2023 # 014 Age-Related Macular Degeneration (AMD): Dilated Macular Examination

CMS Measure ID: #14

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

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 agerelated macular degeneration (in either one or both eyes) will submit this measure.

Measure Submission Type:

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 for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

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 the 12 month performance period

2022 Benchmarks (from 2020 CMS data)

Registry

Topped out: Yes
Capped at 7: Yes

Minimum: 0 – 87.98
Decile 3: 87.99 – 92.44
Decile 4: 92.45 – 95.81
Decile 5: 95.82 – 97.85
Decile 6: 97.86 – 99.33
Decile 7: 99.34 – 99.99
Decile 10: 100 – 100

Denominator

All patients aged ≥ 50 years and older with a diagnosis of AMD 

Denominator Criteria (Eligible Cases):
Patients aged ≥ 50 years on date of encounter

AND

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

AND

Patient encounter during the performance period (CPT): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

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

WITHOUT

Place of Service (POS): 12

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

Definitions:

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; or active choroidal neovascularization, inactive choroidal neovascularization, or with inactive scar.

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

Numerator Options:  

Performance Met: 

Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level ofmacular degeneration severity (G9974)

OR

Denominator Exception: 

Documentation of medical reason(s) for not performing a dilated macular examination (G9975)

OR

Denominator Exception: 

Documentation of patient reason(s) for not performing a dilated macular examination (G9892)

OR

Performance Not Met: 

Dilated macular exam was not performed, reason not otherwise specified (G9893)