• IRIS59: Regaining Vision After Cataract Surgery


    Updated January 2021. Note, 2021 changes 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: Management of Chronic Conditions

    Meaningful Measure Area: Promote Effective Prevention & Treatment of Chronic Disease

    Description: Percentage of eyes of patients aged 18 years and older with a diagnosis of cataract who had cataract surgery and had a best-corrected distance visual acuity of 20/20 or better OR an improvement in best-corrected distance visual acuity achieved within 30 days following the cataract surgery. Weighted average of performance rates reported,

    Risk Adjusted: No
    Performance Rate: 3, and a weighted average
    High Priority Measure: Yes
    Inverse Measure: No
    Proportional Measure

    Instructions: 
    This measure is to be calculated each time a procedure for cataracts is performed during the reporting period. This measure is intended to reflect the quality of services provided for the patients receiving cataract surgery.

    • Include only procedures performed through November 30 of the reporting period. This will allow the postoperative period to occur within the reporting year.
    • Clinicians who indicate modifier 55, postoperative management only OR modifier -56, preoperative management only, will not qualify for this measure

    To Which Patients Does the Measure Apply?

    Denominator:  Eyes of patients aged 18 years and older with a diagnosis of cataract who had cataract surgery.

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Denominator” (see above).
    2. Procedure codes (CPT): Codes located in “CPT Codes.” 

    The quality measure also has exclusions for the denominator.

    CPT Codes

    66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988

    How to Report the Measure

    Numerator:  Eyes of patients aged 18 years and older who had cataract surgery and had a best-corrected distance visual acuity of 20/20 or better OR an improvement in best-corrected distance visual acuity achieved within 30 days following the cataract surgery:

    Eyes of patients with no comorbidities or additional procedures on the same date as the cataract surgery and a 20/20 or better post-operative best corrected distance visual acuity

    AND

    Eyes of patients with comorbidities with a pre-operative visual acuity of 20/200 or better and a
    2 lines or better improvement in the post-operative best-corrected distance visual acuity from preoperative visual acuity

    AND

    Eyes of patients with comorbidities with a pre-operative visual acuity of 20/400 or worse and a
    1 line or better improvement in the post-operative best-corrected distance visual acuity from pre-operative visual acuity

    Denominator Exclusions:

    • Eyes of patients with high risk combined cataract surgery and glaucoma surgery procedures: 66982, 66984, 66987 or 66988 and one of the following codes:  0191T, 0253T, 0376T, 0474T, 0449T, 65820, 65850, 66174, 66170, 66172, 66179, 66180, 66183, 66184, 66185

    Table 1: Comorbidities

    Comorbidity

    Corresponding ICD-10-CM Codes

    Acute and Subacute Iridocyclitis

    H20.00, H20.011, H20.012, H20.013, H20.021, H20.022, H20.023, H20.031, H20.032, H20.033, H20.041, H20.042, H20.043, H20.051, H20.052, H20.053,

    Amblyopia

    H53.011, H53.012, H53.013, H53.021, H53.022, H53.023, H53.031, H53.032, H53.033, H53.041, H53.042, H53.043

    Burn Confined to Eye and Adnexa

    T26.01XA, T26.02XA, T26.11XA, T26.12XA,T26.21XA, T26.22XA, T26.31XA, T26.32XA, , T26.41XA, T26.42XA,T26.51XA, T26.52XA, T26.61XA, T26.62XA, T26.71XA, T26.72XA, T26.81XA, T26.82XA,T26.91XA, T26.92XA

    Cataract Secondary to Ocular Disorders

    H26.211, H26.212, H26.213, H26.221, H26.222, H26.223

    Central Corneal Ulcer

    H16.011, H16.012, H16.013

    Certain Types of Iridocyclitis

    H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.821, H20.822, H20.823, H20.9,  

    Chorioretinal Scars

    H31.011, H31.012, H31.013, H31.021, H31.022, H31.023,

    Choroidal Degenerations

    H35.33

    Choroidal Detachment

    H31.411, H31.412, H31.413

    Choroidal Hemorrhage and Rupture

    H31.301, H31.302, H31.303, H31.311, H31.312, H31.313, , H31.321, H31.322, H31.323

    Chronic Iridocyclitis

    A18.54, H20.10, H20.11, H20.12, H20.13

     

    Cloudy Cornea

    H17.01, H17.02, H17.03, H17.11, H17.12, H17.13,

    Corneal Edema

    H18.11, H18.12, H18.13, H18.221, H18.222, H18.223, ,H18.231, H18.232, H18.233,  H18.421, H18.422, H18.423,

    Corneal Opacity and Other Disorders of Cornea

    H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.89, H17.9

    Degeneration of Macula and Posterior Pole

    H35.30, H35.3110, H35.3111, H35.3112, H35.3113, H35.3114, H35.3120, H35.3121, H35.3122, H35.3123, H35.3124, H35.3130, H35.3131, H35.3132, H35.3133, H35.3134, , H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233, H35.341, H35.342, H35.343, H35.351, H35.352, H35.353, , H35.361, H35.362, H35.363, , H35.371, H35.372, H35.373, , H35.381, H35.382, H35.383,

    Degenerative Disorders of Globe

    H44.2A1, H44.2A2, H44.2A3, H44.2B1, H44.2B2, H44.2B3, H44.2C1, H44.2C2, H44.2C3, H44.2D1, H44.2D2, H44.2D3, H44.2E1, H44.2E2, H44.2E3, H44.21, H44.22, H44.23, H44.311, H44.312, H44.313, H44.321, H44.322, H44.323, H44.391, H44.392, H44.393

     

    Diabetic Macular Edema

    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, , E08.3521, E08.3522, E08.3523, E08.3531, E08.3532, E08.3533, E08.3541, E08.3542, E08.3543, E08.3551, E08.3552, E08.3553, , E08.37X1, E08.37X2, E08.37X3, 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, , E09.3521, E09.3522, E09.3523, E09.3531, E09.3532, E09.3533, E09.3541, E09.3542, E09.3543, E09.3551, E09.3552, E09.3553, E09.37X1, E09.37X2, E09.37X3, , 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, E10.3521, E10.3522, E10.3523, E10.3531, E10.3532, E10.3533, E10.3541, E10.3542, E10.3543, E10.3551, E10.3552, E10.3553, E10.37X1, E10.37X2, E10.37X3, , 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, E11.3521, E11.3522, E11.3523, E11.3531, E11.3532, E11.3533, E11.3541, E11.3542, E11.3543, E11.3551, E11.3552, E11.3553, E11.37X1, E11.37X2, E11.37X3, , 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, , E13.3521, E13.3522, E13.3523, E13.3531, E13.3532, E13.3533, E13.3541, E13.3542, E13.3543, E13.3551, E13.3552, E13.3553, E13.37X1, E13.37X2, E13.37X3,

    Diabetic Retinopathy without Macular Edema

    E08.319, E08.3291, E08.3292, E08.3293, E08.3391, E08.3392, E08.3393, E08.3491, E08.3492, E08.3493, E08.3521, E08.3522, E08.3523, , E08.3531, E08.3532, E08.3533, , E08.3541, E08.3542, E08.3543, , E08.3551, E08.3552, E08.3553, E08.3591, E08.3592, E08.3593, , E09.319, E09.3291, E09.3292, E09.3293,  E09.3391, E09.3392, E09.3393, E09.3491, E09.3492, E09.3493, E09.3521, E09.3522, E09.3523, E09.3531, E09.3532, E09.3533, , E09.3541, E09.3542, E09.3543, E09.3551, E09.3552, E09.3553, , E09.3591, E09.3592, E09.3593, E10.319, E10.3291, E10.3292, E10.3293,  E10.3391, E10.3392, E10.3393, E10.3491, E10.3492, E10.3493, E10.3521, E10.3522, E10.3523, E10.3531, E10.3532, E10.3533, , E10.3541, E10.3542, E10.3543, E10.3551, E10.3552, E10.3553, E10.3591, E10.3592, E10.3593,  E11.319, E11.3291, E11.3292, E11.3293,  E11.3391, E11.3392, E11.3393, E11.3491, E11.3492, E11.3493, E11.3521, E11.3522, E11.3523, E11.3531, E11.3532, E11.3533, E11.3541, E11.3542, E11.3543, E11.3551, E11.3552, E11.3553, E11.3591, E11.3592, E11.3593, E13.319, , E13.3291, E13.3292, E13.3293, E13.3391, E13.3392, E13.3393, E13.3491, E13.3492, E13.3493, E13.3521, E13.3522, E13.3523, E13.3531, E13.3532, E13.3533, E13.3541, E13.3542, E13.3543, E13.3551, E13.3552, E13.3553, , E13.3591, E13.3592, E13.3593,

    Disorders of Optic Chiasm

    H47.41, H47.42, H47.43,

    Disorders of Visual Cortex

    H47.611, H47.612,

    Disseminated Chorioretinitis and Disseminated Retinochoroiditis

    A18.53, H30.101, H30.102, H30.103, H30.111, H30.112, H30.113, H30.121, H30.122, H30.123, , H30.131, H30.132, H30.133, H30.141, H30.142, H30.143,

    Focal Chorioretinitis and Focal Retinochoroiditis

    H30.001, H30.002, H30.003, H30.011, H30.012, H30.013, , H30.021, H30.022, H30.023, H30.031, H30.032, H30.033, H30.041, H30.042, H30.043

    Glaucoma

    H40.10X3, H40.10X4, H40.1113, H40.1114, H40.1123, H40.1124, H40.1133, H40.1134, H40.1213, H40.1214, H40.1223, H40.1224, H40.1233, H40.1234,  H40.1313, H40.1314, , H40.1323, H40.1324, H40.1333, H40.1334, H40.1413, H40.1414, H40.1423, H40.1424, H40.1433, H40.1434, H40.20X0, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.211, H40.212, H40.213, H40.2213, H40.2214, H40.2223, H40.2224, H40.2233, H40.2234,  H40.31X3, H40.31X4, H40.32X3, H40.32X4, H40.33X3, H40.33X4, H40.41X3, H40.41X4, H40.42X3, H40.42X4, H40.43X3, H40.43X4, H40.51X3, H40.51X4, H40.52X3, H40.52X4, H40.53X3, H40.53X4, H40.61X3, H40.61X4, H40.62X3, H40.62X4, H40.63X3, H40.63X4, H40.821, H40.822, H40.823, H40.831, H40.832, H40.833, H40.9, Q15.0

    Hereditary Choroidal Dystrophies

    H31.20, H31.21, H31.22, H31.23

    Hereditary Corneal Dystrophies

    H18.50, H18.51, H18.52, H18.53, H18.54, H18.55

    Hereditary Retinal Dystrophies

    H35.50, H35.51, H35.52, H35.53, H35.54

    Injury to Optic Nerve and Pathways

    S04.011A, S04.012A, S04.02XA, S04.031A, S04.032A, S04.041A, S04.042A

    Moderate or Severe Impairment, Better Eye, Profound Impairment Lesser Eye

    , H54.1131, H54.1132, H54.1141, H54.1142, H54.1151, H54.1152, H54.1213, H54.1214, H54.1215, H54.1223, H54.1224, H54.1225

    Nystagmus and Other Irregular Eye Movements

    H55.01H55.03, H55.04, H55.09

    Open Wound of Eyeball

    , S05.11XA, S05.12XA, S05.21XA, S05.22XA, , S05.31XA, S05.32XA, S05.41XA, S05.42XA, , S05.51XA, S05.52XA, S05.61XA, S05.62XA, S05.71XA, S05.72XA, S05.8X1A, S05.8X2A, S05.91XA, S05.92XA

    Optic Atrophy

    H47.20, H47.211, H47.212, H47.213, H47.22, H47.231, H47.232, H47.233, H47.291, H47.292, H47.293

    Optic Neuritis

    H46.01, H46.02, H46.03, H46.11, H46.12, H46.13, H46.2, H46.3, H46.8, H46.9

    Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis

    H30.21, H30.22, H30.23, H30.811, H30.812, H30.813,  H30.891, H30.892, H30.893, H30.91,

    Other Background Retinopathy and Retinal Vascular Changes

    H35.021, H35.022, H35.023,

    Other Corneal Deformities

    H18.711, H18.712, H18.713, H18.721, H18.722, H18.723, , H18.731, H18.732, H18.733

    Other Disorders of Optic Nerve

    H47.011, H47.012, H47.013

    Other Disorders of Sclera

    H15.831, H15.832, H15.833, H15.841, H15.842, H15.843

    Other Endophthalmitis and other entities

    H16.241, H16.242, H16.243, H21.331, H21.332, H21.333, , H33.121, H33.122, H33.123, H44.111, H44.112, H44.113, H44.121, H44.122, H44.123, , H44.131, H44.132, H44.133, , H44.19

    Other Proliferative Retinopathy

    H35.101, H35.102, H35.103, H35.111, H35.112, H35.113, , H35.121, H35.122, H35.123, , H35.131, H35.132, H35.133, H35.141, H35.142, H35.143, , H35.151, H35.152, H35.153, H35.161, H35.162, H35.163, , H35.171, H35.172, H35.173

    Keratoconus

    H18.601, H18.602, H18.603, H18.611, H18.612, H18.613, H18.621, H18.622, H18.623

    Profound Impairment, Both Eyes

    H54.0X33, H54.0X34, H54.0X35, H54.0X43, H54.0X44, H54.0X45, H54.0X53, H54.0X54, H54.0X55

    Purulent Endophthalmitis

    H44.001, H44.002, H44.003, H44.011, H44.012, H44.013, H44.021, H44.022, H44.023

    Retinal Detachment with Retinal Defect

    H33.001, H33.002, H33.003, H33.011, H33.012, H33.013, H33.021, H33.022, H33.023, H33.031, H33.032, H33.033, , H33.041, H33.042, H33.043, H33.051, H33.052, H33.053, H33.8

    Retinal Vascular Occlusion

    H34.11, H34.12, H34.13, H34.231, H34.232, H34.233, H34.8110, H34.8111, H34.8112, H34.8120, H34.8121, H34.8122, H34.8130, H34.8131, H34.8132, H34.8310, H34.8311, H34.8312, H34.8320, H34.8321, H34.8322, H34.8330, H34.8331, H34.8332

    Scleritis and Episcleritis

    H15.021, H15.022, H15.023, H15.031, H15.032, H15.033, H15.041, H15.042, H15.043, H15.051, H15.052, H15.053

    Separation of Retinal Layers

    H35.711, H35.712, H35.713, H35.721, H35.722, H35.723H35.731, H35.732, H35.733

    Visual Field Defects

    H53.411, H53.412, H53.413

    How CMS Scores Your Performance

    No scoring benchmark currently exists for this measure.

      • If you successfully report a measure for less than 70 percent 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 percent of your patients, but do not report at least 20 cases, you will receive 3 points.

    If at least 20 physicians report the measure on at least 70 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2020 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.

    © 2017-2020 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 2020 American Medical Association.