• IRIS2: Glaucoma – Intraocular Pressure Reduction


    Updated December 2021. No changes for 2022. Changes for 2021 are indicated in red.

    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: Management of Chronic Conditions

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

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

    To Which Patients Does the Measure Apply?

    Denominator: Total number of visits for 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: H40.11X1, H40.11X2, H40.11X3)
    • 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)
    • Chronic angle-closure glaucoma (ICD-10: 2211, H40.2212, H40.2213, H40.2221, H40.2222, H40.2223, H40.2231, H40.2232, H40.2233, H40.2311, H40.2312, H40.2313, H40.2321, H40.2322, H40.2323, H40.2331, H40.2332, H40.2333, H40.2411, H40.2412, H40.2413, H40.2421, H40.2422, H40.2423, H40.2431, H40.2432, H40.2433)

    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: H40.12)
    • Eyes with a documented severity of indeterminate stage (ICD-10: H40.11X4, H40.1314, H40.1324, H40.1334, H40.1394, H40.1414, H40.1424, H40.1434, 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, 66179, 66180, 66183, 66184, 66185, 66250, 65820, 65850, 66711, 66984, 66982, 0191T, 03076T, 0449T, 0405T)
    • Visual acuity findings: Count fingers (CF or FC), hand motion (HM), light perception (LP), no light perception (NLP)

    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.

    © 2017-2022 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 2022 American Medical Association.