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  • Measure 140: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry for manual data entry: 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 50 years and older, with a diagnosis of age-related macular degeneration, who they or their caregiver(s) were counseled about the benefits and/or risks of the Age-Related Eye Disease Study formulation for preventing progression of AMD, within the 12-month performance period.It’s anticipated that clinicians who provide the primary management of patients with AMD will submit this measure.Definition: Counseling – Documentation in the medical record should include a discussion of risk or benefits of the AREDS 2 formulation. Counseling can be discussed with all patients with AMD, even those who do not meet the criteria for the AREDS 2 formulation, or other reasons why the patient would not meet criteria for AREDS 2 formulation as outlined in the AREDS. The ophthalmologist or optometrist can explain why these supplements are not appropriate for their particular situation. Also, given the purported risks associated with antioxidant use, patients would be informed of the risks and benefits and make their choice based on valuation of vision loss vs. other risks. As such, the measure seeks to educate patients about overuse as well as appropriate use.

    To Which Patients Does the Measure Apply?

    Denominator: All Patients aged 50 years and older with a diagnosis of AMD. 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 Code.”

    Diagnosis Codes

    CMS has stated that providers should code ICD-10 to the greatest specificity; unspecified codes may be denied. You should not include the strikethrough codes listed below on your claim or submit them with this quality measure.2018 deletions in redH35.3190, H35.3191, H35.3192, H35.3193, H35.3194H35.30, H35.3110, H35.3111, H35.3112, H35.3113, H35.3114, H35.3120, H35.3121, H35.3122, H35.3123, H35.3124, H35.3130, H35.3131, H35.3132, H35.3133, H35.3134, H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233

    CPT Codes

    2018 additions in red.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, 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. 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

    Numerator: Patients with AMD or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the AREDS 2 formulation for preventing progression of AMDNote: If patient is already receiving AREDS 2 formulation, the assumption is that counseling about AREDS has already been performed.

    • Performance met (patient included in numerator and denominator): 4177F Counseling about the benefits and/or risks of the Age-Related Eye Disease Study 2 formulation for preventing progression of age-related macular degeneration (AMD) provided to patient and/or caregiver(s)
    • Performance not met (patient not included in numerator, but included in denominator): 4177F 8P Optic nerve head evaluation was not performed, reason not otherwise specified

    Clinical Recommendation Statements: Updated in 2018All patients with AMD should be educated about the prognosis of the disease and the potential value of treatment as appropriate for their visual and functional status. Patients can be educated that while central visual loss is common, total visual loss is extremely rare. Patients with AMD can be reassured that there is no harm in using their eyes for normal visual tasks, and they may be told that the effect of total sunlight exposure remains uncertain (III; Good; Strong)Treatment with antioxidants and minerals as described previously in the original AREDS and AREDS2 trials is recommended for patients who have progressed to intermediate or advanced AMD in at least one eye. (I++; Good; Strong) American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern® Guidelines. Age-Related Macular Degeneration. San Francisco, CA: American Academy of Ophthalmology; 2015. Available at: Preferred Practice Pattern® Guidelines.Antioxidant Vitamin and Mineral Supplements Used in the AREDS

    SupplementDaily Dose (see note below)
    Vitamin C 500 mg
    Vitamin E 400 IU
    Lutein/zeaxanthin 10 mg/2 mg
    Zinc oxide 80 mg or 25 mg
    Cupric oxide 2 mg

    Note: These doses are not those listed on the commercially available vitamin/mineral supplements because of a change in labeling rules by the U.S. Food and Drug Administration that specifies that the doses must reflect the amounts available at the end of the shelf life.

    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.
    Decile/Points Claims Registry (No EHR) 
    3 97.33-99.99 35.90 – 57.88
    4 -- 57.89 – 71.75
    5 -- 71.76 – 86.38
    6 -- 86.39 – 94.22
    7 -- 94.23 – 98.31
    8 -- 98.32 – 99.99
    9 -- --
    10 100 100

    Copyright

    The measures are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license or distribution of the measures for commercial gain, or incorporation of the measures into a product or service that is sold, licensed or distributed for commercial gain.Commercial uses of the measures require a license agreement between the user and the American Medical Association [on behalf of the Physician Consortium for Performance Improvement®] or the American Academy of Ophthalmology.Neither the AMA, the Academy, PCPI nor its members shall be responsible for any use of the measures. The AMA’s and PCPI’s significant past efforts and contributions to the development and updating of the measures is acknowledged.The Academy is solely responsible for the review and enhancement (“maintenance”) of the measures as of May 15, 2014.The Academy encourages use of the measures by other health care professionals, where appropriate.