MIPS Clinical Quality Measures (CQMS)
Description
Percentage of patients with a diagnosis of acute posterior vitreous detachment (PVD) in either eye who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks.
Instructions
This measure is to be submitted once for each occurrence of acute PVD in either eye during the performance period. For the purpose of submitting this measure, only unique occurrences with an onset of acute PVD diagnosed within the current performance period will be submitted. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided the measure-specific denominator coding.
Measure Submission Type
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. 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 by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
Patients with a diagnosis of acute PVD in either eye and eligible encounter during performance period
Definition:
Acute PVD – For the purposes of this measure, acute PVD is defined as a recent onset of 30 days or less. Acute can be documented as new onset vitreous separation or vitreous detachment.
DENOMINATOR NOTE: A new diagnosis code, that meets the definition of acute, indicates a new occurrence of PVD. If a patient presents with right eye acute PVD then returns with new onset of left eye acute PVD symptoms, then the left eye diagnosed as acute PVD would be considered a new unique occurrence, separate from the right eye acute PVD occurrence.
*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for posterior vitreous detachment (ICD-10-CM): H33.001, H33.002, H33.003, H33.009, H33.011, H33.012, H33.013, H33.019, H33.021, H33.022, H33.023, H33.029, H33.031, H33.032, H33.033, H33.039, H33.041, H33.042, H33.043, H33.049, H33.051, H33.052, H33.053, H33.059, H33.301, H33.302, H33.303, H33.309, H33.311, H33.312, H33.313, H33.319, H33.321, H33.322, H33.323, H33.329, H33.331, H33.332, H33.333, H33.339, H33.40, H33.41, H33.42, H33.43, H33.8, H35.411, H35.412, H35.413, H35.419, H43.811, H43.812, H43.813, H43.819
AND
Patient encounters during the performance period (CPT): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02, POS 10
Denominator Exclusions:
Patients with a post-operative encounter of the eye with the acute PVD within 2 weeks before the initial encounter or 8 weeks after initial acute PVD encounter: M1329
OR
Patients with a diagnosis of acute vitreous hemorrhage: M1328
Numerator:
Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks
Definitions:
Initial exam – To meet performance of the measure, an initial exam must include a vitreous examination AND peripheral dilated examination with documentation of scleral depression of the affected eye or contact lens (e.g., 3-mirror Goldmann) that provides visualization to the ora for 360 degrees OR if the retina cannot be adequately visualized, then ultrasound was performed OR referred to another provider for additional examination (e.g., if retina cannot be visualized and ultrasound is not available).
Re-evaluation exam – To meet performance of the measure, a re-evaluation must occur no later than 8 weeks from initial examination and must include a vitreous examination AND an adequate dilated examination to evaluate the peripheral retina for tears or detachment OR if the retina cannot be adequately visualized, then ultrasound was performed OR referred to another provider for additional examination (e.g., if retina cannot be visualized and ultrasound is not available).
NUMERATOR NOTE: If the initial exam occurs from November 5th – December 31st of the performance period and the patient is not able to be seen for follow-up within the performance period, it would be appropriate to report the denominator exception for inadequate time for follow-up.
Numerator Options:
Performance Met: Patients who were appropriately evaluated during the initial exam AND were re-evaluated no later than 8 weeks from initial exam (M1331)
OR
Denominator Exception: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) (M1330)
OR
Performance Not Met: Patients who were not appropriately evaluated during the initial exam AND/OR who were not re-evaluated within 8 weeks (M1327)
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