• IRIS43: Glaucoma – Intraocular Pressure Reduction Following Laser Trabeculoplasty


    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: Effective Clinical Care

    Meaningful Measure Area: Management of Chronic Conditions

    Description:  Percentage of patients who underwent laser trabeculoplasty who had IOP reduced by 20% or more from their pretreatment level or had a reduction in overall number of glaucoma medications.

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

    To Which Patients Does the Measure Apply?

    Denominator:  Patients aged between 40 and 85 years who underwent laser trabeculoplasty.

    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

    • Laser trabeculoplasty procedure (CPT: 65855 with modifier RT, LT, -50)

    How to Report the Measure

    Numerator:Patients with a reduction in IOP ≥ 20% from the pretreatment level or had a reduction in overall number of glaucoma medications. (If two eyes of patient meet denominator criteria, select one eye with the smaller percentage decrease in IOP or no reduction in overall number of glaucoma medications).

    Numerator calculation:

    • Percent change between pretreatment IOP (do not include IOP values taken on the day of procedure) and the lowest IOP measures between 2 and 4 months postoperatively.
    • Calculation is based on the IOP of the eye that underwent the procedure.
    • Number of glaucoma medication is compared prior to laser trabeculoplasty and after laser trabeculoplasty between 2 and 4 months postoperatively.

    Denominator Exclusions

    • Eyes with absolute glaucoma blindness (ICD-10: H44.511, H44.512, H44.513)
    • Visual acuity findings: Count fingers (CF or FC), hand motion (HM), light perception (LP), no light perception (NLP)

    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.