Thank you for your inquiry regarding CMS143v11: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation. Per the measure specifications, all patients aged 18 years and older who have a qualifying encounter during the measurement period and a diagnosis of primary open-angle glaucoma meet the denominator criteria.
The value sets which include codes that identify appropriate qualifying encounters are:
Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)
Ophthalmological Services (2.16.840.1.113883.3.526.3.1285)
Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)
Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)
Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014)
The Primary Open-Angle Glaucoma value set (2.16.840.1.113883.3.526.3.326) includes codes that correspond to a POAG diagnosis.
To meet the numerator criteria, patients must have an optic nerve head evaluation during one or more visits within 12 months. Optic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. The Cup to Disc Ratio (2.16.840.1.113883.3.526.3.1333) and Optic Disc Exam for Structural Abnormalities (2.16.840.1.113883.3.526.3.1334) value sets contain codes that correspond to examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities.
We encourage you to review codes included in each value set on the Value Set Authority Center (VSAC) website at
https://vsac.nlm.nih.gov.