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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
012 0086 Process Yes Effective Clinical Care Claims

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 eligible clinicians who provide the primary management of patients with primary open-angle glaucoma (in either one or both eyes) will submit this measure.

NOTE: No additional notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients who have an optic nerve head evaluation during one or more office visits within 12 months

 

Definition

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

Numerator Quality-Data Coding Options

Performance Met: CPT II 2027F:
Optic Nerve Head Evaluation Performed:

Optic nerve head evaluation performed

Denominator Exception: 2027F with 1P:
Optic Nerve Head Evaluation not Performed for Medical Reasons:

Documentation of medical reason(s) for not performing an optic nerve head evaluation

Performance Not Met: 2027F with 8P:
Optic Nerve Head Evaluation not Performed, Reason not Otherwise Specified

Optic nerve head evaluation was not performed, reason not otherwise specified

Append a submission modifier (8P) to CPT Category II code 5015F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

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 PFS
(Physician Fee Schedule). These non-covered services will not be counted in the denominator population
for claims-based measures.

Option 1 – 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, H40.1190, H40.1191, H40.1192, H40.1193, H40.1194, 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, H40.1290, H40.1291, H40.1292, H40.1293, H40.1294, H40.151, H40.152, H40.153, H40.159

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