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Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

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Compare Versions of: "Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care"

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Table Options
Measure Information 2025 Performance Period
Title Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
CMS eCQM ID CMS142v13
CBE ID* Not Applicable
MIPS Quality ID 019
Measure Steward American Academy of Ophthalmology
Description

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the...

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Measure Scoring Proportion measure
Measure Type Process
Stratification

None

Risk Adjustment

None

Rationale

Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care...

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Clinical Recommendation Statement

The ophthalmologist should refer patients with diabetes to a primary care physician for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient's ongoing diabetes care (III; Good Quality; Strong Recommendation)...

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Improvement Notation

Higher score indicates better quality

Definition

Communication - May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the...

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Guidance

The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction)....

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Initial Population

All patients aged 18 years and older with a diagnosis of diabetic retinopathy

Denominator

Equals Initial Population who had a dilated macular or fundus exam performed

Denominator Exclusions

None

Numerator

Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care

Numerator Exclusions

Not Applicable

Denominator Exceptions

Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.

Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus...

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Telehealth Eligible No
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Last Updated: May 06, 2025