Measure Description
Percentage of patients aged 18 years and older who had cataract surgery performed and had an unplanned rupture of the posterior capsule requiring vitrectomy
Instructions
This measure is to be calculated each time a procedure for cataracts is performed during the performance period. This measure is intended to reflect the quality of services provided for the patient receiving cataract surgery.
Note: This is an outcome measure and will be calculated solely using MIPS eligible clinician, group, or third party intermediary submitted data.
• For patients who receive the surgical procedures specified in the denominator coding, it should be submitted whether or not the patient had a rupture of the posterior capsule during anterior segment surgery requiring vitrectomy.
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 18 years and older who had cataract surgery
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Patient procedure during the performance period (CPT): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
WITHOUT
Modifier: 55 or 56
AND NOT
DENOMINATOR EXCLUSION:
History of preoperative posterior capsule rupture: G9759
Numerator
Patients who experienced an unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
Numerator Instructions:
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
Numerator Options:
Performance Met: Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery (G9389)
OR
Performance Not Met: No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery (G9390)