Updated January 2021. Note, 2021 changes are indicated in red.
Care Setting: Ambulatory Care: Clinician Office/Clinic
- 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 with a macular hole who have evidence of anatomic closure documented by OCT within 90 days after surgical treatment.
Risk Adjusted: No
Performance Rate: 1
High Priority Measure: Yes
Inverse Measure: No
To Which Patients Does the Measure Apply?
Denominator: All patients aged 18 years or older with a diagnosis of macular hole and a surgical treatment for macular hole.
There are three criteria for inclusion of a patient into the denominator.
- Patient characteristics: Description located in “Denominator” (see above).
- Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
- Procedure codes (CPT): Codes located in “CPT Codes.”
The quality measure also has exclusions for the denominator.
- Diagnosis of macular hole (ICD-10: H35.341, H35.342, H35.343)
- Had a surgical procedure to treat or close macular hole (CPT: 67036, 67039, 67041, 67042)
Instructions: This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. It is anticipated that clinicians who provide the primary management of patients with macular hole will submit this measure.
How to Report the Measure
Numerator: All patients with a macular hole who received surgical treatment and had anatomic closure within 90 days. This could consist of documentation based on OCT that the macular hole is closed or resolved.
- Performance met: Evidence of anatomic closure within 90 days of surgical treatment (e.g., macular hole is closed or resolved based on OCT)
- Performance not met: No evidence of anatomic closure within 90 days of surgical treatment (e.g., macular hole is open or not closed or not resolved based on OCT)
- Associated retinal detachment before the date of the surgical treatment (ICD-10: 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)
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.
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.