High Priority MeasureNo
Percentage of Patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) or their caregiver(s) who were counseled within the 12 month performance period on the benefits and/or risks of the AgeRelated Eye Disease Study (AREDS) formulation for preventing progression of AMD
This measure is to be submitted a minimum of once per performance period for AMD patients seen during the performance period. It is anticipated that eligible clinicians who provide the primary management of patients with AMD will submit this measure.
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.
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
Diagnosis for AMD (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
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*, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
Telehealth Modifier: GQ, GT, 95, POS 02
Patients with AMD or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the AREDS 2 formulation for preventing progression of AMD
Counseling – Documentation in the medical record should include a discussion of risk or benefits of the AREDS 2 formulation. Counseling can be discussed with all patients with AMD, even those who do not meet the criteria for the AREDS 2 formulation, or other reasons why the patient would not meet criteria for AREDS 2 formulation as outlined in the AREDS. The ophthalmologist or optometrist can explain why these supplements are not appropriate for their particular situation. Also, given the purported risks associated with antioxidant use, patients would be informed of the risks and benefits and make their choice based on valuation of vision loss vs. other risks. As such, the measure seeks to educate patients about overuse as well as appropriate use.
NUMERATOR NOTE: If patient is already receiving AREDS 2 formulation, the assumption is that counseling about AREDS has already been performed.
Performance Met: Counseling about the benefits and/or risks of the AgeRelated Eye Disease Study (AREDS) 2 formulation for preventing progression of age-related macular degeneration (AMD) provided to patient and/or caregiver(s) (4177F)
Performance Not Met: AREDS counseling not performed, reason not otherwise specified (4177F with 8P)