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


    Reporting Option: 

    • IRIS Registry group reporting
    • IRIS Registry manual data entry
    • Claims based reporting

    Measure Type: Process 

    Instructions:  This measure is to be reported a minimum of once per reporting period for patients, aged 50 years and older, with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening 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

    Category II Codes:

    2019F Dilated macular exam performed, including documentation of the presence or absence of macular thickening or hemorrhage and the level of macular degeneration severity; or

    2019F 1P Documentation of medical reason(s) for not performing a dilated macular examination; or

    2019F 2P Documentation of patient reason(s) for not performing a dilated macular examination; or

    2019F 8P Dilated macular exam was not performed, reason not otherwise specified

    CPT Codes:

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

    Without Telehealth Modifier: GQ, GT.

    Diagnosis Codes:

    CMS has stated that ICD-10 should be coded to the greatest specificity and unspecified codes may be denied. Therefore the codes listed below with a strikethrough should not be included on your claim or submitted 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, H35.3190, H35.3191, H35.3192, H35.3193, H35.3194, H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233

    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 report this measure for at least 50 percent of applicable 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.
    • If you successfully report a measure for less than 50 percent of your patients, you will earn 3 points.
    Decile/Points Benchmark
    3 31.01 - 55.12
    4 55.13 - 77.24
    5 77.25 - 91.17
    6 91.18 - 98.18
    7 98.19 - 99.99
    8 N/A - no points
    9 N/A - no points
    10 100