Measure Description
Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment and achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye.
Instructions
This measure is to be submitted each time a procedure for primary rhegmatogenous retinal detachment is performed during the performance period. This measure is intended to reflect the quality of services provided for the patient receiving primary rhegmatogenous retinal detachment 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 achieved an improvement of their visual acuity within 90 days of surgery.
- Include only procedures performed through September 30 of the performance period. This will allow the postoperative period to occur before third-party intermediaries must submit data to CMS.
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
Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on the date of the procedure
AND
Patient procedure during the performance period (CPT): 67107, 67108, 67110
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02, POS 10
AND NOT
DENOMINATOR EXCLUSIONS:
Patients with a pre-operative visual acuity better than 20/40
OR
Surgical procedures that included the use of silicone oil: G9757
Numerator
Patients who achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye
Numerator Options:
Performance Met: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery (G9516)
OR
Performance Not Met: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given (G9517)
Rationale
For management and treatment for PVD and RRD, the following apply (for goals of treatment):
- Prevention of visual loss and functional impairment
- Maintenance of quality of life
All patients with risk factors should be instructed to notify their ophthalmologist as soon as possible if they have a substantial change in symptoms, such as an increase in floaters, loss of visual field, or decrease in visual acuity develop.
Studies demonstrate that the success rate increases with the recognition of risk factors and the practice of retina subspecialization. International studies report primary rhegmatogenous retinal surgery success rates ranging from 64 to 91%.
References
Flaxel CJ, Adelman RA, Bailey ST et al. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology. 2020:127;P146-P181.
Wickham, BC, Wong, D, Charteris, DG, Retinal detachment repair by vitrectomy: simplified formulae to estimate the risk of failure, Br J Ophthalmology 2011 Feb 16.
Sullivan PM, Luff AJ, Aylward GW. Results of primary retinal reattachment surgery: a prospective audit. Eye 1997; 11:869-71.
Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP. One year outcomes after retinal detachment surgery among Medicare beneficiaries. Am J Ophthalmol 2010; 150(3):338-45.
Clinical Recommendation Statements
This is an outcome measure. As such, no clinical recommendations are included.