eCQM: Diabetes: Eye Exam (CMS 131v5)

eCQM:

Diabetes: Eye Exam

CMS ID:

CMS 131v5

NQF Number:

0055

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)
  • Comprehensive Primary Care Plus (CPC+)

Description:

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.

  • Numerator: Patients from the denominator with one of the following:
    • A retinal or dilated eye exam by an eye care professional in the measurement period, or

    • A negative retinal or dilated eye exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period.

  • Denominator: Patients 18-75 years of age with diabetes with an eligible visit (defined as a signed chart note with one of the following encounter types: Office Visit, Nurse Visit, Home Visit or Nursing Home Visit) during the measurement period.

    • Denominator Exclusions: None

    • Denominator Exceptions: None

Performance Benchmark for MIPS: 100%
For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click
here.

Practice Fusion Suggested 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 with diabetes have an appropriate diagnosis, with a start date, recorded in the medical record. Examples of diabetes diagnosis codes that can be used for this measure can be found in Table 1.
  2. Once performed or confirmed, document the exam in the patient encounter using the suggested workflow in Table 2.

Table 1: Examples of Coded Values that can be Recorded for CMS 131v5

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 an Eye Exam

Procedure Performed

Practice Fusion Suggested Workflow

Eye exam

  • In the Screenings/Interventions/Assessments section of the encounter, search for the numerator-eligible eye exam performed. Examples include:

    • Examination of retina (procedure) (SNOMED CT 274798009)

    • Photopic electroretinography (procedure) (SNOMED CT 252782004)

    • Examination of optic disc (procedure) (SNOMED CT 274795007)

  • Once selected, 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 you choose, you may include a note about the eye care professional who completed the examination here.

Additional Measure Information
  • To be eligible for numerator credit for this measure, the diabetic eye exam must be performed by an ophthalmologist or optometrist.
  • To be eligible for numerator credit for this measure, the diabetic eye exam performed must be present in the complete list of numerator-eligible diabetic eye exams in the measure specifications. To access a complete list of numerator-eligible diabetic eye exams, visit the United States Health Information Knowledgebase (USHIK) and review the Data Criteria. 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.
  • To access a complete list of applicable diagnosis codes, visit the United States Health Information Knowledgebase (USHIK).

More Information

eCQMs

  1. How does the eCQM Dashboard work?
  2. eCQM: Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS 2v6)
  3. eCQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v5)
  4. eCQM: Closing the Referral Loop: Receipt of Specialist Report (CMS 50v5)
  5. eCQM: Documentation of Current Medications in the Medical Record (CMS 68v6)
  6. eCQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan (CMS 69v5)
  7. eCQM: Functional Status Assessments for Congestive Heart Failure (CMS 90v6)
  8. eCQM: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) (CMS 122v5)
  9. eCQM: Diabetes: Foot Exam (CMS 123v5)
  10. eCQM: Cervical Cancer Screening (CMS 124v5)
  11. eCQM: Breast Cancer Screening (CMS 125v5)
  12. eCQM: Pneumococcal Vaccination Status for Older Adults (CMS 127v5)
  13. eCQM: Colorectal Cancer Screening (CMS 130v5)
  14. eCQM: Diabetes: Eye Exam (CMS 131v5)
  15. eCQM: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CMS 138v5)
  16. eCQM: Falls: Screening for Future Fall Risk (CMS 139v5)
  17. eCQM: Preventive Care and Screening: Influenza Immunization (CMS 147v6)
  18. eCQM: Dementia: Cognitive Assessment (CMS 149v5)
  19. eCQM: Chlamydia Screening for Women (CMS 153v5)
  20. eCQM: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (CMS 155v5)
  21. eCQM: Use of High-Risk Medications in the Elderly (CMS 156v5)
  22. eCQM: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet (CMS 164v5)
  23. eCQM: Controlling High Blood Pressure (CMS 165v5)
  24. eCQM: Use of Imaging Studies for Low Back Pain (CMS 166v6)

Feedback and Knowledge Base