• CMS Alerts Ophthalmologists of Incorrect Usage of Quality Measure


    Some ophthalmologists are continuing to use an incorrect Healthcare Common Procedure Coding System (HCPCS) code for measure 14 Dilated macular exam, a problem that originally was due to a failure by the Centers for Medicare & Medicaid Services.

    In January, CMS changed the code and failed to communicate the change. At the time, the Academy reached out to the agency to question denials reported by members, and CMS updated the specification sheet with the new and current codes.

    Due to the error, CMS said it would count this measure for 11 months rather than the 12-month period for other quality measures.

    CMS now reports that ophthalmologists are still using the incorrect code.

    If you report quality measures via claims submission, be sure you use the correct codes:

    • G9974 Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity, or
    • G9975 Documentation of medical reason(s) for not performing a dilated macular examination, or
    • G9892 Documentation of patient reason(s) for not performing a dilated macular examination, or
    • G9893 Dilated macular exam was not performed, reason not otherwise specified

    The previous codes, G9890 and G9891, are no longer applicable to measure 14. CMS reassigned them to another measure and ophthalmologists continuing to use these codes will not have this measure count as one of their six applicable measures. To learn more about this and other quality measures, use Academy resources available at aao.org/medicare.