• IRIS21: Ocular Myasthenia Gravis: Improvement of ocular deviation or absence of diplopia or functional improvement

    Updated January 2018.

    Reporting Option: 

    • IRIS Registry QCDR manual data entry: groups and individuals

    Measure Type: Outcome

    Description: Percentage of patients with a diagnosis of ocular myasthenia gravis who had an improvement of ocular deviation or were absent of diplopia in primary gaze or had functional improvement of ptosis 6 months after initial treatment.

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years or older diagnosed with ocular myasthenia gravis between Jan. 1 and June 30 of the reporting period and received treatment for the condition.

    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 and HCPCS): Codes located in “CPT Codes.” 

    Diagnosis Codes

     Diagnosis of ocular myasthenia gravis

    • Myasthenia gravis with (acute) exacerbation (ICD-10: G70.01)
    • Myasthenia gravis without (acute) exacerbation (ICD-10: G70.00)


    Ptosis and/or diplopia

    • Diplopia (ICD-10: H53.2)
    • Myogenic ptosis of eyelid (ICD-10: H02.421, H02.422, H02.423, H02.429)
    • Unspecified ptosis of eyelid (ICD-10: H02.401, H02.402, H02.403, H02.409)

    CPT Codes

    Two or more encounters within the last 6 months (CPT: 99201, 99202, 99203, 99204, 99205, 99244, 99245, 92002, 92004, 92012, 92014, 99212, 99213, 99214, 99215)


    Treatment initiated

    • Extraocular muscle procedure (CPT: 67345)
    • Occluder lens (HCPCS: V2770)
    • Patient prescribed one of the following medications - pyridostigmine, prednisone, mycophenolate mofetil, azathioprine, cyclosporine, rituximab.
    • Press-on prism (HCPCS: V2718)
    • Repair of blepharoptosis (CPT: 67901, 67902, 67903, 67904, 67906, 67908)
    • Strabismus surgery (CPT: 67311, 67312, 67314, 67316, 67318)

    How To Report the Measure

    Numerator: Patients with improvement of ocular deviation or absence of diplopia in primary gaze after treatment or functional improvement of ptosis at 6 months 

    • Performance met:  
      • Patient had an improvement in ocular deviation 6 months after initial treatment.
      • Patient had absence of diplopia in primary gaze 6 months after initial treatment.
      • Patient had a functional improvement of ptosis 6 months after initial treatment.
    • Performance not met: Patient did not meet any of the performance criteria


    • 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. 


    © 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.