#141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care

Quality ID

141

NQF

0563

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Ophthalmology

Measure description

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months

 

Instructions

This measure is to be submitted a minimum of once per performance period for glaucoma patients seen during the performance period. It is anticipated that eligible clinicians who provide the primary management of patients with POAG 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-based submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma

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 ≥ 18 years on date of encounter

AND

Diagnosis for primary open-angle glaucoma (ICD-10-CM): H40.1111, H40.1112, H40.1113, H40.1114, H40.1121, H40.1122, H40.1123, H40.1124, H40.1131, H40.1132, H40.1133, H40.1134, H40.1211, H40.1212, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232, H40.1233, H40.1234, H40.151, H40.152, H40.153

AND

Patient encounter during the submission 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

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

 

Numerator

Patients whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from thepreintervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months

Definitions:

Plan of Care – May include: recheck of IOP at specified time, change in therapy, perform additional diagnostic evaluations, monitoring per patient decisions or health system reasons, and/or referral to a specialist.

Plan to Recheck – In the event certain factors do not allow for the IOP to be measured (e.g., patient has an eye infection) but the physician has a plan to measure the IOP at the next visit; the plan of care code should be submitted.

Glaucoma Treatment Not Failed – The most recent IOP was reduced by at least 15% in the affected eye or if both eyes were affected, the reduction of at least 15% occurred in both eyes.

Numerator Instructions:

Pre-Intervention Level – The patient’s IOP in the affected eye prior to the initiation of therapy. For patients who have just begun management of their POAG, i.e. a newly diagnosed patient or a patient recently transferred to the care of the physician, a provider can meet the measure’s performance requirements by documenting a plan of care and submitting CPT II 0517F. Patients whose POAG is well managed are assumed to have met the requirement to reduce their IOP by greater than or equal to 15% and should submit CPT II 3284F.

Numerator Quality-Data Coding Options:

Performance Met: Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level or equivalent (3284F)

OR

Performance Met: Glaucoma plan of care documented or equivalent (0517F)

AND

Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level or equivalent (3285F)

OR

Performance Not Met: Glaucoma plan of care not documented, reason not otherwise specified or equivalent (0517F with 8P)

AND

Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level or equivalent (3285F)

OR

Performance Not Met: IOP measurement not documented, reason not otherwise specified or equivalent (3284F with 8P)

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