Measure Description
Percentage of patients with a diagnosis of acute posterior vitreous detachment (PVD) in either eye who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks.
Instructions
This measure is to be submitted once for once per performance period for denominator eligible cases as defined in the denominator criteria.
Intent and Clinician Applicability:
This measure is intended to reflect the quality of services provided for patients with a diagnosis of acute posterior vitreous detachment (PVD). This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions, as defined by the numerator, based on the services provided the measure-specific denominator coding.
Measure Strata and Performance Rates:
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. Implementation Considerations: For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.
Telehealth:
This measure is not appropriate for nor applicable to the telehealth setting. Patient encounters for this measure conducted via telehealth should be removed from the denominator eligible patient population. Therefore, if the patient meets all denominator criteria but the encounter is conducted via telehealth, it would be appropriate to remove them from the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.
Measure Submission:
The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic. When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. 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 in either eye and eligible encounter during performance period
Definition:
Acute PVD – For the purposes of this measure, acute PVD is defined as a recent onset of 30 days or less. Acute can be documented as new onset vitreous separation or vitreous detachment.
DENOMINATOR NOTE: A new diagnosis code, that meets the definition of acute PVD, indicates a new occurrence of PVD. If there are multiple occurrences of acute PVD, then the most recent occurrence should be utilized as denominator eligible for the purposes of submitting this measure.
*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 posterior vitreous detachment (ICD-10-CM): H43.811, H43.812, H43.813, H43.819
AND
Acute PVD: M1383
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
Encounters conducted via telehealth: M1426
AND NOT
DENOMINATOR EXCLUSIONS:
Patients with a post-operative encounter of the eye with the acute PVD within 2 weeks before the initial encounter or 8 weeks after initial acute PVD encounter: M1329
OR
Patients with a diagnosis of acute vitreous hemorrhage: M1328
Numerator
Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 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 8 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 November 5th – 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 8 weeks from initial exam (M1331)
OR
Denominator Exception: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) (M1330)
OR
Performance Not Met: Patients who were not appropriately evaluated during the initial exam AND/OR who were not re-evaluated within 8 weeks (M1327)
Rationale
Retinal tears, if treated promptly, are less likely to result in detachment (AAO, 2019; ASRS, 2016). Most retinal tears occur in the setting of an acute PVD where patient experience flashes of light and/or new onset of floaters. While the onset of PVD is generally not preventable, prompt examination is critical 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, 2019).
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.
Follow-up Evaluation:
The guidelines in Table 3 are recommendations for the timing of re-evaluation in the absence of additional symptoms. Patients with new symptoms or a change in symptoms may require more frequent evaluation. Patients with no positive findings at the initial examination should be seen at the intervals recommended in the Comprehensive Adult Medical Eye Evaluation PPP. All patients with risk factors should be advised to contact their ophthalmologist promptly if new symptoms such as flashes, floaters, peripheral visual field loss, or decreased visual acuity develop.
Type of Lesion
- Symptomatic PVD with no retinal break
Follow-up Interval
- Depending on symptoms, risk factors, and clinical findings, patients may be followed within 2 months, then 6–12 months