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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
141 0563 Outcome Yes Communication and Care Coordination
Registry

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months

Instructions

This measure is to be submitted a minimum of once per performance period for glaucoma patients seen during the performance period. It is anticipated that eligible clinicians who provide the primary management of patients with POAG will submit this measure.

NOTE: No notes for this Quality ID

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 whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months

Numerator Instructions:

Data not available

Numerator Quality-Data Coding Options

Performance Met: CPT II 3284F:

Intraocular Pressure (IOP) Reduced Greater Than or Equal to 15% Pre-Intervention Level

Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level

 

Performance Met: CPT II 0517F:

Intraocular Pressure (IOP) Reduced Less Than 15% Pre-Intervention Level with Plan of Care

(Two CPT II codes [0517F & 3285F] are required on the claim form to submit this numerator option)

Glaucoma plan of care documented

 

Performance Met: CPT II 3285F:

Intraocular Pressure (IOP) Reduced Less Than 15% Pre-Intervention Level with Plan of Care

(Two CPT II codes [0517F & 3285F] are required on the claim form to submit this numerator option)

Intraocular pressure (IOP) reduced by a value less than15% from the pre-intervention level

Performance Not Met: CPT II 0517F with 8P:

Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified

(Two CPT II codes [0517F-8P & 3285F] are required on the claim form to submit this numerator option) Append a submission modifier (8P) to CPT Category II code 0517F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Glaucoma plan of care not documented, reason not otherwise specified

Performance Met: CPT II 3285F:

Glaucoma Plan of Care Not Documented, Reason Not Otherwise Specified

(Two CPT II codes [0517F-8P & 3285F] are required on the claim form to submit this numerator option) Append a submission modifier (8P) to CPT Category II code 0517F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Intraocular pressure (IOP) reduced by a value less than15% from the pre-intervention level

Numerator Note:

Data not available

Denominator

All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for primary open-angle glaucoma (ICD-10-CM): H40.1111, H40.1112, H40.1113, H40.1114, H40.1121, H40.1122, H40.1123, H40.1124, H40.1131, H40.1132, H40.1133, H40.1134, H40.1211, H40.1212, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232,
H40.1233, H40.1234, H40.151, H40.152, H40.153

AND

Patient encounter during the performance period (CPT): 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

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