Measure 192: Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures

Updated January 2019. This measure is not available for MIPS reporting beginning in 2020.

Reporting Options: 

• IRIS Registry EHR: group and individual
• IRIS Registry manual entry: groups and individuals
• EHR through your vendor (if offered): group and individual

Measure Type: Outcome

Meaningful Measure Area: Management of Chronic Conditions

Instructions: This measure is to be calculated each time a patient aged 18 years and older, during the performance period, had a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

Inverse measure - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100 percent means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

This measure is intended to reflect the quality of services provided for the patients receiving uncomplicated cataract surgery.

This measure is to be submitted by the clinician performing the cataract surgery procedure.

Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.

To Which Patients Does the Measure Apply?

Denominator: All patients aged 18 years and older who had cataract surgery and no significant ocular conditions impacting the surgical complication rate 

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

1. Patient characteristics: Description located in “Instructions” (see above).
2. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

The quality measure also has exclusions for the denominator.

CPT Codes

66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984

Without modifiers: 55, 56

Exclusions (patient ineligible): Any of the following significant ocular conditions that impact the surgical complication rate (Patients with documentation of the presence of one or more of the following significant ocular conditions that impact the visual outcome of surgery prior to date of cataract surgery which is still active at the time of the cataract surgery are excluded from the measure calculation).

• Acute and subacute iridocyclitis: H20.00, H20.011, H20.012, H20.013, H20.021, H20.022, H20.023, H20.031, H20.032, H20.033, H20.041, H20.042, H20.043, H20.051, H20.052, H20.053
•  Adhesions and disruptions of iris and ciliary body: H21.41, H21.42, H21.43, H21.511, H21.512, H21.513, H21.521, H21.522, H21.523, H21.531, H21.532, H21.533, H21.541, H21.542, H21.543, H21.551, H21.552, H21.553, H21.561, H21.562, H21.563, H21.81, H21.82, H21.89, H22
• Anomalies of pupillary function: H57.03
• Aphakia and other disorders of lens: H27.10, H27.111, H27.112, H27.113, H27.121, H27.122, H27.123, H27.131, H27.132, H27.133
• Burn confined to eye and adnexa: T26.01XA, T26.02XA, T26.11XA, T26.12XA, T26.21XA, T26.22XA, T26.31XA, T26.32XA, T26.41XA, T26.42XA, T26.51XA, T26.52XA, T26.61XA, T26.62XA, T26.71XA, T26.72XA, T26.81XA, T26.82XA, T26.91XA, T26.92XA
• Cataract, congenital: Q12.0
• Cataract, posterior polar: Q12.0
• Cataract, secondary to ocular disorders: H26.211, H26.212, H26.213, H26.221, H26.222, H26.223
• Cataract, traumatic: H26.101, H26.102, H26.103, H26.111, H26.112, H26.113, H26.121, H26.122, H26.123, H26.131, H26.132, H26.133
• Central corneal ulcer: H16.011, H16.012, H16.013
• Certain types of iridocyclitis: H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.821, H20.822, H20.823, H20.9
• Chronic iridocyclitis: A18.54, H20.11, H20.12, H20.13, H20.9
• Cloudy cornea: H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.811, H17.812, H17.813, H17.821, H17.822, H17.823
• Corneal opacity and other disorders of cornea: H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.89, H17.9
• Corneal edema: H18.11, H18.12, H18.13, H18.20, H18.221, H18.222, H18.223, H18.231, H18.232, H18.233, H18.421, H18.422, H18.423, H18.43
• Cysts of iris, ciliary body and anterior chamber: H21.301, H21.302, H21.303, H21.311, H21.312, H21.313, H21.321, H21.322, H21.323, H21.331, H21.332, H21.333, H21.341, H21.342, H21.343, H21.351, H21.352, H21.353
• Enophthalmos: H05.401, H05.402, H05.403, H05.411, H05.412, H05.413, H05.421, H05.422, H05.423
• 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, H40.1210, 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, H40.1310, H40.1311, H40.1312, H40.1313, H40.1314, H40.1320, H40.1321, H40.1322, H40.1323, H40.1324, H40.1330, H40.1331, H40.1332, H40.1333, H40.1334, H40.1410, H40.1411, H40.1412, H40.1413, H40.1414, H40.1420, H40.1421, H40.1422, H40.1423, H40.1424, H40.1430, H40.1431, H40.1432, H40.1433, H40.1434, H40.1490, H40.1491, H40.1492, H40.1493, H40.1494, H40.151, H40.152, H40.153, H40.20X0, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.211, H40.212, H40.213, H40.2210, H40.2211, H40.2212, H40.2213, H40.2214, H40.2220, H40.2221, H40.2222, H40.2223, H40.2224, H40.2230, H40.2231, H40.2232, H40.2233, H40.2234, H40.231, H40.232, H40.233, H40.241, H40.242, H40.243, H40.31X0, H40.31X1, H40.31X2, H40.31X3, H40.31X4, H40.32X0, H40.32X1, H40.32X2, H40.32X3, H40.32X4, H40.33X0, H40.33X1, H40.33X2, H40.33X3, H40.33X4, H40.41X0, H40.41X1, H40.41X2, H40.41X3, H40.41X4, H40.42X0, H40.42X1, H40.42X2, H40.42X3, H40.42X4, H40.43X0, H40.43X1, H40.43X2, H40.43X3, H40.43X4, H40.51X0, H40.51X1, H40.51X2, H40.51X3, H40.51X4, H40.52X0, H40.52X1, H40.52X2, H40.52X3, H40.52X4, H40.53X0, H40.53X1, H40.53X2, H40.53X3, H40.53X4, H40.61X0, H40.61X1, H40.61X2, H40.61X3, H40.61X4, H40.62X0, H40.62X1, H40.62X2, H40.62X3, H40.62X4, H40.63X0, H40.63X1, H40.63X2, H40.63X3, H40.63X4, H40.811, H40.812, H40.813, H40.821, H40.822, H40.823, H40.831, H40.832, H40.833, H40.89, Q15.0
• Hereditary corneal dystrophies: H18.50, H18.51, H18.52, H18.53, H18.54, H18.55, H18.59
• High hyperopia: H52.01, H52.02, H52.03
• Hypotony of eye: H44.40, H44.411, H44.412, H44.413, H44.421, H44.422, H44.423, H44.431, H44.432, H44.433, H44.441, H44.442, H44.443
• Injury to optic nerve and pathways: S04.011A, S04.012A, S04.02XA, S04.031A, S04.032A, S04.041A, S04.042A
• Marganian cataract: H25.21, H25.22, H25.23
• Open wound of eyeball: S05.11XA, S05.12XA, S05.21XA, S05.22XA, S05.31XA, S05.32XA, S05.51XA, S05.52XA, S05.61XA, S05.62XA, S05.71XA, S05.72XA, S05.8X1A, S05.8X2A, S05.8X9A, S05.91XA, S05.92XA
• Pathologic myopia: H44.2A1, H44.2A2, H44.2A3, H44.2B1, H44.2B2, H44.2B3, H44.2C1, H44.2C2, H44.2C3, H44.2D1, H44.2D2, H44.2D3, H44.2E1, H44.2E2, H44.21, H44.22, H44.23, H44.30
• Posterior lenticonus: Q12.2, Q12.4, Q12.8
• Prior pars plana vitrectomy: CPT codes: 67036, 67039, 67040, 67041, 67042, 67043 (patient with history of this procedure)
• Pseudoexfoliation syndrome: H40.1410, H40.1411, H40.1412, H40.1413, H40.1414, H40.1420, H40.1421, H40.1422, H40.1423, H40.1424, H40.1430, H40.1431, H40.1432, H40.1433, H40.1434
• Retrolental fibroplasias: H35.171, H35.172, H35.173
• Use of systemic sympathetic alpha-1a antagonist medication for treatment of prostatic hypertrophy: Patient taking tamsulosin hydrochloride: G9503
• Uveitis: H44.111, H44.112, H44.113, H44.131, H44.132, H44.133
• Vascular disorders of iris and ciliary body: H21.1X1, H21.1X2, H21.1X3

How to Report the Measure

IRIS Registry Manual Reporting

Numerator: Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence

Clinicians who indicate modifier 55, postoperative management only OR modifier -56, preoperative management only, will not qualify for this measure.

Numerator instructions: Codes for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence): 65235, 65860, 65880, 65900, 65920, 65930, 66030, 66250, 66820, 66825, 66830, 66852, 66986, 67005, 67010, 67015, 67025, 67030, 67031, 67036, 67039, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67141, 67145, 67250, 67255

HCPCS Codes

• Performance met (patient included in numerator and denominator): G8627 Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence)
• Performance not met (patient not included in numerator, but included in denominator): G8628 Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence)

IRIS Registry EHR Reporting

Instructions: Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of the specified list of surgical procedures in the 30 days following cataract surgery which would indicate fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

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

• Cataract surgery performed (based on cataract CPT codes);
• No significant ocular conditions (specified by a list of codes to be excluded);
• Specified procedure indicative of a complication (intravitreal injection procedures which were initially thought to indicate the occurrence of endophthalmitis will be proposed for removal for 2016).

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.
• Note: For those reporting this measure using IRIS Registry manual/ web portal or IRIS Registry EHR integration, there is a 7 point cap.

Benchmarks