| 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 |
Denominator
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
Encounter Codes Eligible for Denominator
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
Diagnosis
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.
Denominator Exclusions
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.
Note
SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.
Numerator
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.
Document a Retinal or Dilated Eye Exam in the Diabetes Care Flowsheet
- Go to Encounter > Flowsheets/Labs > Standard Flowsheets
- Click Add New Flowsheet
- Select the Diabetes Care flowsheet and click Add
- Click Add Column
- Populate a Date and a Value for Dilated Eye Exam or Retinal Eye Exam
- Click OK to save
eCQI Reference
Return to 2018 eCQMs