eCQM: Diabetes: Eye Exam (CMS 131v5)


eCQM:

Diabetes: Eye Exam

CMS ID:

CMS 131v5

Measure Type:

Process

MIPS High Priority Measure:

No

Quality ID:

117

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance Benchmark for MIPS:

100%

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

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 131v5 Diabetes: Eye Exam are:

  • Initial patient population
  • Denominator
  • Numerator

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 required information in the modal window that opens:

    • Status: Performed

    • Result: Applicable result

    • Start Date: Date the examination was performed

    • End Date: Applicable examination end date (if appropriate, the end date and start date may be the same)
    • Comments: If you choose, you may include a note about the eye care professional who completed the examination here.

    All required information listed above must be completed in order to accurately generate numerator credit for this measure.
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).

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