Measure Description
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence
Instructions
This measure is to be calculated each time a procedure for uncomplicated cataract is performed during the performance period. This measure is intended to reflect the quality of services provided for the patients receiving uncomplicated cataract surgery. This measure is to be submitted by the Merit-based Incentive Payment System (MIPS) eligible clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.
Note: This is an outcome measure and can be calculated solely using third party intermediary data.
• For patients who receive the cataract surgical procedures specified in the denominator coding, claims should be reviewed to determine if any of the procedure codes listed in the numerator were performed within 30 days of the date of cataract surgery.
• Patients who have any of the listed significant ocular conditions in the exclusion criteria should be removed from the denominator, and not considered as having a complication within 30 days following cataract surgery.
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 and no significant ocular conditions impacting the surgical complication rate
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Patient encounter during the performance period (CPT): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
WITHOUT
Modifier: 56 or 55
AND NOT
DENOMINATOR EXCLUSION:
Any of the following significant ocular conditions that impact the surgical complication rate
(Patients with documentation of the presence of one or more of the following significant ocular conditions that impact the surgical complication rate prior to date of cataract surgery which is still active at the time of the cataract surgery are excluded from the measure calculation.)
Table 1 - Significant Ocular Conditions
Significant Ocular Condition | Corresponding ICD-10-CM Codes, Procedure Codes, and Medication Identified |
Acute and Subacute Iridocyclitis | H20.00, H20.011, H20.012, H20.013, H20.021, H20.022, H20.023, H20.031, H20.032, H20.033, H20.041, H20.042, H20.043, H20.051, H20.052, H20.053 |
Adhesions and Disruptions of Iris and Ciliary Body | H21.41, H21.42, H21.43, H21.511, H21.512, H21.513, H21.521, H21.522, H21.523, H21.531, H21.532, H21.533, H21.541, H21.542, H21.543, H21.551, H21.552, H21.553, H21.561, H21.562, H21.563, H21.81, H21.82, H21.89, H22 |
Anomalies of Pupillary Function | H57.03 |
Aphakia and Other Disorders of Lens | H27.10, H27.111, H27.112, H27.113, H27.121, H27.122, H27.123, H27.131, H27.132, H27.133 |
Burn Confined to Eye and Adnexa | T26.01XA, T26.02XA, T26.11XA, T26.12XA, T26.21XA, T26.22XA, T26.31XA, T26.32XA, T26.41XA, T26.42XA, T26.51XA, T26.52XA, T26.61XA, T26.62XA, T26.71XA, T26.72XA, T26.81XA, T26.82XA, T26.91XA, T26.92XA |
Cataract Secondary to Ocular Disorders | H26.211, H26.212, H26.213, H26.221, H26.222, H26.223 |
Cataract, Congenital | Q12.0 |
Cataract, Mature or Hypermature | H26.9 |
Cataract, Posterior Polar | Q12.0 |
Central Corneal Ulcer | H16.011, H16.012, H16.013 |
Certain Types of Iridocyclitis | H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.821, H20.822, H20.823, H20.9 |
Chronic Iridocyclitis | A18.54, H20.11, H20.12, H20.13, H20.9 |
Cloudy Cornea | H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.811, H17.812, H17.813, H17.821, H17.822, H17.823 |
Corneal Edema | H18.11, H18.12, H18.13, H18.20, H18.221, H18.222, H18.223, H18.231, H18.232, H18.233, H18.421, H18.422, H18.423, H18.43 |
Corneal Opacity and Other Disorders of Cornea | H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.89, H17.9 |
Cysts of Iris, Ciliary Body, and Anterior Chamber | H21.301, H21.302, H21.303, H21.311, H21.312, H21.313, H21.321, H21.322, H21.323, H21.331, H21.332, H21.333, H21.341, H21.342, H21.343, H21.351, H21.352, H21.353 |
Enophthalmos | H05.401, H05.402, H05.403, H05.411, H05.412, H05.413, H05.421, H05.422, H05.423 |
Glaucoma | H40.10X0, H40.10X1, H40.10X2, H40.10X3, H40.10X4, H40.1110, H40.1111, H40.1112, H40.1113, H40.1114, H40.1120, H40.1121, H40.1122, H40.1123, H40.1124, H40.1130, H40.1131, H40.1132, H40.1133, H40.1134, H40.1210, H40.1211, H40.1212, H40.1213, H40.1214, H40.1220, H40.1221, H40.1222, H40.1223, H40.1224, H40.1230, H40.1231, H40.1232, H40.1233, H40.1234, H40.1310, H40.1311, H40.1312, H40.1313, H40.1314, H40.1320, H40.1321, H40.1322, H40.1323, H40.1324, H40.1330, H40.1331, H40.1332, H40.1333, H40.1334, H40.1410, H40.1411, H40.1412, H40.1413, H40.1414, H40.1420, H40.1421, H40.1422, H40.1423, H40.1424, H40.1430, H40.1431, H40.1432, H40.1433, H40.1434, H40.151, H40.152, H40.153, H40.20X0, H40.20X1, H40.20X2, H40.20X3, H40.20X4, H40.211, H40.212, H40.213, H40.2210, H40.2211, H40.2212, H40.2213, H40.2214, H40.2220, H40.2221, H40.2222, H40.2223, H40.2224, H40.2230, H40.2231, H40.2232, H40.2233, H40.2234, H40.231, H40.232, H40.233, H40.241, H40.242, H40.243, H40.31X0, H40.31X1, H40.31X2, H40.31X3, H40.31X4, H40.32X0, H40.32X1, H40.32X2, H40.32X3, H40.32X4, H40.33X0, H40.33X1, H40.33X2, H40.33X3, H40.33X4, H40.41X0, H40.41X1, H40.41X2, H40.41X3, H40.41X4, H40.42X0, H40.42X1, H40.42X2, H40.42X3, H40.42X4, H40.43X0, H40.43X1, H40.43X2, H40.43X3, H40.43X4, H40.51X0, H40.51X1, H40.51X2, H40.51X3, H40.51X4, H40.52X0, H40.52X1, H40.52X2, H40.52X3, H40.52X4, H40.53X0, H40.53X1, H40.53X2, H40.53X3, H40.53X4, H40.61X0, H40.61X1, H40.61X2, H40.61X3, H40.61X4, H40.62X0, H40.62X1, H40.62X2, H40.62X3, H40.62X4, H40.63X0, H40.63X1, H40.63X2, H40.63X3, H40.63X4, H40.811, H40.812, H40.813, H40.821, H40.822, H40.823, H40.831, H40.832, H40.833, H40.89, Q15.0 |
Hereditary Corneal Dystrophies | H18.50, H18.51, H18.52, H18.53, H18.54, H18.55, H18.59 |
High Hyperopia | H52.01, H52.02, H52.03 |
Hypotony of Eye | H44.40, H44.411, H44.412, H44.413, H44.421, H44.422, H44.423, H44.431, H44.432, H44.433, H44.441, H44.442, H44.443 |
Injury to Optic Nerve and Pathways | S04.011A, S04.012A, S04.02XA, S04.031A, S04.032A, S04.041A, S04.042A |
Morgagnian Cataract | H25.21, H25.22, H25.23 |
Open Wound of Eyeball | S05.11XA, S05.12XA, S05.21XA, S05.22XA, S05.31XA, S05.32XA, S05.51XA, S05.52XA, S05.61XA, S05.62XA, S05.71XA, S05.72XA, S05.8X1A, S05.8X2A, S05.91XA, S05.92XA |
Pathologic Myopia | H44.2A1, H44.2A2, H44.2A3, H44.2B1, H44.2B2, H44.2B3, H44.2C1, H44.2C2, H44.2C3, H44.2D1, H44.2D2, H44.2D3, H44.2E1, H44.2E2, H44.21, H44.22, H44.23, H44.30 |
Posterior Lenticonus | Q12.2, Q12.4, Q12.8 |
Prior Pars Plana Vitrectomy | 67036, 67039, 67040, 67041, 67042, 67043 (patient with history of this procedure) |
Pseudoexfoliation Syndrome | H40.1410, H40.1411, H40.1412, H40.1413, H40.1414, H40.1420, H40.1421, H40.1422, H40.1423, H40.1424, H40.1430, H40.1431, H40.1432, H40.1433, H40.1434 |
Retrolental Fibroplasias | H35.171, H35.172, H35.173 |
Traumatic Cataract | H26.101, H26.102, H26.103, H26.111, H26.112, H26.113, H26.121, H26.122, H26.123, H26.131, H26.132, H26.133 |
Use of Systemic Sympathetic Alpha-1a Antagonist Medication for Treatment of Prostatic Hypertrophy | Patient taking tamsulosin hydrochloride: G9503 |
Uveitis | H44.111, H44.112, H44.113, H44.131, H44.132, H44.133 |
Vascular Disorders of Iris and Ciliary Body | H21.1X1, H21.1X2, H21.1X3 |
Numerator
Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence
Numerator Instruction:
Codes for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence): 65235, 65860, 65880, 65900, 65920, 65930, 66030, 66250, 66820, 66825, 66830, 66852, 66986, 67005, 67010, 67015, 67025, 67030, 67031, 67036, 67039, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67141, 67145, 67250, 67255.
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: Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence) (G8627)
OR
Performance Not Met: Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence) (G8628)