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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
014 0087 Process No Effective Clinical Care Claims, Registry

Measure Description

Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity 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 age-related macular degeneration (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 had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

NUMERATOR NOTE: Denominator Exception(s) are determined on any date during the performance period prior to the date of the denominator eligible encounter

Definition

Macular Thickening – Acceptable synonyms for “macular thickening” include: intraretinal thickening, serous detachment of the retina, pigment epithelial detachment or macular edema.

Severity of Macular Degeneration – Early, intermediate and advanced.

Geographic Atrophy – the advanced form of non-neovascular AMD, will have one or more zones of well demarcated retinal pigment epithelial and/or choriocapillaris atrophy

Numerator Quality-Data Coding Options

Performance Met: G9974:
Dilated Macular Examination Performed:

Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND
the level of macular degeneration severity

Denominator Exception: G9975:

Submit code G9975 or G9892 for documented circumstances that appropriately exclude patients from the denominator

Denominator Exception: G9975:

Documentation of medical reason(s) for not performing a dilated macular examination

Denominator Exception: G9892:

Documentation of patient reason(s) for not performing a dilated macular examination

Performance Not Met: G9893:
Dilated Macular Examination not Performed, Reason not Otherwise Specified:

Dilated macular exam was not performed, reason not otherwise specified

Submit code G9893 for circumstances when the action described in the numerator is not performed and the
reason is 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 50 years and older with a diagnosis of AMD

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 ≥ 50 years on date of encounter

 

AND

Diagnosis for age-related macular degeneration  (ICD-10-CM)

H35.30, H35.3110, H35.3111, H35.3112, H35.3113, H35.3114, H35.3120, H35.3121, H35.3122, H35.3123, H35.3124, H35.3130, H35.3131, H35.3132, H35.3133, H35.3134, H35.3210, H35.3211, H35.3212, H35.3213, H35.3220, H35.3221, H35.3222, H35.3223, H35.3230, H35.3231, H35.3232, H35.3233

 

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