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  • Measure 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15 Percent or Documentation of a Plan of Care


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry for manual data entry: groups and individuals
    • Claims-based reporting: individuals only

    Measure Type: Outcome

    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, 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 pre-intervention level, a plan of care was documented within 12 months.

    It’s anticipated that clinicians who provide the primary management of patients with POAG will submit this measure.

    Definition:

    Plan of care – May include: recheck of IOP at specified time, change in therapy, perform additional diagnostic evaluations, monitoring per patient decisions or health system reasons, and/or referral to a specialist.

    Plan to recheck – In the event certain factors do not allow for the IOP to be measured (e.g., patient has an eye infection) but the physician has a plan to measure the IOP at the next visit; the plan of care code should be submitted.

    Glaucoma treatment not failed – The most recent IOP was reduced by at least 15% in the affected eye or if both eyes were affected, the reduction of at least 15% occurred in both eyes.

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma. 

    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.

    H40.1111, H40.1112, H40.1113, H40.1114, H40.1121, H40.1122, H40.1123, H40.1124, H40.1131, H40.1132, H40.1133, H40.1134, H40.1211, H40.1212, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232, H40.1233, H40.1234, H40.151, H40.152, H40.153

    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 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 pre-intervention level, a plan of care was documented within 12 months.

    2018 additions in red

    Pre-intervention level – The patient’s IOP in the affected eye prior to the initiation of therapy. For patients who have just begun management of their POAG, i.e. a newly diagnosed patient or a patient recently transferred to the care of the physician, a provider can meet the measure’s performance requirements by documenting a plan of care and submitting CPT II 0517F.

    Patients whose POAG is well managed are assumed to have met the requirement to reduce their IOP by greater than or equal to 15% and should submit CPT II 3284F.

    • Performance met (patient included in numerator and denominator): 3284F Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level or equivalent
      OR
      0517F
      Glaucoma plan of care documented or equivalent, and
      3285F Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level or equivalent
    • Performance not met (patient not included in numerator, but included in denominator): 3284F 8P IOP measurement not documented, reason not otherwise specified or equivalent
      OR
      0517F 8P Glaucoma plan of care not documented, reason not otherwise specified or equivalent, and
      3285F Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level or equivalent

    Clinical Recommendation Statements: 

    The goal of treatment is to maintain the IOP in a range at which visual field loss is unlikely to significantly reduce a patient’s health-related quality of life over his or her lifetime. (II+, moderate quality, discretionary recommendation) The estimated upper limit of this range is considered the “target pressure.” The initial target pressure is an estimate and a means toward the ultimate goal of protecting the patient’s vision. The target pressure should be individualized and may need adjustment further down or even up during the course of the disease. (III, insufficient quality, discretionary recommendation) When initiating therapy, the ophthalmologist assumes that the measured pretreatment pressure range contributed to optic nerve damage and is likely to cause additional damage in the future. Factors to consider when choosing a target pressure include the stage of overall glaucoma damage as determined by the degree of structural optic nerve injury and/or functional visual field loss, baseline IOP at which damage occurred, age of patient, and additional risk factors (e.g., central corneal thickness (CCT), life expectancy, prior rate of progression). Lowering the pretreatment IOP by 25% or more has been shown to slow progression of POAG. Choosing a lower target IOP can be justified if there is more severe optic nerve damage, if the damage is progressing rapidly, or if other risk factors such as family history, age, or disc hemorrhages are present. Prum BE Jr, Rosenberg LF, Gedde SJ, et al. Primary Open-Angle Glaucoma Preferred Practice Pattern® Guidelines. Ophthalmology 2016;123:P41-P111.

    The intent of this measure is to have this indicator apply to both optometrists and ophthalmologists (and any other physician who provides glaucoma care); the use of “ophthalmologists” only in the preceding verbatim section reflects the wording in the American Academy of Ophthalmology Preferred Practice pattern. 

    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 -- 69.40 – 86.96
    4 -- 86.97 – 95.04
    5 -- 95.05 – 97.95
    6 -- 97.96 – 99.64
    7 -- 99.65 – 99.99
    8 -- --
    9 -- --
    10 100 100