eMeasure Title : Complications within 30 Days Following Surgery Requiring Additional Surgical Procedures eMeasure 132 eMeasure 4.0.000 Identifier Version (Measure number Authoring Tool)

NQF Number 0564 GUID 9a0339c2-3d9b- 11e1-8634- 00237d5bf174

Measurement January 1, 20XX through December 31, 20XX Period

Measure Steward American Medical Association-convened Consortium for Performance Improvement(R) (AMA-PCPI)

Measure American Medical Association-convened Physician Consortium Developer for Performance Improvement(R) (AMA-PCPI)

Endorsed By National Quality Forum

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, , dislocated or wrong power IOL, , or wound dehiscence

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Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004- 2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.

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Measure Scoring Proportion

Measure Type Outcome

Measure Item Procedure, Performed: Cataract Surgery Count

Stratification None

Risk Adjustment None

Rate None Aggregation

Rationale 1. Scientific basis for assessing short-term complications following cataract surgery Complications that may result in a permanent loss of vision following cataract surgery are uncommon. This short-term outcome of surgery indicator seeks to identify those complications from surgery that can reasonably be attributed to the surgery and and which reflect situations which - if untreated - generally result in significant avoidable vision loss that would negatively impact patient functioning. Further, it seeks to reduce surgeon burden and enhance accuracy in reporting by focusing on those significant complications that can be assessed from administrative data alone and which can be captured by the care of another physician or the provision of additional, separately coded, post-operative services. Finally, it focuses on patient safety and monitoring for events that, while hopefully uncommon, can signify important issues in the care being provided. For example, the need to reposition or exchange an intraocular (IOL) reflects in part "wrong power" IOL placement, a major patient safety issue.

In order to achieve these ends, the indicator excludes patients with other known, pre-operative ocular conditions that could impact the likelihood of developing a . Based on the results of the Cataract Appropriateness Project at RAND, other published studies, and one analysis performed on a national MCO data base, the exclusion codes would preserve over 2/3 of all cataract surgery cases for analysis. Thus, this provides a "clean" indicator that captures care for the large majority of patients undergoing cataract surgery.

2. Evidence for gap in care The advances in technology and surgical skills over the last 30 years have made cataract surgery much safer and more effective. An analysis of a single company's database (commercial age MCO) demonstrated that the rate of complications found for this indicator was approximately 1 to 2%. Nevertheless, as noted above, the occurrence of one of these events is associated with a significant potential for vision loss that is otherwise avoidable. Furthermore, with an annual volume of 2.8 million cataract surgeries in the US, a 2% rate would mean that over 36,000 surgeries are accompanied by these complications (2/3 of 56,000 surgeries).

A synthesis of the literature published prior to 1992 found weighted mean complication rates among all patients undergoing cataract surgery of 0.13% for endophthalmitis, 0.3% for bullous keratopathy, 1.4% clinically detectable CME, 3.5% for angiographically demonstrated CME, 0.7% for retinal detachment, and 1.1% for IOL dislocation. Bullous keratopathy and CME are not included in this indicator because they are conditions that are almost always temporary and resolve without additional intervention through additional procedures and associated care in this population of patients without prior known ocular conditions.

Additional studies similarly demonstrate the low occurrence of complications, including many that are temporary in nature and without a significant impact on patient outcomes. A national survey of over 100 hospitals from 1997 to 1998 found the following results on 18,454 patients 50 years old or older. Seventy-seven percent of these patients had surgery performed by . Rates for events that occurred during surgery were 4.4% for posterior capsule rupture and vitreous loss, 1.0% for incomplete cortical cleanup, 1.0% for anterior chamber hemorrhage and or collapse, and 0.77% for damage. Short-term (within 48 hours) perioperative complications included corneal edema (9.5%), increased IOP (7.9%), uveitis (5.6%), wound leak (1.2%), hyphema (1.1%), and retained lens material (1.1%).

A retrospective study from New Zealand of 1,793 consecutive patients undergoing phacoemulsification reported a rate of 1.8% for posterior capsule rupture and a rate of 1.2% for rhegmatogenous retinal detachment. (AAO, 2006)

Clinical This is an outcome measure. As such, there are no statements Recommendation in the guideline specific to this measurement topic. Statement

Improvement Lower score indicates better quality Notation

Reference American Academy of . Preferred Practice Pattern: Cataract In the Adult . 2006.

Reference Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999 Dec;83(12):1336-40.

Reference Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J, Steinberg EP. Synthesis of the literature on and complications following cataract extraction with implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994 Feb;112(2):239-52.

Reference Russell M, Gaskin B, Russell D, Polkinghorne PJ. Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review. J Cataract Refract Surg 2006 Mar;32(3):442-5.

Definition None

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. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.

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 specificity (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 professional 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.

Transmission TBD Format

Initial All patients aged 18 years and older who had cataract surgery Population and no significant ocular conditions impacting the surgical complication rate

Denominator Equals Initial Population

Denominator Patients with any one of a specified list of significant ocular Exclusions conditions that impact the surgical complication rate

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

Numerator Not Applicable Exclusions

Denominator None Exceptions

Measure Not Applicable Population

Measure Not Applicable Population Exclusions

Measure Not Applicable Observations Supplemental For every patient evaluated by this measure also identify payer, Data Elements race, ethnicity and sex.

Table of Contents

 Population Criteria  Data Criteria (QDM Variables)  Data Criteria (QDM Data Elements)  Supplemental Data Elements  Risk Adjustment Variables

Population Criteria

 Initial Population = o AND: Age >= 18 year(s) at: "Measurement Period" o AND: "Occurrence A of Procedure, Performed: Cataract Surgery" during "Measurement Period"  Denominator = o AND: Initial Population  Denominator Exclusions = o OR: Union of: . "Procedure, Performed: Prior Pars Plana " ends before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Acute and Subacute Iridocyclitis" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Adhesions and Disruptions of Iris and Ciliary Body" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Central " satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Burn Confined to Eye and Adnexa" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Pseudoexfoliation Syndrome" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Senile Cataract" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Hypotony of Eye" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cataract Secondary to Ocular Disorders" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: High Hyperopia" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Injury to Optic Nerve and Pathways" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cataract, Congenital" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cysts of Iris, Ciliary Body, and Anterior Chamber" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: " satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cataract, Mature or Hypermature" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Traumatic Cataract" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cataract, Posterior Polar" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Pathologic Myopia" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Open Wound of Eyeball" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Certain Types of Iridocyclitis" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Vascular Disorders of Iris and Ciliary Body" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Hereditary Corneal Dystrophies" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Enophthalmos" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Uveitis" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Chronic Iridocyclitis" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Corneal Opacity and Other Disorders of " satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Cloudy Cornea" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Posterior Lenticonus" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: and Other Disorders of Lens" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Corneal Edema" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Retrolental Fibroplasias" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Medication, Active: Use of Systemic Sympathetic alpha-1a Antagonist Medication for Treatment of Prostatic Hypertrophy" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery" . "Diagnosis, Active: Anomalies of Pupillary Function" satisfies all . starts before start of "Occurrence A of Procedure, Performed: Cataract Surgery" . overlaps "Occurrence A of Procedure, Performed: Cataract Surgery"  Numerator = o AND: Union of: . "Procedure, Performed: Removal Procedures" . "Procedure, Performed: Excision of Adhesions" . "Procedure, Performed: Aspiration and Injection Procedures" . "Procedure, Performed: Lens Procedure" . "Procedure, Performed: Vitreous Procedures" . "Procedure, Performed: Retinal Repair Procedures" . "Procedure, Performed: Scleral Procedures" . "Procedure, Performed: Revision Procedures" . <= 30 day(s) starts after end of "Occurrence A of Procedure, Performed: Cataract Surgery"  Numerator Exclusions = o None  Denominator Exceptions = o None  Stratification = o None

Data Criteria (QDM Variables)

 None Data Criteria (QDM Data Elements)

 "Diagnosis, Active: Acute and Subacute Iridocyclitis" using "Acute and Subacute Iridocyclitis Grouping Value Set (2.16.840.1.113883.3.526.3.1241)"  "Diagnosis, Active: Adhesions and Disruptions of Iris and Ciliary Body" using "Adhesions and Disruptions of Iris and Ciliary Body Grouping Value Set (2.16.840.1.113883.3.526.3.1405)"  "Diagnosis, Active: Anomalies of Pupillary Function" using "Anomalies of Pupillary Function Grouping Value Set (2.16.840.1.113883.3.526.3.1406)"  "Diagnosis, Active: Aphakia and Other Disorders of Lens" using "Aphakia and Other Disorders of Lens Grouping Value Set (2.16.840.1.113883.3.526.3.1407)"  "Diagnosis, Active: Burn Confined to Eye and Adnexa" using "Burn Confined to Eye and Adnexa Grouping Value Set (2.16.840.1.113883.3.526.3.1409)"  "Diagnosis, Active: Cataract Secondary to Ocular Disorders" using "Cataract Secondary to Ocular Disorders Grouping Value Set (2.16.840.1.113883.3.526.3.1410)"  "Diagnosis, Active: Cataract, Congenital" using "Cataract, Congenital Grouping Value Set (2.16.840.1.113883.3.526.3.1412)"  "Diagnosis, Active: Cataract, Mature or Hypermature" using "Cataract, Mature or Hypermature Grouping Value Set (2.16.840.1.113883.3.526.3.1413)"  "Diagnosis, Active: Cataract, Posterior Polar" using "Cataract, Posterior Polar Grouping Value Set (2.16.840.1.113883.3.526.3.1414)"  "Diagnosis, Active: Central Corneal Ulcer" using "Central Corneal Ulcer Grouping Value Set (2.16.840.1.113883.3.526.3.1428)"  "Diagnosis, Active: Certain Types of Iridocyclitis" using "Certain Types of Iridocyclitis Grouping Value Set (2.16.840.1.113883.3.526.3.1415)"  "Diagnosis, Active: Chronic Iridocyclitis" using "Chronic Iridocyclitis Grouping Value Set (2.16.840.1.113883.3.526.3.1416)"  "Diagnosis, Active: Cloudy Cornea" using "Cloudy Cornea Grouping Value Set (2.16.840.1.113883.3.526.3.1417)"  "Diagnosis, Active: Corneal Edema" using "Corneal Edema Grouping Value Set (2.16.840.1.113883.3.526.3.1418)"  "Diagnosis, Active: Corneal Opacity and Other Disorders of Cornea" using "Corneal Opacity and Other Disorders of Cornea Grouping Value Set (2.16.840.1.113883.3.526.3.1419)"  "Diagnosis, Active: Cysts of Iris, Ciliary Body, and Anterior Chamber" using "Cysts of Iris, Ciliary Body, and Anterior Chamber Grouping Value Set (2.16.840.1.113883.3.526.3.1420)"  "Diagnosis, Active: Enophthalmos" using "Enophthalmos Grouping Value Set (2.16.840.1.113883.3.526.3.1421)"  "Diagnosis, Active: Glaucoma" using "Glaucoma Grouping Value Set (2.16.840.1.113883.3.526.3.1423)"  "Diagnosis, Active: Hereditary Corneal Dystrophies" using "Hereditary Corneal Dystrophies Grouping Value Set (2.16.840.1.113883.3.526.3.1424)"  "Diagnosis, Active: High Hyperopia" using "High Hyperopia Grouping Value Set (2.16.840.1.113883.3.526.3.1425)"  "Diagnosis, Active: Hypotony of Eye" using "Hypotony of Eye Grouping Value Set (2.16.840.1.113883.3.526.3.1426)"  "Diagnosis, Active: Injury to Optic Nerve and Pathways" using "Injury to Optic Nerve and Pathways Grouping Value Set (2.16.840.1.113883.3.526.3.1427)"  "Diagnosis, Active: Open Wound of Eyeball" using "Open Wound of Eyeball Grouping Value Set (2.16.840.1.113883.3.526.3.1430)"  "Diagnosis, Active: Pathologic Myopia" using "Pathologic Myopia Grouping Value Set (2.16.840.1.113883.3.526.3.1432)"  "Diagnosis, Active: Posterior Lenticonus" using "Posterior Lenticonus Grouping Value Set (2.16.840.1.113883.3.526.3.1433)"  "Diagnosis, Active: Pseudoexfoliation Syndrome" using "Pseudoexfoliation Syndrome Grouping Value Set (2.16.840.1.113883.3.526.3.1435)"  "Diagnosis, Active: Retrolental Fibroplasias" using "Retrolental Fibroplasias Grouping Value Set (2.16.840.1.113883.3.526.3.1438)"  "Diagnosis, Active: Senile Cataract" using "Senile Cataract Grouping Value Set (2.16.840.1.113883.3.526.3.1441)"  "Diagnosis, Active: Traumatic Cataract" using "Traumatic Cataract Grouping Value Set (2.16.840.1.113883.3.526.3.1443)"  "Diagnosis, Active: Uveitis" using "Uveitis Grouping Value Set (2.16.840.1.113883.3.526.3.1444)"  "Diagnosis, Active: Vascular Disorders of Iris and Ciliary Body" using "Vascular Disorders of Iris and Ciliary Body Grouping Value Set (2.16.840.1.113883.3.526.3.1445)"  "Medication, Active: Use of Systemic Sympathetic alpha-1a Antagonist Medication for Treatment of Prostatic Hypertrophy" using "Use of Systemic Sympathetic alpha-1a Antagonist Medication for Treatment of Prostatic Hypertrophy Grouping Value Set (2.16.840.1.113883.3.526.3.1442)"  "Procedure, Performed: Aspiration and Injection Procedures" using "Aspiration and Injection Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1408)"  "Procedure, Performed: Cataract Surgery" using "Cataract Surgery Grouping Value Set (2.16.840.1.113883.3.526.3.1411)"  "Procedure, Performed: Excision of Adhesions" using "Excision of Adhesions Grouping Value Set (2.16.840.1.113883.3.526.3.1422)"  "Procedure, Performed: Lens Procedure" using "Lens Procedure Grouping Value Set (2.16.840.1.113883.3.526.3.1429)"  "Procedure, Performed: Prior Pars Plana Vitrectomy" using "Prior Pars Plana Vitrectomy Grouping Value Set (2.16.840.1.113883.3.526.3.1434)"  "Procedure, Performed: Removal Procedures" using "Removal Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1436)"  "Procedure, Performed: Retinal Repair Procedures" using "Retinal Repair Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1437)"  "Procedure, Performed: Revision Procedures" using "Revision Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1439)"  "Procedure, Performed: Scleral Procedures" using "Scleral Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1440)"  "Procedure, Performed: Vitreous Procedures" using "Vitreous Procedures Grouping Value Set (2.16.840.1.113883.3.526.3.1447)"

Supplemental Data Elements

 "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"  "Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"  "Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"  "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeGender Value Set (2.16.840.1.113762.1.4.1)"

Risk Adjustment Variables

 None

Measure Set None