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SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
CATARACTS MEASURES GROUP OVERVIEW
2012 PHYSICIAN QUALITY REPORTING OPTIONS FOR MEASURES GROUPS:
REGISTRY ONLY

2012 PHYSICIAN QUALITY REPORTING MEASURES IN CATARACTS MEASURES GROUP:

#191. Cataracts: 20/40 or Bet er Visual Acuity within 90 days Following Cataract Surgery #192. Cataracts: Complications within 30 days Following Cataract Surgery Requiring Additional #303. Cataracts: Improvement in Patient’s Visual Function within 90 days Following Cataract #304. Cataracts: Patient Satisfaction within 90 days Following Cataract Surgery
INSTRUCTIONS FOR REPORTING: (These instructions apply to registry reporting. Do not
report this measures group via claims.)
• It is not necessary to submit the measures group-specific intent G-code for registry-based submissions. However, the measures group-specific intent G-code has been created for registry only measures groups for use by registries that utilize claims data. G8906: I intend to report the Cataracts Measures Group
30 Patient Sample Method: 30 unique Medicare Part B FFS (fee for service) patients
meeting patient sample criteria for the measures group. 80% Patient Sample Method: Al patients meeting patient sample criteria for the measure
group during the entire reporting period (January 1 through December 31, 2012 OR July 1
through December 31, 2012). For the 12-month reporting period, a minimum of 15 Medicare Part B FFS patients must meet the measures group patient sample criteria to report satisfactory. For the 6-month reporting period, a minimum of 8 Medicare Part B FFS patients must meet the measures group patient sample criteria to report satisfactory. • Patient sample criteria for the Cataracts Measures Group are patients aged 18 years and older that have a specific procedure for cataract surgery performed: One of the following procedure codes indicating cataract surgery: 66840, 66850,
66852, 66920, 66930, 66940, 66983, 66984 Modifier 56 (preoperative management only) • Measures #191 and #192 need only be reported when the patient also has a diagnosis of uncomplicated cataract. Refer to the measure specification on the following pages for specific codes indicating a diagnosis of uncomplicated cataract for each of these two measures. Measures #303 and #304 need not be reported when the cataract surgery
includes a modifier 55 (postoperative management only). Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
• Report a numerator option on all applicable measures within the Cataracts Measures
Group for each procedure (patient) within the eligible professional’s patient sample. • Instructions for qualifying numerator option reporting for each of the measures within the Cataracts Measures Group are displayed on the next several pages. The following composite G-code has been created for registry only measures groups for use by registries that utilize claims data. This composite G-code may be reported in lieu of the individual quality-data codes for each of the measures within the group, if all quality actions for the patient have been performed for all the measures within the group. However, it is not necessary to submit the following composite G-code for registry-based submissions.
Composite G-code G8765: Al quality actions for the applicable measures in the
Cataracts Measures Group have been performed for this patient • To report satisfactorily the Cataracts Measures Group it requires all applicable measures
for each patient within the eligible professional’s patient sample to be reported each time a cataract surgery is performed during the reporting period. • Measures groups containing a measure with a 0% performance rate wil not be counted as satisfactorily reporting the measures group. The recommended clinical quality action must be performed on at least one patient for each measure within the measures group reported by the eligible professional. Performance exclusion quality data codes are not counted in the performance denominator. If the eligible professional submits all performance exclusion quality data codes, the performance rate would be 0/0 and would be considered satisfactorily reporting. If a measure within a measures group is not applicable to a patient, the patient would not be counted in the performance denominator for that measure (e.g., Preventive Care Measures Group - Measure #39: Screening or Therapy for Osteoporosis for Women would not be applicable to male patients according to the patient sample criteria). If the measure is not applicable for all patients within the sample, the performance rate would be 0/0 and would be considered satisfactorily reporting. When a lower rate indicates better performance, such as Measure #192, a 0% performance rate wil be counted as satisfactorily reporting (100% performance rate would not be considered • When using the 30 Patient Sample Method, report all applicable measures for the 30 unique Medicare Part B FFS patients seen. When using the 80% Patient Sample Method, report all applicable measures on at least 80% of the patient sample for the eligible professional for the 12-month or 6-month reporting period. NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For all other claims-based or registry-based reporting options, please see the measures’ full specifications in the document “2012 Physician Quality Reporting Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS Physician Quality Reporting website Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Fol owing Cataract

DESCRIPTION:

Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days
Note: This is an outcomes measure and can be calculated solely using registry data.
• For patients who receive the cataract surgical procedures specified in the common denominator coding, it should be reported whether or not the patient had best- corrected visual acuity of 20/40 or better achieved within 90 days following cataract • Patients who have any of the listed comorbid conditions in the exclusion criteria should be removed from the denominator; these patients have existing ocular conditions that could impact the outcome of surgery and are not included in the measure calculation for those patients who have best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery. • Include only procedures performed through September 30 of the reporting period. This will allow the post operative period to occur within the reporting year. Patients with documentation of any of the following comorbid conditions that
impact the visual outcome of surgery prior to date of cataract surgery are excluded
from the measure calculation.
Comorbid Condition
Corresponding ICD-9-CM Codes
Acute and subacute iridocyclitis 364.00, 364.01, 364.02, 364.03, 364.04, 364.05 940.0, 940.1, 940.2, 940.3, 940.4, 940.5, 940.9 371.20, 371.21, 371.22, 371.23, 371.43, 371.44 362.50, 362.51, 362.52, 362.53, 362.54, 362.55, Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Comorbid Condition
Corresponding ICD-9-CM Codes
362.01, 362.02, 362.03, 362.04, 362.05, 362.06 Disseminated chorioretinitis and 363.10, 363.11, 363.12, 363.13, 363.14, 363.15 363.00, 363.01, 363.03, 363.04, 363.05, 363.06, 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.20, 365.21, 365.22, 365.23, 365.24, 365.31, 365.32, 365.51, 365.52, 365.59, 365.60, 365.61, 365.62, 365.63, 365.64, 365.65, 365.81, 365.82, 365.41, 365.42, 365.43, 365.44, 365.60, 365.61, 365.62, 365.63, 365.64, 365.65, 365.81, 365.82, 371.50, 371.51, 371.52, 371.53, 371.54, 371.55, Hereditary choroidal dystrophies 363.50, 363.51, 363.52, 363.53, 363.54, 363.55, 362.70, 362.71, 362.72, 362.73, 362.74, 362.75, Moderate or severe impairment, 369.10, 369.11, 369.12, 369.13, 369.14, 369.15, better eye, profound impairment 369.16, 369.17, 369.18 871.0, 871.1, 871.2, 871.3, 871.4, 871.5, 871.6, 377.10, 377.11, 377.12, 377.13, 377.14, 377.15, 377.30, 377.31, 377.32, 377.33, 377.34, 377.39 362.81, 362.82, 362.83, 362.84, 362.85, 362.89 Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Comorbid Condition
Corresponding ICD-9-CM Codes
Profound impairment, both eyes 369.00, 369.01, 369.02, 369.03, 369.04, 369.05, 361.00, 361.01, 361.02, 361.03, 361.04, 361.05, 362.20, 362.21, 362.22, 362.23, 362.24, 362.25,
NUMERATOR:
Patients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved within Numerator Options:
Best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days Best-corrected visual acuity of 20/40 or better (distance or near) not achieved within 90
days following cataract surgery, reason not otherwise specified (4175F with 8P) NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For all other claims-based or registry-based reporting options, please see the measures’ full specifications in the document “2012 Physician Quality Reporting Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS Physician Quality Reporting website Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #192: Cataracts: Complications within 30 Days Fol owing Cataract Surgery
Requiring Additional Surgical Procedures

DESCRIPTION:

Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or
Note: This is an outcomes measure and can be calculated solely using registry data.
• For patients who receive the cataract surgical procedures specified in the denominator coding, claims should be reviewed to determine if any of the procedure codes listed in the numerator were performed within 30 days of the date of cataract surgery. • Patients who have any of the listed comorbid conditions in the exclusion criteria should be removed from the denominator, and not considered as having a complication within 30 Patients with documentation of one or more of the following comorbid conditions
prior to date of cataract surgery are excluded from the measure calculation.
Comorbid Condition
Corresponding ICD-9-CM Codes
940.0, 940.1, 940.2, 940.3, 940.4, 940.5, Cataract secondary to ocular disorders 366.32, 366.33 Cataract, congenital Corneal opacity and other disorders of 371.00, 371.03, 371.04 Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Comorbid Condition
Corresponding ICD-9-CM Codes
Cysts of iris, ciliary body, and anterior 364.60, 364.61, 364.62, 364.63, 364.64 871.0, 871.1, 871.2, 871.3, 871.4, 871.5, 67036, 67039, 67040, 67041, 67042, 67043 (patient with history of this procedure) Use of systemic sympathetic alpha-1a Patient taking tamsulosin hydrochloride
NUMERATOR:

Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Numerator Instructions: Codes for major complications (e.g., retained nuclear fragments,
endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence): 65235, 65800, 65810, 65815, 65860, 65880, 65900, 65920, 65930, 66030, 66250, 66820, 66825, 66830, 66852, 66986, 67005, 67010, 67015, 67025, 67028, 67030, 67031, 67036, 67039, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112,
NUMERATOR NOTE:
For performance, a lower rate indicates better performance.

Numerator Options:

Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence) (G8627) Surgical procedure not performed within 30 days following cataract surgery for major
complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment or wound dehiscence) (G8628)

.


NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures

groups option. For all other claims-based or registry-based reporting options, please see the measures’ full specifications in the document “2012 Physician Quality Reporting Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS Physician Quality Reporting website Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #303: Improvement in Patient’s Visual Function within 90 Days Following
Cataract Surgery

DESCRIPTION:

Percentage of patients aged 18 years and older in sample who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and post-operative visual function survey
Note: This is an outcomes measure and wil be calculated solely using registry data.
• For patients who receive the cataract surgical procedures specified in the denominator coding in the sample, it should be reported whether or not the patient had improvement in visual function achieved within 90 days following the cataract • Include only procedures performed through September 30 of the reporting period. This will allow the post-operative period to occur within the reporting year.
NUMERATOR:
Patients 18 years and older who had improvement in visual function achieved within 90 days following cataract surgery, based on completing a pre-operative and post-operative visual function Numerator Options:
Improvement in visual function achieved within 90 days following cataract surgery (G0913) Patient care survey was not completed by patient (G0914) Improvement in visual function not achieved within 90 days following cataract surgery
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For all other claims-based or registry-based reporting options, please see the measures’ full specifications in the document “2012 Physician Quality Reporting Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS Physician Quality Reporting website. Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #304: Patient Satisfaction within 90 Days Following Cataract Surgery

DESCRIPTION:

Percentage of patients aged 18 years and older in sample who had cataract surgery and were satisfied with their care within 90 days following the cataract surgery, based on completion of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey
Note: This is an outcomes measure and wil be calculated solely using registry data.
• For patients who receive the cataract surgical procedures specified in the denominator coding in the sample, it should be reported whether or not the patient was satisfied with their care within 90 days following the cataract surgery. • Include only procedures performed through September 30 of the reporting period. This will allow the post-operative period to occur within the reporting year.
NUMERATOR:

Patients 18 years and older in the sample who were satisfied with their care within 90 days following cataract surgery, based on completion of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey Numerator Options:
Satisfaction with care achieved within 90 days following cataract surgery (G0916) Patient care survey was not completed by patient (G0917) Satisfaction with care not achieved within 90 days following cataract surgery (G0918)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For all other claims-based or registry-based reporting options, please see the measures’ full specifications in the document “2012 Physician Quality Reporting Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS Physician Quality Reporting website. Version 5.1 CPT only copyright 2011 American Medical Association. Al rights reserved. 12/15/2011

Source: http://www.mdinteractive.net/files/uploaded/2012_Cataracts_PhysQualRptg_MeasuresGroups_SpecificationsManual_12152011.pdf

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