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  • IRIS1: Endothelial Keratoplasty - Post-operative improvement in best corrected visual acuity to 20/40 or greater (better)

    Updated December 2022. No changes for 2023. 
    The measure is approved for traditional MIPS submission pathway only.

    Care Setting: Ambulatory Care: Clinician Office/Clinic

    Reporting Option: 

    • IRIS Registry QCDR for EHR: groups and individuals
    • IRIS Registry QCDR manual data entry: groups and individuals

    Measure Type: Outcome

    NQS Domain: Effective Clinical Care

    Meaningful Measure Area: Management of Chronic Conditions

    Description: Percentage of endothelial keratoplasty patients with a best corrected visual acuity of 20/40 or better at 90 days after surgery

    Risk Adjusted: No 
    Performance Rate: 1
    High Priority Measure: Yes 
    Inverse Measure: No
    Proportional Measure

    To Which Patients Does the Measure Apply?

    Denominator: Patients aged 18 years or older who underwent a corneal graft procedure.

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

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

    The quality measure also has exclusions for the denominator

    ICD-10 Diagnosis Codes

    • Bullous keratopathy (ICD-10: H18.11, H18.12, H18.13)
    • Idiopathic corneal edema (ICD-10: H18.221, H18.222, H18.223)
    • Secondary corneal edema (ICD-10: H18.231, H18.232, H18. 233)
    • Endothelial corneal dystrophy (ICD-10: H18.511, H18.512, H18.513)
    • Other hereditary corneal dystrophies (ICD-10: H18.591, H18.592, H18.593)

    CPT Codes

    Corneal graft procedure (CPT: 65756 with modifier RT, LT)

    How to Report the Measure

    Numerator: Patients with a best corrected visual acuity of 20/40 or better within 90 days of surgery.

    Denominator Exclusions:

    • 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: H21.40, H21.41, H21.42, H21.43, H21.501, H21.502,  H21.503, 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
    • Anterior chamber IOL (identified by mapping IRIS for “AC IOL,” “anterior chamber IOL,” “AC lens” or “anterior chamber lens” and matching laterality)
    • Aphakia: H27.01, H27.02, H27.03– match laterality with reported CPT laterality
    • Blindness and low vision: H54.0X33, H54.0X34, H54.0X35, H54.0X43, H54.0X44, H54.0X45, H54.0X53, H54.0X54, H54.0X55, H54.1131, H54.1132, H54.1141, H54.1142, H54.1151, H54.1152, , H54.1213, H54.1214, H54.1215, H54.1223, H54.1224, H54.1225, H54.2X11, H54.2X12,H54.2X21, H54.2X22
    • Cataract secondary to ocular disorders: H26.211, H26.212, H26.213, H26.221, H26.222, H26.223,
    • Cataract, congenital: Q12.0
    • Cataract, mature or hypermature: H25.89
    • Cataract, posterior polar: Q12.0
    • 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
    • Choroidal hemorrhage and rupture: H31.301, H31.302, H31.303, H31.311, H31.312, H31.313, H31.321, H31.322, H31.323
    • Chronic iridocyclitis: A18.54, H20.11, H20.12, H20.13
    • Cystoid macular degeneration: H35.351, H35.352, H35.353
    • Degeneration of macula and posterior pole: 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, H35.3224, H35.3230, H35.3231, H35.3232, H35.3233, H35.3234
    • Degenerative disorders of globe: H44.21, H44.22, H44.23, H44.311, H44.312, H44.313, H44.321, H44.322, H44.323, H44.391, H44.392, H44.393
    • Diabetic Macular Edema: E08.311, E08.3211, E08.3212, E08.3213, E08.3311, E08.3312, E08.3313, E08.3411, E08.3412, E08.3413, E08.3511, E08.3512, E08.3513, E09.311, E09.3211, E09.3212, E09.3213, E09.3311, E09.3312, E09.3313, E09.3411, E09.3412, E09.3413, E09.3511, E09.3512, E09.3513, E10.311, E10.3211, E10.3212, E10.3213, E10.3311, E10.3312, E10.3313, E10.3411, E10.3412, E10.3413, E10.3511, E10.3512, E10.3513, E11.311, E11.3211, E11.3212, E11.3213, E11.3311, E11.3312, E11.3313, E11.3411, E11.3412, E11.3413, E11.3511, E11.3512, E11.3513, E13.311, E13.3211, E13.3212, E13.3213, E13.3311, E13.3312, E13.3313, E13.3411, E13.3412, E13.3413, E13.3511, E13.3512, E13.3513
    • Diabetic Retinopathy with Macular Edema: E08.319, E08.3291, E08.3292, E08.3293, E08.3391, E08.3392, E08.3393, E08.3491, E08.3492, E08.3493,  E08.3521, E08.3522, E08.3523, E08.3529, E08.3531, E08.3532, E08.3533, E08.3541, E08.3542, E08.3543, E08.3551, E08.3552, E08.3553, E08.37X1, E08.37X2, E08.37X3, E08.37X9, E09.311, E09.319, E09.3291, E09.3292, E09.3293, E09.3299,E09.3391, E09.3392, E09.3393, E09.3399, E09.3491, E09.3492, E09.3493, E09.3499, E09.3521, E09.3522, E09.3523, E09.3529, E09.3531, E09.3532, E09.3533, E09.3539, E09.3541, E09.3542, E09.3543, E09.3549, E09.3551, E09.3552, E09.3553, E09.3559, E09.3591, E09.3592, E09.3593,  E10.3291, E10.3292, E10.3293, E10.3391, E10.3392, E10.3393, E10.3491, E10.3492, E10.3493, E10.3521, E10.3522, E10.3523, E10.3531, E10.3532, E10.3533, E10.3541, E10.3542, E10.3543, E10.3551, E10.3552, E10.3553, E10.3591, E10.3592, E10.3593, E10.319;E11.319, E11.3291, E11.3292, E11.3293, E11.3391, E11.3392, E11.3393, E11.3491, E11.3492, E11.3493, E11.3521, E11.3522, E11.3523, E11.3531, E11.3532, E11.3533, E11.3541, E11.3542, E11.3543, E11.3551, E11.3552, E11.3553, E11.3591, E11.3592, E11.3593, E13.319, E13.3291, E13,3292, E13.3293, E13.3391, E13.3392, E13.3393, E13.3491, E13.3492, E13.3493, E13.3521, E13.3522, E13.3523, E13.3531, E13.3532, E13.3533, E13.3541, E13.3542, E13.3543, E13.3551, E13.3552, E13.3553, E13.3591, E13.3592, E13.3593
    • Dislocation of lens: H27.10, H27.111, H27.112, H27.113, H27.121, H27.122, H27.123, H27.131, H27.132, H27.133
    • Disorders of optic chiasm: H47.41, H47.42, H47.43
    • Disorders of visual cortex: H47.611, H47.612
    • Disseminated chorioretinitis and disseminated retinochoroiditis: A18.53, H30.101, H30.102, H30.103, H30.111, H30.112, H30.113, H30.121, H30.122, H30.123, H30.131, H30.132, H30.133, H30.141, H30.142, H30.143
    • Drusen (degenerative) of macula: H35.361, H35.362, H35.363
    • Hereditary choroidal dystrophies: H31.20, H31.21, H31.22, H31.23
    • Hereditary retinal dystrophies: H35.50, H35.51, H35.52, H35.53, H35.54, H36
    • High hyperopia: H52.00, 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
    • Macular cyst, hole or pseudohole: H35.341, H35.342, H35.343
    • Nystagmus and other irregular eye movements: H55.01
    • 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. S05.92X
    • Optic atrophy: H47.20, H47.211, H47.212, H47.213, H47.22, H47.231, H47.232, H47.233, H47.291, H47.292, H47.293
    • Other endophthalmitis: H16.241, H16.242, H16.243, H21.331, H21.332, H21.333, H33.121, H33.122, H33.123, H44.111, H44.112, H44.113, H44.121, H44.122, H44.123, H44.131, H44.132, H44.133, H44.19
    • Other proliferative retinopathy: H35.101, H35.102, 103, H35.111, H35.112, H35.113, H35.121, H35.122, H35.123, H35.131, H35.132, H35.133, H35.141, H35.142, H35.143, H35.151, H35.152, H35.153, H35.161, H35.162, H35.163, H35.171, H35.172, H35.173
    • Pathologic myopia: H44.20, H44.21, H44.22, H44.23, 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, H44.2E3, H44.30
    • Posterior lenticonus: Q12.2, Q12.4, Q12.8
    • Prior glaucoma filtering surgery: CPT 66170, 66172, 66179, 66180, 66183, 66184, 66185 – match laterality
    • Prior pars plana vitrectomy: CPT 67036, 67039, 67040, 67041, 67042, 67043 (patient with history of this procedure or IRIS mapping to a past surgical history of vitrectomy)
    • Prior penetrating keratoplasty: CPT 65730, 65750, 65755 – match laterality)
    • Puckering of macula: H35.371, H35.372, H35.373
    • Purulent endophthalmitis: H44.001, H44.002, H44.003, H44.011, H44.012, H44.013, H44.021, H44.022, H44.023
    • Retinal vascular occlusion: H34.10, H34.11, H34.12, H34.13, H34.231, H34.232, H34.233, H34.811, H34.812, H34.813, H34.831, H34.832, H34.833
    • Retrolental fibroplasias: H35.171, H35.172, H35.173
    • Scleritis and episcleritis: A18.51, H15.021, H15.022, H15.023, H15.031, H15.032, H15.033
    • Toxic maculopathy: H35.381, H35.382, H35.383
    • 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 CMS Scores Your Performance

    • If you successfully report a measure for less than 70% 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 0 points.
    • If you successfully report a measure for at least 70% of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 70% 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.


    See QPP resource library for benchmarks.


    This measure has been developed by the H. Dunbar Hoskins Jr. MD Center for Quality Eye Care of the American Academy of Ophthalmology. The measure is not a clinical guideline and does not establish a medical standard. It has not been tested in all possible applications.

    The measure, while copyrighted, can be reproduced and distributed with appropriate credit, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. The American Academy of Ophthalmology encourages use of the measure by other health care professionals, where applicable.

    Commercial use is defined as the sale, license or distribution of the measures for commercial gain, or incorporation of some or all of a measure 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 Academy of Ophthalmology. Neither the Academy nor its members shall be responsible for any use of the measures. 


    © 2017-2023 American Academy of Ophthalmology. All rights reserved. Limited proprietary coding from Current Procedural Terminology (CPT®) is contained in the measure specifications. Users of this code set should obtain all necessary licenses. The Academy disclaims all liability for use or accuracy of the coding contained in these measure specifications. CPT® contained in the measures specifications is copyright 2023 American Medical Association.