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  • IRIS22: Giant Cell Arteritis: Absence of fellow eye involvement after treatment


    Updated January 2018.

    Reporting Option: IRIS Registry QCDR manual data entry

    Measure Type: Outcome

    Description: Percentage of patients without fellow eye involvement 1-26 weeks after initiating treatment in patients with unilateral visual loss.

    This measure is to be reported a minimum of once per reporting period for patients diagnosed with giant cell arteritis between Jan. 1 and June 30. It is anticipated that clinicians who provide the primary management of patients with giant cell arteritis will submit this measure.

    To Which Patients Does the Measure Apply:

    Denominator:  

    All patients aged 18 years or older diagnosed with giant cell arteritis between Jan. 1 and June 30 with unilateral vision loss.

    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.” 

    Diagnosis Codes

    Diagnosis of giant cell arteritis

    • Giant cell arteritis with polymyalgia rheumatica (ICD-10: M31.5)
    • Other giant cell arteritis (ICD-10: M31.6)

    AND

    Unilateral vision loss from optic nerve or retinal ischemia

    • Ischemic optic neuropathy (ICD-10: H47.011, H47.012)
    • Central retinal artery occlusion (ICD-10: H34.11, H34.12)
    • Other retinal artery occlusion (ICD-10: H34.211, H34.212, H34.231, H34.232)

    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)

    AND

    Patient receiving treatment.

    How to Report the Measure

    Numerator: Patients without fellow eye involvement 1-26 weeks after initiating treatment.

    1. Performance met (patient is included in numerator and denominator):
      Patients without fellow eye involvement 1 week to 26 weeks after initiating treatment.
    2. Performance not met (patient not included in numerator, but included in denominator):
      Patients with fellow eye involvement 1 week to 26 weeks after initiating with fellow eye involvement 1 week to 26 weeks after initiating treatment. 

    Benchmark

    • 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.