#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 of macular 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 Merit-based Incentive Payment System (MIPS) 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 Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

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

Denominator Criteria (Eligible Cases):

Patients aged ≥ 50 years on date of encounter

AND

Diagnosis for age-related macular degeneration (ICD-10-CM): 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, 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 or 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 of macular degeneration severity (G9974)

OR

Denominator Exception: Documentation of medical reason(s) for not performing 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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