2024 MIPS Measure #501: Acute Posterior Vitreous Detachment and Acute Vitreous Hemorrhage Appropriate Examination and Follow-up

Quality ID 501
High Priority Measure No
Specifications Registry
Measure Type Process
Specialty Ophthalmology

Measure Description

Percentage of patients with a diagnosis of acute posterior vitreous detachment (PVD) and acute vitreous hemorrhage in either eye who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks.

 

Instructions

This measure is to be submitted once for each occurrence of acute PVD and acute vitreous hemorrhage in either eye during the performance period. For the purpose of submitting this measure, only unique occurrences with an onset of acute PVD and acute vitreous hemorrhage diagnosed within the current performance period will be submitted. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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 with a diagnosis of acute PVD and acute vitreous hemorrhage in either eye and eligible encounter during performance period

Definition:

Acute PVD – For the purposes of this measure, acute PVD and vitreous hemorrhage is defined as recent onset of 30 days or less. For PVD, acute can be documented as new onset vitreous separation or vitreous detachment. Vitreous hemorrhage should occur at the same time as PVD and/or have an onset of 30 days or less to ensure vitreous hemorrhage is acute and not chronic.

DENOMINATOR NOTE: The measure includes any degree of vitreous hemorrhage rather than "meaningful" vitreous hemorrhage since it is difficult to quantify and no criteria exist. If a patient is diagnosed with vitreous hemorrhage, it is assumed that it is meaningful. A new diagnosis code, that meets the definition of acute, indicates a new occurrence of PVD. If a patient presents with right eye acute PVD then returns with new onset of left eye acute PVD symptoms, then the left eye diagnosed as acute PVD would be considered a new unique occurrence, separate from the right eye acute PVD occurrence.

*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):

All patients regardless of age

AND

Diagnosis for PVD (ICD-10-CM): H33.001, H33.002, H33.003, H33.009, H33.011, H33.012, H33.013, H33.019, H33.021, H33.022, H33.023, H33.029, H33.031, H33.032, H33.033, H33.039, H33.041, H33.042, H33.043, H33.049, H33.051, H33.052, H33.053, H33.059, H33.301, H33.302, H33.303, H33.309, H33.311, H33.312, H33.313, H33.319, H33.321, H33.322, H33.323, H33.329, H33.331, H33.332, H33.333, H33.339, H33.40, H33.41, H33.42, H33.43, H33.8, H35.411, H35.412, H35.413, H35.419, H43.811, H43.812, H43.813, H43.819

AND

Acute PVD: M1337

AND

Diagnosis for vitreous hemorrhage (ICD-10-CM): H43.10, H43.11, H43.12, H43.13

AND

Acute vitreous hemorrhage: M1333

AND

Patient encounters during the performance period (CPT): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02, POS 10

DENOMINATOR EXCLUSION:

Patients with a post-operative encounter of the eye with the acute PVD within 2 weeks before the initial encounter or 2 weeks after initial acute PVD encounter: M1334

 

Numerator

Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks

Definitions:

Initial exam – To meet performance of the measure, an initial exam must include a vitreous examination AND peripheral dilated examination with documentation of scleral depression of the affected eye or contact lens (e.g., 3-mirror Goldmann) that provides visualization to the ora for 360 degrees OR if the retina cannot be adequately visualized, then ultrasound was performed OR referred to another provider for additional examination (e.g., if retina cannot be visualized and ultrasound is not available).

Re-evaluation exam – To meet performance of the measure, a re-evaluation must occur no later than 2 weeks from initial examination and must include a vitreous examination AND an adequate dilated examination to evaluate the peripheral retina for tears or detachment OR if the retina cannot be adequately visualized, then ultrasound was performed OR referred to another provider for additional examination (e.g., if retina cannot be visualized and ultrasound is not available).

NUMERATOR NOTE: If the initial exam occurs from December 17th – December 31st of the performance period and the patient is not able to be seen for follow-up within the performance period, it would be appropriate to report the denominator exception for inadequate time for follow-up.

Numerator Options:

Performance Met: Patients who were appropriately evaluated during the initial exam AND were re-evaluated no later than 2 weeks (M1336)

OR

Denominator Exception: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) (M1335)

OR

Performance Not Met: Patients who were not appropriately evaluated during the initial exam AND/OR who were not re-evaluated within 2 weeks (M1332)

 

Rational

Retinal tears, if treated promptly, are less likely to result in detachment (AAO, 2019, ASRS, 2016). Pigmented cells and hemorrhage in the setting of an acute PVD are associated with an increased risk of retinal tears, and these findings necessitate close follow-up examination to identify and treat any associated retinal tears. Prompt treatment will minimize the potential for complications such as retinal detachment and improve a patient’s quality of life (AAO, 2014)

 

Clinical Recommendation Statements

This measure is based on clinical recommendations adapted from the AAO Preferred Practice Guidelines (AAO, 2019), which are excerpted below.

The eye examination should include the following elements:

  • Examination of the vitreous for hemorrhage, detachment, and pigmented cells
  • Careful examination of the peripheral fundus using scleral depression

There are no symptoms that can reliably distinguish between a PVD with or without an associated retinal break; therefore, a peripheral retinal examination is required. The preferred method of evaluating patients for peripheral vitreoretinal pathology is to use an indirect ophthalmoscope combined with scleral depression. Many patients with retinal tears have blood and pigmented cells in the anterior vitreous. In fully dilated eyes, slit-lamp biomicroscopy with a mirrored contact lens or a condensing lens is an alternative method in fully dilated eyes instead of a scleral depressed indirect examination of the peripheral retina.

A spontaneous vitreous hemorrhage can be the presenting sign of PVD or may occur during the evolution of the PVD. Two-thirds of patients who present with associated vitreous hemorrhage were found to have at least one break. In this subgroup, one-third had more than one break and approximately 88% of the breaks occurred in the superior quadrants.

If media opacity or patient cooperation precludes an adequate examination of the peripheral retina, B- scan ultrasonography should be performed to search for retinal tears, RRD, mass lesions, or other causes of vitreous hemorrhage. Bilateral patching and/or elevation of the head while sleeping may be used when attempting to clear the vitreous hemorrhage. If no abnormalities are found, frequent follow-up examinations are recommended (i.e., every 1–2 weeks initially). Wide-field color photography can detect some peripheral retinal breaks but does not replace careful ophthalmoscopy and may be useful in patients not able to tolerate the exam.

Even if the vitreous hemorrhage is sufficiently dense to obscure the posterior pole, the peripheral retina frequently can be examined using indirect ophthalmoscopy and scleral depression. Patients who present with vitreous hemorrhage sufficient to obscure all retinal details and have a negative B-scan ultrasonographic evaluation should be followed closely. When a retinal tear is suspected, repeat ultrasonographic examination should be performed within 1 to 2 weeks of the initial evaluation.

 

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