Exclusions for Reporting CMS 132v3 (NQF 0564) and CMS 133v3 (NQF 0565)

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    • Type: Value Sets
    • Resolution: Done
    • Priority: Minor
    • Component/s: ValueSet
    • None
    • Kara Webb
    • 7038371018
    • American Optometric Association
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      Modifiers are used in billing to ‘modify’ payment based on the modification of a service. While eCQMs use coding systems that are also used for billing, there is currently no way to attach a modifier to a billing code when used in an eCQM specification.
      Version 4 of the eCQM specifications for CMS132 and CMS133 will reflect updated Guidance indicating that EPs who provide pre or post-op services only are not eligible to report this measure.
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      Modifiers are used in billing to ‘modify’ payment based on the modification of a service. While eCQMs use coding systems that are also used for billing, there is currently no way to attach a modifier to a billing code when used in an eCQM specification. Version 4 of the eCQM specifications for CMS132 and CMS133 will reflect updated Guidance indicating that EPs who provide pre or post-op services only are not eligible to report this measure.

      For the measures (CMS 132v3 (NQF 0564) Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures) and CMS 133v3 (NQF 0565) Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery (Clinical Process/Effectiveness), the Registry specifications for these measures indicate, “Denominator Instructions: Clinicians who indicate modifier 55, postoperative management only OR modifier 56, preoperative management only, will not qualify for this measure.” Do the same exclusions exist for the e-specified versions of this measure?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Kara Webb (Inactive)
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