• IRIS8: Surgical Esotropia: Postoperative alignment

    Updated January 2018.

    Reporting Option: 

    • IRIS Registry QCDR manual data entry: groups and individuals

    Measure Type: Outcome

    Description: Percentage of surgical esotropia patients with a postoperative alignment of 15 prism diopters or less.

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years or less who underwent a surgical procedure for esotropia.

    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

    • Esotropia (ICD-10: H50.00, H50.011, H50.012, H50.021, H50.022, H50.031, H50.032, H50.041, H40.042, H50.05, H50.06, H50.07, H50.08)
    • Intermittent esotropia (ICD-10: H50.30, H50.311, H50.312, H50.32)
    • Partially accommodative esotropia (ICD-10: 43)

    CPT Codes

    • Surgical intervention for esotropia (CPT: 67311, 67312)

    How to Report the Measure

    Numerator: Postoperative alignment of 15 PD or less recorded between 4 and 12 weeks after surgery.

    Note: Prism diopter can be assessed by the alternate cover test or the simultaneous prism and cover test.

    • For alignment values ≤ 15 PD, results from either test are acceptable.
    • For alignment values > 15 PD, only results from the SPCT are acceptable.

    Denominator Exclusions

    • Patients with a history of diplopia (H49.20, H49.21, H49.22, H49.23), or Duane syndrome (ICD-9: 378.71, ICD-10: H50.811, H50.812)
    • Patients who have a reoperation between the original surgery and the visit 4 to 12 weeks after the original surgery date (CPT: 67311, 67312)


    • Must not have re-operation (second occurrence of CPT codes listed above) between original surgery date and outcome visit.
    • Must have alignment within 15 PD for at least one testing condition
    • Tropia measurements that are >15 PD but only assessed by ACT and not by SPCT (or equivalent) will be considered indeterminate. For tropia measurements <15 PD, an ACT measurement may be used.


    • No scoring benchmark currently exists for this QCDR measure.
    • If 19 or fewer physicians each report the measure or 20 physicians do not report the measure on at least 60 percent of qualifying patients, and a minimum of 20 patients, you will earn 3 out of 10 points toward your total quality score. Choose measures assuming you’ll only earn 3 points per QCDR measure.
    • If at least 20 physicians report the measure on at least 60 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2018 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. 


    © 2017 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 2004-2017 American Medical Association.