Updated January 2018.
- IRIS Registry QCDR for EHR: groups and individuals
- IRIS Registry QCDR manual data entry: groups and individuals
Measure Type: Outcome
Description: Percentage of patients with a diagnosis of diabetic macular edema with of loss of less than 0.3 logMar of visual acuity within the past 12 months.
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, and 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.
- Patient characteristics: Description located in “Denominator” (see above).
- Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
- Procedure codes (CPT): Codes located in “CPT Codes.”
The quality measure also has exclusions for the denominator.
- 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)
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)
- Ranibizumab (Lucentis®) injections (CPT: 67028 and HCPCS: J2778)
- Aflibercept (EYLEA®) injections (CPT: 67028 and HCPCS: J0178)
- Fluocinolone acetonide (Iluvien) injections (CPT: 67028 and HCPCS: J7311)
- 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)
- 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 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, H33.40, H33.41, H33.42, H33.43, H43.10, H43.11, H43.12, H43.13
- No scoring benchmark currently exists for this QCDR measure.
- If 19 or fewer physicians each report the measure or 20 physicians do not report the measure on at least 60 percent of qualifying patients, and a minimum of 20 patients, you will earn 3 out of 10 points toward your total quality score. Choose measures assuming you’ll only earn 3 points per QCDR measure.
- If at least 20 physicians report the measure on at least 60 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2018 reporting year.
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 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 2004-2017 American Medical Association.