• Measure 14: Age-Related Macular Degeneration (AMD): Dilated Macular Examination


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry manual entry: groups and individuals
    • Claims-based reporting: individuals only
    • AMD clinical cluster: IRIS Registry reporting only

    Measure Type: Process 

    2018 additions in red.

    Instructions: This measure is to be reported a minimum of once per performance period for patients, aged 50 years and older, with a diagnosis of age-related macular degeneration (AMD). This measure quantifies the percentage of these patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity during one or more office visits. 

    It’s anticipated that clinicians who provide the primary management of patients with age-related macular degeneration (in either one or both eyes) will submit this measure.

    Definitions:

    • Macular thickening – Acceptable synonyms for “macular thickening” include: intraretinal thickening, serous detachment of the retina, pigment epithelial detachment
    • Severity of macular degeneration – Early, intermediate and advanced
    • New in 2018: Geographic atrophy - the advanced form of non-neovascular AMD, will have one or more zones of well demarcated retinal pigment epithelial and/or choriocapillaris atrophy.

    To Which Patients Does this Measure Apply?

    Denominator: All patients, aged 50 years and older, with the diagnosis of AMD. 

    There are three criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
    3. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

    The quality measure may also have exclusions for the denominator.

    Diagnosis Codes:

    CMS has stated that providers should code ICD-10 to the greatest specificity; unspecified codes may be denied. You should not include the strikethrough codes listed below on your claim or submit them with this quality measure.

    Diagnosis for age-related macular degeneration]: H35.30, H35.3110, H35.3111, H35.3112, H35.3113, H35.3114, H35.3120, H35.3121, H35.3122, H35.3123, H35.3124, H35.3130, H35.3131, H35.3132, H35.3133, H35.3134, H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233

    CPT Codes:

    2018 additions in red.

    92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule. These non-covered services should be counted in the denominator population for registry-based measures.

    How to Report the Measure

    Claims and IRIS Registry Manual Reporting

    2018 additions in red.

    Numerator: Patients who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months.

    Numerator note: Denominator Exception(s) are determined on any date during the performance period prior to the date of the denominator eligible encounter.

    HCPCS Codes:

    2018 changes in red.

    • Performance met (patient included in numerator and denominator): 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 (2018: G9890; 2017 and before: 2019F)
    • Denominator exclusion (patient not included in numerator or denominator): Documentation of medical reason(s) for not performing a dilated macular examination (2018: G9891; 2017 and before: 2019F 1P) OR
      Documentation of patient reason(s) for not performing a dilated macular examination; (2018: G9892; 2017 and before: 2019F 2P)
    • Performance not met (patient not included in numerator, but included in denominator): Dilated macular exam was not performed, reason not otherwise specified (2018: G9893; 2017 and before: 2019F 8P)

    Clinical Recommendation Statements: According to the American Academy of Ophthalmology, a physical examination should include stereoscopic biomicroscopic examination of the macula. (III; Good; Strong) Binocular slit-lamp biomicroscopy of the ocular fundus is often necessary to detect subtle clinical signs of CNV. (III; Good; Strong)

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 60 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 1 point.
    • If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.
    Decile/Points Registry Benchmark Claims Benchmark
    3 64.21 – 81.81 99.60 – 99.99
    4 81.82 – 90.85 --
    5 90.86 – 95.69 --
    6 95.70 – 98.64 --
    7 98.65 – 99.99 --
    8 -- --
    9 -- --
    10 100 100

    Copyright

    The measures are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license or distribution of the measures for commercial gain, or incorporation of the measures 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 Medical Association [on behalf of the Physician Consortium for Performance Improvement®] or the American Academy of Ophthalmology.

    Neither the AMA, the Academy, PCPI nor its members shall be responsible for any use of the measures. The AMA’s and PCPI’s significant past efforts and contributions to the development and updating of the measures is acknowledged.

    The Academy is solely responsible for the review and enhancement (“maintenance”) of the measures as of May 15, 2014.

    The Academy encourages use of the measures by other health care professionals, where appropriate.