MIPS Clinical Quality Measures (CQMS)
MEASURE TYPE: Outcome – High Priority
Description
Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment and achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye.
Instructions
This measure is to be submitted each time a procedure for primary rhegmatogenous retinal detachment is performed during the performance period. This measure is intended to reflect the quality of services provided for the patient receiving primary rhegmatogenous retinal detachment surgery.
NOTE: This is an outcome measure and will be calculated solely using MIPS eligible clinician, group, or third-party intermediary submitted data.
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For patients who receive the surgical procedures specified in the denominator coding, it should be submitted whether or not the patient achieved an improvement of their visual acuity within 90 days of surgery.
Include only procedures performed through September 30 of the performance period. This will allow the post- operative period to occur before third-party intermediaries must submit data to CMS.
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 aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on the date of the procedure
AND
Patient procedure during the performance period (CPT): 67107, 67108, 67110
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02, POS 10
AND NOT
Denominator Exclusions:
Patients with a pre-operative visual acuity better than 20/40
OR
Surgical procedures that included the use of silicone oil: G9757
Numerator
Patients who achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye
Numerator Options:
Performance Met: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery (G9516)
OR
Performance Not Met: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given (G9517)
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