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Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery

Last updated: September 14, 2018

CMS Measure ID: CMS133v7
Version: 7
NQF Number: 0565
Measure 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 following the cataract surgery

Initial Patient Population:

All patients aged 18 years and older who had cataract surgery and did not meet any exclusion criteria

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

Patients with significant ocular conditions impacting the visual outcome of surgery

Numerator Statement:

Patients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following cataract surgery

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

This is an episode-based measure, meaning there may be more than one reportable event for a given patient during the measurement period. The level of analysis for this measure is each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominatorinfo-icon event for the measure calculation.

Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial populationinfo-icon.

The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificityinfo-icon (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professionalinfo-icon or eligible clinicianinfo-icon will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.

Quality ID: 191
Meaningful Measure: Management of Chronic Conditions

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated References.

    Measure Section: Reference

    Source of Change: Measure Lead

Logic

  • Replaced SNOMEDCT single code value setsinfo-icon with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: Numeratorinfo-icon

    Source of Change: Standards Update

  • Added supplemental timing attributes to most datatypes in QDMinfo-icon 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Acute and Subacute Iridocyclitis (2.16.840.1.113883.3.526.3.1241): Deleted 5 ICD10CM codes (H20.019, H20.029, H20.039, H20.049, H20.059).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Burn Confined to Eye and Adnexa (2.16.840.1.113883.3.526.3.1409): Deleted 10 ICD10CM codes (T26.00XA, T26.10XA, T26.20XA, T26.30XA, T26.40XA, T26.50XA, T26.60XA, T26.70XA, T26.80XA, T26.90XA).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Cataract Secondary to Ocular Disorders (2.16.840.1.113883.3.526.3.1410): Deleted 2 ICD10CM codes (H26.219, H26.229). Added 2 SNOMEDCT codes (15738161000119104, 15738201000119109).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Certain Types of Iridocyclitis (2.16.840.1.113883.3.526.3.1415): Deleted 4 ICD10CM codes (H20.20, H20.819, H20.829, H40.40X0).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Chronic Iridocyclitis (2.16.840.1.113883.3.526.3.1416): Deleted 1 ICD10CM code (H20.10). Added 1 SNOMEDCT code (6869001).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Cloudy Cornea (2.16.840.1.113883.3.526.3.1417): Deleted 4 ICD10CM codes (H17.00, H17.10, H17.819, H17.829).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Corneal Edema (2.16.840.1.113883.3.526.3.1418): Deleted 4 ICD10CM codes (H18.10, H18.229, H18.239, H18.429). Added 7 SNOMEDCT codes (15736081000119108, 15736161000119100, 15736201000119105, 15736241000119107, 15736281000119102, 373428006, 373430008).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Corneal Opacity and Other Disorders of Cornea (2.16.840.1.113883.3.526.3.1419): Deleted 2 ICD10CM codes (H17.00, H17.10).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hereditary Corneal Dystrophies (2.16.840.1.113883.3.526.3.1424): Deleted 2 SNOMEDCT codes (231936006, 32935005).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Injury to Optic Nerve and Pathways (2.16.840.1.113883.3.526.3.1427): Deleted 3 ICD10CM codes (S04.019A, S04.039A, S04.049A). Added 1 SNOMEDCT code (230513000).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Central Corneal Ulcer (2.16.840.1.113883.3.526.3.1428): Deleted 1 ICD10CM code (H16.019).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Open Wound of Eyeball (2.16.840.1.113883.3.526.3.1430): Deleted 8 ICD10CM codes (S05.10XA, S05.20XA, S05.30XA, S05.50XA, S05.60XA, S05.70XA, S05.8X9A, S05.90XA). Added 5 SNOMEDCT codes (12403101000119108, 3018008, 416931008, 722613000, 95725002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Pathologic Myopia (2.16.840.1.113883.3.526.3.1432): Deleted 5 ICD10CM codes (H44.20, H44.2A9, H44.2B9, H44.2C9, H44.2D9).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Uveitis (2.16.840.1.113883.3.526.3.1444): Deleted 2 ICD10CM codes (H44.119, H44.139).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Visual Field Defects (2.16.840.1.113883.3.526.3.1446): Deleted 1 ICD10CM code (H53.419).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Amblyopia (2.16.840.1.113883.3.526.3.1448): Added 3 ICD10CM codes (H53.001, H53.002, H53.003) and deleted 4 ICD10CM codes (H53.019, H53.029, H53.039, H53.049). Added 1 ICD9CM code (368.00).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Choroidal Degenerations (2.16.840.1.113883.3.526.3.1450): Deleted 1 SNOMEDCT code (392049002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Chorioretinal Scars (2.16.840.1.113883.3.526.3.1449): Deleted 4 ICD10CM codes (H31.009, H31.019, H31.029, H31.099).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Choroidal Detachment (2.16.840.1.113883.3.526.3.1451): Deleted 1 ICD10CM code (H31.419).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Choroidal Hemorrhage and Rupture (2.16.840.1.113883.3.526.3.1452): Deleted 3 ICD10CM codes (H31.309, H31.319, H31.329).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Degenerative Disorders of Globe (2.16.840.1.113883.3.526.3.1454): Deleted 8 ICD10CM codes (H44.20, H44.2A9, H44.2B9, H44.2C9, H44.2D9, H44.319, H44.329, H44.399).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Disorders of Visual Cortex (2.16.840.1.113883.3.526.3.1458): Deleted 1 ICD10CM code (H47.619).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Disseminated Chorioretinitis and Disseminated Retinochoroiditis (2.16.840.1.113883.3.526.3.1459): Deleted 5 ICD10CM codes (H30.109, H30.119, H30.129, H30.139, H30.149).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Focal Chorioretinitis and Focal Retinochoroiditis (2.16.840.1.113883.3.526.3.1460): Deleted 5 ICD10CM codes (H30.009, H30.019, H30.029, H30.039, H30.049).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes (2.16.840.1.113883.3.526.3.1461): Deleted 18 ICD10CM codes. Added 16 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Moderate or Severe Impairment, Better Eye, Profound Impairment Lesser Eye (2.16.840.1.113883.3.526.3.1464): Deleted 3 ICD10CM codes (H54.10, H54.11, H54.12). Added 7 SNOMEDCT codes (193714008, 193716005, 193718006, 193719003, 193720009, 23320001, 4490000).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Nystagmus and Other Irregular Eye Movements (2.16.840.1.113883.3.526.3.1465): Added 2 SNOMEDCT codes (285765003, 68610001).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Optic Atrophy (2.16.840.1.113883.3.526.3.1466): Deleted 3 ICD10CM codes (H47.219, H47.239, H47.299). Added 5 SNOMEDCT codes (715374003, 717336005, 717975006, 718221007, 719517009).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Optic Neuritis (2.16.840.1.113883.3.526.3.1467): Deleted 2 ICD10CM codes (H46.00, H46.10). Added 4 SNOMEDCT codes (15631011000119102, 15631051000119101, 2691000124105, 432521000124106).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis (2.16.840.1.113883.3.526.3.1468): Deleted 4 ICD10CM codes (H30.20, H30.819, H30.899, H30.90). Deleted 1 SNOMEDCT code (72764003).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Background Retinopathy and Retinal Vascular Changes (2.16.840.1.113883.3.526.3.1469): Deleted 3 ICD10CM codes (H35.029, H35.059, H35.069). Added 2 SNOMEDCT codes (677651000119102, 677681000119109).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Corneal Deformities (2.16.840.1.113883.3.526.3.1470): Deleted 4 ICD10CM codes (H18.719, H18.729, H18.739, H18.799).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Disorders of Optic Nerve (2.16.840.1.113883.3.526.3.1471): Deleted 1 ICD10CM code (H47.019). Added 2 SNOMEDCT codes (15731601000119100, 15731641000119103).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Disorders of Sclera (2.16.840.1.113883.3.526.3.1472): Deleted 2 ICD10CM codes (H15.839, H15.849).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Endophthalmitis (2.16.840.1.113883.3.526.3.1473): Deleted 6 ICD10CM codes (H16.249, H21.339, H33.129, H44.119, H44.139, H44.129). Added 1 SNOMEDCT code (415737009).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Retinal Disorders (2.16.840.1.113883.3.526.3.1474): Deleted 1 ICD10CM code (H35.60).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Prior Penetrating Keratoplasty (2.16.840.1.113883.3.526.3.1475): Deleted 3 ICD10CM codes (H18.609, H18.619, H18.629). Deleted 1 SNOMEDCT code (424960002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Profound Impairment, Both Eyes (2.16.840.1.113883.3.526.3.1476): Deleted 2 ICD10CM codes (H54.0, H54.10). Added 1 SNOMEDCT code (193699007) and deleted 19 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Purulent Endophthalmitis (2.16.840.1.113883.3.526.3.1477): Deleted 3 ICD10CM codes (H44.009, H44.019, H44.029). Added 2 SNOMEDCT codes (15678441000119103, 15678481000119108).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Retinal Detachment with Retinal Defect (2.16.840.1.113883.3.526.3.1478): Deleted 6 ICD10CM codes (H33.009, H33.019, H33.029, H33.039, H33.049, H33.059).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Other Proliferative Retinopathy (2.16.840.1.113883.3.526.3.1480): Deleted 8 ICD10CM codes (H35.109, H35.119, H35.129, H35.139, H35.179, H35.149, H35.159, H35.169).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Scleritis and Episcleritis (2.16.840.1.113883.3.526.3.1481): Deleted 5 ICD10CM codes (H15.029, H15.039, H15.049, H15.059, H15.099).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Separation of Retinal Layers (2.16.840.1.113883.3.526.3.1482): Deleted 3 ICD10CM codes (H35.719, H35.729, H35.739).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Degeneration of Macula and Posterior Pole (2.16.840.1.113883.3.526.3.1453): Deleted 16 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Diabetic Macular Edema (2.16.840.1.113883.3.526.3.1455): Deleted 65 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Retinal Vascular Occlusion (2.16.840.1.113883.3.526.3.1479): Deleted 16 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Diabetic Retinopathy (2.16.840.1.113883.3.526.3.327): Deleted 99 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Glaucoma (2.16.840.1.113883.3.526.3.1423): Deleted 57 ICD10CM codes. Added 93 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Value set Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes (2.16.840.1.113883.3.526.3.1461): Added 1 SNOMEDCT code (95717004) and deleted 1 SNOMEDCT code (193551004).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Retinal Detachment with Retinal Defect (2.16.840.1.113883.3.526.3.1478): Deleted 2 SNOMEDCT codes (193321006, 267608003).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Separation of Retinal Layers (2.16.840.1.113883.3.526.3.1482): Added 1 SNOMEDCT code (232004004) and deleted 3 SNOMEDCT codes (193321006, 267608003, 43031006).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Glaucoma (2.16.840.1.113883.3.526.3.1423): Deleted 2 SNOMEDCT codes (15739841000119103, 193551004).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources