, H40.1133, H40.1134, H40.1190, H40.1191, H40.1192, H40.1193, H40.1194, H40.1210, H40.1211, H40.1212, H40.1213, H40.1214, H40.1220, H40.1221, H40.1222, H40.1223, H40.1224, H40.1230, H40.1231, H40.1232, H40.1233, H40.1234, H40.1290H40.1291, H40.1292, H40.1293, H40.1294, H40.151, H40.152, H40.153, H40.159

    CPT Codes

    2018 additions in red.

    92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

    How to Report the Measure

    Claims and IRIS Registry Manual Reporting

    Category II Codes:

    2018 additions in red.

    Numerator: Patients who have an optic nerve head evaluation during one or more office visits within 12 months.

    Numerator note: Denominator exception(s) are determined on the date of the denominator eligible encounter.

    • Performance met (patient included in numerator and denominator): 2027F Optic nerve head evaluation performed
    • Denominator exclusion (patient not included in numerator or denominator): 2027F 1P Documentation of medical reason(s) for not performing an optic nerve head evaluation
    • Performance not met (patient not included in numerator, but included in denominator): 2027F 8P Optic nerve head evaluation was not performed, reason not otherwise specified

    IRIS Registry EHR Reporting

    Instructions: This measure is to be reported a minimum of once per reporting period for patients, aged 18 years and older, seen during the reporting period. It’s anticipated that clinicians who provide the primary management of patients with primary open-angle glaucoma (in either one or both eyes) will submit this measure.

    These are the required elements to be documented at least once a year to meet the measure performance requirements.

    • Cup-to-disc ratio
    • Structural abnormalities of the optic disc

    Clinical Recommendation Statements:

    Updated in 2018

    In completing the elements in the comprehensive adult medical eye evaluation, the ophthalmic evaluation specifically focuses on the following elements:

    • History [A:III]
    • Visual acuity measurement [A:III]
    • Pupil examination [B:II]
    • Anterior segment examination [A:III]
    • Intraocular pressure measurement [A:I]
    • Gonioscopy [A:III]
    • Optic nerve head and retinal nerve fiber layer examination [A:III]
    • Fundus examination [A:III]

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:
      • Small practices (≤ 15 clinicians) will receive 3 points,
      • Larger practices (> 15 clinicians) will receive 1 point.
    • If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.

    Benchmarks

    Decile/Points eCQM (Integrated EHR) Web Registry Claims
    3 82.75 – 87.40 94.70 – 98.14 98.99 – 99.99
    4 87.41 – 90.76 98.15 – 99.16 --
    5 90.77 – 93.62 99.17 – 99.99 --
    6 96.63 – 96.16 -- --
    7 96.17 – 97.87 -- --
    8 97.88 – 98.96 -- --
    9 98.97 – 99.99 -- --
    10 100.00 100 100