2023 # 389 Cataract Surgery: Difference Between Planned and Final Refraction

CMS Measure ID: #389

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: Yes

High Priority: Yes

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be calculated each time a cataract procedure is performed during the performance period. This measure is intended to reflect the quality of services provided for the patient receiving cataract surgery.

Note: This is an outcome measure and will be calculated solely using registry data.

  • For patients who receive the surgical procedures specified in the denominator coding, it should be reported whether or not the patient had a difference between planned and final refraction.
  • Include only procedures performed through September 30 of the performance period. This will allow the post- operative period to occur before registries must submit data to CMS.

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 18 years and older who had cataract surgery performed and who achieved a final refraction within +/- 1.0 diopters of their planned (target) refraction

2022 Benchmarks (from 2020 CMS data)

Registry

Topped out: No
Capped at 7: No

Minimum: 0 – 22.57
Decile 3: 22.58 – 30.5
Decile 4: 30.51 – 40.47
Decile 5: 40.48 – 69.93
Decile 6: 69.94 – 92.85
Decile 7: 92.86 – 97.19
Decile 8: 97.2 – 99.86
Decile 10: 100 – 100
Decile 9: 99.87 – 99.99

Denominator

All patients aged 18 years and older who had cataract surgery

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter

AND

Patient encounter during the performance period (CPT): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988

WITHOUT

Modifier: 55 or 56

WITHOUT

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

Numerator

Patients who achieved a final refraction (spherical equivalent) of +/- 1.0 diopters of their planned (target) refraction (spherical equivalent) within 90 days following cataract surgery. The refraction planned and final refraction values should correspond to the eye that underwent the cataract procedure

Numerator Options:

Performance Met:

Patient achieves final refraction (spherical equivalent) +/- 1.0 Diopters of their planned refraction within 90 days of surgery (G9519)

OR

Performance Not Met:

Patient does not achieve final refraction (spherical equivalent) +/- 1.0 Diopters of their planned refraction within 90 days of surgery (G9520)


Tags

CQM-2023