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2020 MIPS Measure #012: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Quality ID 012
eMeasure ID CMS143v8
NQF 0086
High Priority Measure No
Specifications EHR Registry
Measure Type Process
Specialty Ophthalmology

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months

 

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 primary open-angle glaucoma (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 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 MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for primary open-angle glaucoma (ICD-10-CM): 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, H40.151, H40.152, H40.153

AND

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*, 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 have an optic nerve head evaluation during one or more office visits within 12 months

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met: Optic nerve head evaluation performed (2027F)

OR

Denominator Exception: Documentation of medical reason(s) for not performing an optic nerve head evaluation (2027F with 1P)

OR

Performance Not Met: Optic nerve head evaluation was not performed, reason not otherwise specified (2027F with 8P)

 

Rationale

Changes in the optic nerve are one of two characteristics which currently define progression and thus worsening of glaucoma disease status (the other characteristic is visual field). There is a significant gap in documentation patterns of the optic nerve for both initial and follow-up care (Fremont et al., 2003), even among specialists (Lee et al., 2006). Examination of the optic nerve head and retinal nerve fiber layer provides valuable structural information about glaucomatous optic nerve damage.

Visible structural alterations of the optic nerve head or retinal nerve fiber layer and development of peripapillary choroidal atrophy frequently occur before visual field defects can be detected. Careful study of the optic disc neural rim for small hemorrhages is important, since these hemorrhages can precede visual field loss and further optic nerve damage. When initiating therapy, the clinician sets a target range of controlled intraocular pressure (IOP) based on the pretreatment pressure and the presence of optic nerve damage. According to the American Academy of Ophthalmology’s (AAO’s) Glaucoma Preferred Practice Pattern, lowering the pretreatment IOP reduces the risk of developing POAG and slows the progression of POAG to preserve visual function (AAO, 2015).

 

Clinical Recommendation Statements

Ophthalmic Evaluation

The ophthalmic evaluation specifically focuses on the following elements in the comprehensive adult medical eye evaluation:

  • Visual acuity measurement
  • Pupil examination
  • Anterior segment examination
  • IOP measurement
  • Gonioscopy
  • Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) examination
  • Fundus examination

(AAO, 2015)

The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (AAO, 2015).

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