CMS 131v6: Diabetes: Eye Exam

Measure: Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period
Numerator Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period
Denominator Exceptions None
Denominator Exclusions

Exclude patients who were in hospice care during the measurement year

Patients who meet the following criteria will be included in the denominator:

  • Age must be ≥ 18 years and < 75 years at the beginning of the Measurement Period

    AND

  • Must have an active diagnosis of Type 1 or Type 2 diabetes during the Measurement Period

    AND

  • Must have at least one encounter during the Measurement Period finalized by the EC/EP

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99221, 99222, 99223, 99231, 99232, 99233, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99305, 99306, 99307, 99308, 99309, 99310, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99024, 99391, 99392, 99393, 99394, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 92002, 92004, 92012, 92014

HCPCS: G0402, G0438, G0439

The patient must have an active diagnosis of Type 1 or Type 2 diabetes during Measurement Period. Patients with a diagnosis of secondary diabetes due to another condition are not counted.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for diabetes can be located here.

Patients who were in hospice care during the measurement year will be excluded from the measure.

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted in the numerator if they received a retinal eye exam or a dilated eye exam during the Measurement Period OR if they received a retinal or dilated eye exam with a Negative finding in the 12 months before the start of the Measurement Period.

The eye exam must be performed by an ophthalmologist or optometrist.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Diabetes Care flowsheet and click Add
  4. Click Add Column
  5. Populate a Date and a Value for Dilated Eye Exam or Retinal Eye Exam
  6. Click OK to save

https://ecqi.healthit.gov/ecqm/ep/2018/cms131v6

 

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