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CMS Updates G-Codes for Reporting Quality Measure 14 AMD: Dilated Macular Examination

This week, CMS updated G-codes to be used for claims and registry reporting for Quality Measure 14, Age-Related Macular Degeneration: Dilated Macular Examination in 2018. The codes for this measure were changed substantially for 2018, however, some practices reported denials on the new codes included in the 2018 specifications. The new codes CMS released this week for this measure are as follows:

  • Performance Met: G9974 (new code). Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity.
  • Denominator Exception: G9975 (new code). Documentation of medical reason(s) for not performing a dilated macular examination.
  • Denominator Exception: G9892 (no change). Documentation of patient reason(s) for not performing a dilated macular examination.
  • Performance Not Met: G9893 (no change). Dilated macular exam was not performed, reason not otherwise specified.

CMS published a corrected specification document for this measure that can be viewed here. Rejected claims should be fixed retroactively. If you continue to experience denials, please contact Allison Madson, manager of regulatory affairs, at 703-591-2220 or amadson@ascrs.org