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  • Measure 388: Cataract Surgery with Intra-Operative Complications (Unplanned Rupture of Posterior Capsule requiring unplanned vitrectomy)

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

    Reporting Option: 

    • IRIS Registry manual data entry: groups and individuals

    Measure Type: Outcome

    NQS Domain: Patient Safety


    Meaningful Measure Area: Preventable Healthcare Harm

    Description: Percentage of patients aged 18 years and older who had cataract surgery performed and had an unplanned rupture of the posterior capsule requiring vitrectomy

    Instructions: This measure is to be calculated each time a procedure for cataracts is performed during the performance period. This measure is intended to reflect the quality of services provided for the patient receiving cataract surgery.

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years and older who had cataract surgery

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

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

    The quality measure also has exclusions for the denominator.

    Diagnosis Codes

    This measure does not require a specific diagnosis to be submitted during the encounter.

    CPT Codes

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

    Without modifiers: 55, 56

    Exclusion (patient ineligible):

    G9759 History of preoperative posterior capsule rupture

    How to Report the Measure

    IRIS Registry Manual Reporting

    Numerator: Patients who experienced an unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery.

    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% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

    HCPCS Codes

    • Performance met (patient included in numerator and denominator): G9389 Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
    • Performance not met (patient not included in numerator, but included in denominator): G9390 No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery

    Rationale: Although there are numerous complications that can occur after cataract surgery, those resulting in permanent loss of vision are rare. Unplanned anterior vitrectomies are performed following cataract surgery when vitreous inadvertently prolapses into the anterior segment of the eye. This may result in poor visual outcome and additional complications, including retinal detachment. Studies have shown unplanned vitrectomy rates ranging from 1 percent to 4 percent. The literature indicates that this complication can occur more commonly for inexperienced surgeons.

    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 performance 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 via IRIS Registry manual/web portal, there is a 7 point cap.


    Decile/Points IRIS Registry web portal (No EHR)
    3 --
    4 --
    5 --
    6 --
    7 100
    *Capped at 7 points*
    8 --
    9 --
    10 --


    The easures 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 easures require a license agreement between the user and the American Academy of Ophthalmology. Neither the Academy, nor its members, shall be responsible for any use of the measures.

    The American Association of Eye and Ear Centers of Excellence'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 June 5, 2015.

    The Academy encourages use of the measures by other health care professionals, where appropriate.


    © 2017 American Academy of Ophthalmology. All rights reserved. Applicable FARS/DFARS restrictions apply to government use.

    Limited proprietary coding is contained in the measure specifications for convenience. users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The Academy and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

    CPT® contained in the measures specifications is copyright 2004-2017 American Medical Association. All rights reserved.