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  • IRIS2: Glaucoma – Intraocular Pressure (IOP) Reduction


    Updated January 2018.

    Reporting Options: 

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

    Measure Type: Outcome

    Description:  Percentage of glaucoma patient visits where their IOP was below a threshold level based on the severity of their diagnosis.

    To Which Patients Does the Measure Apply?

    Denominator: Patients aged between 40 and 85 years, with a minimum of 4 office visits during the prior 2 years, with a glaucoma diagnosis and documentation of the severity of their glaucoma:

    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 glaucoma with documentation of severity

    • Open-angle glaucoma, unspecified (ICD-10: H40.10X1, H40.10X2, H40.10X3)
    • Pigmentary glaucoma (ICD-10: H40.1311, H40.1312, H40.1313, H40.1321, H40.1322, H40.1323, H40.1331, H40.1332, H40.1333, H40.1391, H40.1392, H40.1393)
    • Primary open angle glaucoma (ICD-10: H40.1111, H40.1112, H40.1113, H40.1121, H40.1122, H40.1123, H40.1131, H40.1132, H40.1133)
    • Pseudoexfoliation glaucoma (ICD-10: H40.1411, H40.1412, H40.1413, H40.1421, H40.1422, H40.1423, H40.1431, H40.1432, H40.1433, H40.1491, H40.1492, H40.1493)

    CPT Codes

    • Patient had ≥ 4 encounters during prior 2 years (CPT: 92012, 92014, 99212, 99213, 99214, 99215)

    How to Report the Measure

    Numerator: Visits where the eye(s) IOP was below a specified threshold based on the severity of their glaucoma

    • Mild Stage: IOP ≤ 22mm HG
    • Moderate Stage: IOP ≤ 18 mm HG
    • Severe Stage: IOP ≤ 15 mm HG

    Denominator Exclusions

    • Patients with a diagnosis of low tension glaucoma (ICD-10: H40.12xx)
    • Eyes with a documented severity of indeterminate stage or stage unspecified (ICD-10: Not included in the qualifying diagnosis codes, H40.1110, H40.1114, H40.1120, H40.1124, H40.1130, H40.1134, H40.1310, H40.1314, H40.1320, H40.1324, H40.1330, H40.1334, H40.1390, H40.1394, H40.1410, H40.1414, H40.1420, H40.1424, H40.1430, H40.1434, H40.1490, H40.1494)
    • Eyes with absolute glaucoma blindness (ICD-10: H44.511, H44.512, H44.513, H44.519)
    • Eyes with a glaucoma incisional surgery performed within the last 90 days (CPT: 66170, 66172, 66174, 66175, 0191T, 6618X, 66180, 66185, 66250, 65850, 66711, 66984, 66982)
    • Visual acuity findings: Count fingers (CF or FC), hand motion (HM), light perception (LP), no light perception (NLP)

    Benchmarks

    • 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.

    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 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.