• IRIS5: Surgery for Acquired Involutional Ptosis: Patients with an improvement of marginal reflex distance (MRD)

    Updated December 2021. This measure is not approved for 2022. Changes for 2021 are indicated in red.

    Care Setting: Ambulatory Care: Clinician Office/Clinic

    Reporting Option: 

    • 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 surgical ptosis patients with an improvement of MRD within 90 days postoperatively.

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

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years or older with a diagnosis of acquired involutional ptosis who underwent a surgical procedure 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): Codes located in “CPT Codes.” 

    Diagnosis Codes

    • Myogenic Ptosis (ICD-10: H02.421, H02.422, H02.423, H02.429)

    CPT Codes

    Ptosis Surgical Procedure

    • Conjunctivo-tarso-Muller's (CPT: 67908)
    • External levator resection (CPT: 67904)
    • Internal levator resection (CPT: 67903)

    How to Report the Measure

    Numerator: Patients with an improvement of MRD within 90 days postoperatively compared to preoperative level. 

    We have had difficulty identifying pre and post op MRD values.  To improve capture of these measures, it would be helpful if you could document these in your electronic health record notes:

      1. “Improved MRD” in your assessment and notes within 90 days of surgery OR
      2. “MRD not improved” in your assessment and notes within 90 days of surgery

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 70% 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% of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 70% of applicable patients and on at least 20 patients during a performance period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.


    See QPP resource library for benchmarks.


    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. 


    © 2017-2021 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.