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  • IRIS56: Adult Diplopia: Improvement of ocular deviation or absence of diplopia or functional improvement

    Updated December 2022. No changes for 2023.
    The measure is approved for traditional MIPS submission pathway only.

    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 with a diagnosis of double vision (diplopia) who had an improvement of ocular deviation as determined by reduction of strabismus in primary gaze to <10 prism diopters horizontal or <2 prism diopters vertical deviation OR were absent of diplopia in primary gaze OR had functional improvement in ptosis within 6 months of initiating treatment.

    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 diagnosed with diplopia between January 1 and June 30 of the reporting period AND received treatment 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

    Diagnosis of diplopia (ICD-10: H53.2)


    Additional diagnostic codes indicating likely cause of diplopia

    • Third nerve palsy (ICD-10: H49.0x), Fourth nerve palsy (ICD-10: H49.1x), Sixth nerve palsy (ICD-10: H49.2x)
    • Mechanical strabismus (ICD-10: H50.6x), restrictive strabismus (ICD-10: H50.89, H50.9)
    • Hypertropia or hypotropia (ICD-10: H50.21, H50.22)
    • Esotropia (ICD-10: H50.0x), intermittent esotropia (ICD-10: H50.30, H50.31x, H50.32)
    • Exotropia (ICD-10: H50.1x), intermittent exotropia (ICD-10: H50.33, H50.34, H50.33x)
    • Ocular myasthenia gravis (ICD-10: G70.0x)
    • Thyroid eye disease (ICD-10: E05.00)
    • Skew deviation (ICD-10: H51.8)
    • Convergence insufficiency (ICD-10: H51.11) or excess (ICD-10: H51.12)
    • Internuclear ophthalmoplegia (ICD-10: H51.2x)


    Treatment initiated

    • Patient prescribed one of the following medications for conditions associated with diplopia - pyridostigmine, prednisone, mycophenolate mofetil, azathioprine, cyclosporine, rituximab.
    • Strabismus surgery (CPT: 67311, 67312, 67314, 67316, 67318)
    • Extraocular muscle procedure (CPT: 67345)
    • Press-on prism (HCPCS: V2718)
    • Occluder lens (HCPCS: V2770)

    CPT Codes

    Two or more encounters within the last 6 months (CPT: 99024, 99201, 99202, 99203, 99204, 99205, 99244, 99245, 92002, 92004, 92012, 92014, 99212, 99213, 99214, 99215)

    How to Report the Measure

    Numerator: Patients with improvement in ocular deviation (<10 PD horizontal and/or <2PD vertical) within 6 months after initial treatment OR absence of diplopia in primary gaze within 6 months after initial treatment OR functional improvement of ptosis within 6 months after initiating treatment.

    Performance Not Met:     Patient did not meet any of the performance criteria (improvement of ocular deviation or absence of diplopia in primary gaze or functional improvement in ptosis).

    How CMS Scores Your Performance

    See the 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. 


    © 2020-23 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 2023 American Medical Association.