#014: Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Quality ID

014

NQF

0087

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Ophthalmology

 

Measure description

Percentage of 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 ofmacular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within the 12 month performance period

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. It is anticipated that eligible clinicians who provide the primary management of patients with age-related macular degeneration (in either one or both eyes) will submit this measure.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients aged 50 years and older with a diagnosis of AMD

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

Denominator Criteria (Eligible Cases):

Patients aged ≥ 50 years on date of encounter

AND

Diagnosis for age-related macular degeneration (ICD-10-CM): 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

AND

Patient encounter during the performance period (CPT): 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 02

 

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

Definitions:

Macular Thickening – Acceptable synonyms for “macular thickening” include: intraretinal thickening, serous detachment of the retina, pigment epithelial detachment or macular edema.

Severity of Macular Degeneration – Early, intermediate and advanced.

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

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

Numerator Options:

Performance Met: Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level ofmacular degeneration severity (G9974)

OR

Denominator Exception: Documentation of medical reason(s) for notperforming a dilated macular examination (G9975)

OR

Denominator Exception: Documentation of patient reason(s) for not performing a dilated macular examination (G9892)

OR

Performance Not Met: Dilated macular exam was not performed, reason not otherwise specified (G9893)

 

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