IRIS13: Diabetic Macular Edema: Loss of Visual Acuity

Updated April 2024

The measure is approved for traditional MIPS submission pathway only.

Care Setting: Ambulatory Care: Clinician Office/Clinic

Reporting Options: 

• 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: Promote Effective Prevention & Treatment of Chronic Disease

Description:  Percentage of patients with a diagnosis of diabetic macular edema with of loss of less than 3 Snellen lines (which is equivalent to less than 0.3 logMar) of visual acuity within the past 12 months.

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

To Which Patients Does the Measure Apply?

Denominator: All patients aged 18 years or older with a diagnosis of diabetic macular edema including documentation of the laterality (OD, OS, OU) who have received anti-VEGF injections, intravitreal injections or laser photocoagulation therapy with 2 visual acuity values with at least one on or after date of treatment.

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.

Diagnosis Codes

• Diagnosis of diabetic macular edema (ICD-10: 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)
  
  AND 
  
  2 visual acuity values with at least one on or after date of treatment

CPT Codes

Treatment with Anti-VEGF agents OR intravitreal steroids OR laser photocoagulation

• Bevacizumab (Avastin®) injections (CPT: 67028 and HCPCS: J9035; CPT: 67028 and HCPCS: J3490; CPT: 67028 and HCPCS: J3590; CPT: 67028 and HCPCS: C9257; CPT: 67028 & HCPCS: J7999; CPT: 67028 & HCPCS: Q5107; CPT: 67028 & HCPCS: Q9977)
• Ranibizumab (Lucentis®) injections (CPT: 67028 and HCPCS: J2778)
• Aflibercept (EYLEA®) injections (CPT: 67028 and HCPCS: J0178)
• Aflibercept (EYLEA^® HD) injections (CPT: 67028 and HCPCS: J3490, J3590 or C9399; J0177 as of 4/1/24)
• Brolucizumab (Beovu^®) injections (CPT: 67028 and HCPCS: J0179)
• Farcimab (Vabysmo^®) injections (CPT: 67028 and HCPCS: J2777)
• Ranibizumab-eqrn (Cimerli^®) injections (CPT: 67028 and HCPCS J3490, J3590, C9399, or Q5128)

OR

• Fluocinolone acetonide (Iluvien^®) injections (CPT: 67028 and HCPCS: J7313)
• Dexamethasone (Ozurdex^®) injections (CPT: 67028 and HCPCS: J7312)
• Triamcinalone (Kenalog^®) injections (CPT: 67028 and HCPCS: J3301)
• Triamcinolone acetonide (Triesence^®) injections (CPT: 67028 and HCPCS: J3300)

OR

• Laser photocoagulation (CPT: 67210, 67228)

How to Report the Measure

Numerator: Patients with two or more recorded visual acuity values within the past 12 months; at least one visual acuity value recorded prior to treatment, at least one visual acuity value recorded after treatment; loss of visual acuity less than 3 Snellen lines (which is equivalent to less than 0.3 logMar).

Denominator Exclusions: Patients with ophthalmic complications of diabetic retinopathy including neovascular glaucoma, traction retinal detachment, vitreous hemorrhage, history of vitreous surgery, history of retinal surgery, development of retinopathy in fellow eye.

Ophthalmic complications of diabetic retinopathy (ICD-10-CM): H40.89, H33.41, H33.42, H33.43, H43.11, H43.12, H43.13

Notes: Loss of less than three Snellen lines would be calculated as follows:

From 20/20 to 20/25 or 20/32 would be considered less than 3 Snellen lines of loss, from 20/20 to 20/40 or greater would be considered 3 Snellen lines of loss
From 20/40 to 20/50 or 20/63 would be considered less than 3 Snellen lines of loss, from 20/40 to 20/80 or greater would be considered 3 Snellen lines of loss
From 20/50 to 20/63 or 20/80 would be considered less than 3 Snellen lines of loss, from 20/50 to 20/100 or greater would be considered 3 Snellen lines of loss
From 20/80 to 20/100 or 20/125 would be considered less than 3 Snellen lines of loss, from 20/80 to 20/160 or great would be considered 3 Snellen lines of loss

The chart shows the conversion of logMAR and Snellen visual acuity (formerly the measure was < 0.3 logMar which is equivalent to less than 3 Snellen Lines)

Visual Acuity Conversion Table

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.

Benchmarks

See QPP resource library for benchmarks.

Copyright

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. 

THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS,” WITHOUT WARRANTY OF ANY KIND.

© 2017-2024 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.