eCQM: Diabetes: Foot Exam (CMS 123v5)

eCQM:

Diabetes: Foot Exam

CMS ID:

CMS 123v5

NQF Number:

0056

NQS Domain:

Effective Clinical Care

Measure Type:

Process

MIPS High Priority Measure:

No

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)

Description:

The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with monofilament and a pulse exam) during the measurement year.

  • Numerator: Patients who received visual, pulse and sensory foot examinations during the measurement period.
  • Denominator: Patients 18-75 years of age (>=18 and <75) with diabetes with an eligible visit (defined as a signed chart note with one of the following encounter types: Office Visit, Nurse Visit, Nursing Home Visit, or Home Visit) during the measurement period.
    • Denominator Exclusions: Patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period.

    • Denominator Exceptions: None

Performance Benchmark for MIPS: 76.17%
For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click
here.

Practice Fusion Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. Ensure that patients age 18-75 years with diabetes have an appropriate diagnosis, with a start date, recorded in the medical record.

    1. Examples of diabetes diagnosis codes that can be used for this measure can be found in Table 1.

  2. Perform and/or record completion of a visual, pulse and sensory foot exam in the patient chart using the suggested workflow in Table 2.

Table 1: Examples of Coded Values that can be Recorded for CMS 123v5

Data Type

Example Codes

Diabetes Diagnosis Codes*


  • 250.00-250.03 (ICD-9)
  • 250.11-250.13 (ICD-9)
  • E10.10 (ICD-10)
  • E10.11 (ICD-10)
  • E10.22 (ICD-10)
  • E10.311(ICD-10)
*Only patients with a diagnosis of Type 1 or Type 2 diabetes will be included in the denominator; patients with a diagnosis of secondary diabetes due to another condition will not be included.

Table 2: Practice Fusion Suggested Workflow for Recording a Foot Exam

Data Type

Practice Fusion Suggested Workflow

Diabetic foot exam

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Diabetic foot exam (visual, sensory, and pulse)” and select the item.

  • The data element “Diabetic foot exam (visual, sensory, pulse)” in Practice Fusion is mapped to the coded values for all three required exams, i.e. Visual Exam of Foot (SNOMED CT 401191002), Sensory Exam of Foot (SNOMED CT 134388005), and Pulse Exam of Foot (SNOMED CT 91161007), necessitating only one selection in the encounter.

  • Record and save the following information in the modal window that opens:

    • Status: Performed

    • Result: Applicable result

    • Start Date: Date the examination was performed

    • Comments: If appropriate, you may include a note about the medical professional who completed the examination, if not you.

  • Though only one selection must be made in the encounter, please note that this measure does require that the patient receive all of the following foot exams:

    • Visual

    • Sensory

    • Pulse

Additional Measure Information
  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:

    • Updated measure description to align with the NQF-endorsed description.

  • To be recognized for the denominator exclusion, the patient must have a qualifying diagnosis recorded in his or her chart. Examples of qualifying diagnoses can be found in Table 3 below.

  • To access a complete list of qualifying diagnosis codes, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

Table 3: Diagnosis Code Examples for CMS 123v5 Denominator Exclusions

Denominator Exclusion Criteria

Diagnosis Code Examples

Bilateral Amputation of Leg Below or Above Knee

  • Congenital complete absence of lower limb, bilateral (ICD-10 Q72.03)
  • Congenital absence of both lower leg and foot, bilateral (ICD-10 Q72.23)

Left Unilateral Amputation Above or Below Knee

  • Congenital absence of both lower leg and foot, left lower limb (ICD-10 Q72.22)
  • Complete traumatic amputation at left hip joint, initial encounter (ICD-10 S78.012A)

Right Unilateral Amputation Above or Below Knee

  • Congenital absence of both lower leg and foot, right lower limb (ICD-10 Q72.21)
  • Acquired absence of right hip joint (ICD-10 Z89.621)

Unilateral Amputation Below or Above Knee, Unspecified Laterality

  • Congenital absence of both lower leg and foot, unspecified lower limb (ICD-10 Q72.20)

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