2023 # 141 Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care

CMS Measure ID: #141

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: Yes

High Priority: Yes

NQS Domain: Communication and Care Coordination

Measure Age: > 2 years

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.

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

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 the 12 month performance period

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 0 – 1.38
Decile 1: 1.39 – 52.26
Minimum: 52.27 – 75.16
Decile 3: 75.17 – 86.3
Decile 4: 86.31 – 93.4
Decile 5: 93.41 – 96.25
Decile 6: 96.26 – 98.25
Decile 7: 98.26 – 99.37
Decile 8: 99.38 – 99.99
Decile 10: 100 – 100

Denominator

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

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, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 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 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 month performance period.

Definitions:

Plan of Care – May include: recheck of IOP at specified time, change in therapy, perform additional diagnostic evaluations, monitoring per patient decisions or health system reasons, and/or referral to a specialist.

Plan to Recheck – In the event certain factors do not allow for the IOP to be measured (e.g., patient has an eye infection) but the physician has a plan to measure the IOP at the next visit; the plan of care code should be submitted.

Glaucoma Treatment Not Failed – The most recent IOP was reduced by at least 15% in the affected eye or if both eyes were affected, the reduction of at least 15% occurred in both eyes.

Numerator Instructions:

Pre-Intervention Level – The patient’s IOP in the affected eye prior to the initiation of therapy. For patients who have just begun management of their POAG, i.e. a newly diagnosed patient or a patient recently transferred to the care of the physician, a provider can meet the measure’s performance requirements by documenting a plan of care and submitting CPT II 0517F. Patients whose POAG is well managed are assumed to have met the requirement to reduce their IOP by greater than or equal to 15% and should submit CPT II 3284F.

Numerator Options:

Performance Met:

Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level (3284F)

OR

Performance Met:

Glaucoma plan of care documented (0517F)

AND

Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level (3285F)

OR

Performance Not Met:

Glaucoma plan of care not documented, reason not otherwise specified (0517F with 8P)

AND

Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level (3285F)

OR

Performance Not Met:

IOP measurement not documented, reason not otherwise specified (3284F with 8P)