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Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

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

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare 2026 version to

Table Options
Measure Information 2026 Performance Period
Title Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
CMS eCQM ID CMS142v14
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 or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient’s ongoing diabetes care (Lim et al., 2025).

A goal...

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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 during the measurement period

Denominator

Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period

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

None

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
Next Version No Version Available
Previous Version

Header

TRN

Measure Section

Source of Change

Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates.

CMS ID

Standards/Technical Update

Updated the eCQM version number.

eCQM Version Number

Annual Update

Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates.

Measurement Period

Standards/Technical Update

Removed 'PCPI(R) Foundation (PCPI[R])' as a Measure Developer to reflect active Measure Developers.

Measure Developer

Annual Update

Updated copyright.

Copyright

Annual Update

Updated disclaimer.

Disclaimer

Annual Update

Revised clinical recommendation statement related to communication between the ophthalmologist and patient's primary care physician to align with updated guidance.

Clinical Recommendation Statement

Measure Lead

Updated references and measure header to reflect current evidence and new or updated literature.

Multiple Sections

Measure Lead

Updated the denominator to clarify that only patients who had a dilated macular or fundus exam performed during the measurement period should be included in the measure, aligning with logic.

Denominator

Measure Lead

Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present.

Numerator Exclusions

Standards/Technical Update

Logic

TRN

Measure Section

Source of Change

Updated Measure Primary CQL Library Name from 'DRCommunicationWithPhysicianManagingDiabetes' to 'CMS142DRCommWithPhysicianManagingDiabetesQDM' for alignment with the CQL Style Guide.

Definitions

Standards/Technical Update

Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'

Definitions

Annual Update

Updated the timing comparison precision in the definitions by adding 'day of' operator to align with the measure intent and address time zone differences.

Definitions

Measure Lead

Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Definitions

Standards/Technical Update

Updated Measure Primary CQL Library Name from 'DRCommunicationWithPhysicianManagingDiabetes' to 'CMS142DRCommWithPhysicianManagingDiabetesQDM' for alignment with the CQL Style Guide.

Functions

Standards/Technical Update

Updated the version number of the Global Common Functions Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'

Functions

Annual Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

TRN

Measure Section

Source of Change

Value Set 'Diabetic Retinopathy' (2.16.840.1.113883.3.526.3.327): Added 2 SNOMEDCT codes (1306699009, 1306700005) based on code system/terminology updates.

Terminology

Annual Update

Value Set 'Level of Severity of Retinopathy Findings' (2.16.840.1.113883.3.526.3.1283): Added 68 SNOMEDCT codes (138901000119108, 138941000119105, 16746901000119101, 16746941000119104, 16747021000119109, 16747101000119101, 16747141000119104, 16747341000119101, 399863006, 399872003, 399873008, 399877009, 769187006, 769188001, 769190000, 769191001, 870420005, 138891000119109, 138921000119104, 16697421000119103, 16697471000119102, 16697521000119104, 16746131000119105, 16746261000119108, 16746341000119103, 769185003, 769186002, 138881000119106, 138911000119106, 16745411000119104, 16745531000119108, 16745611000119102, 16745651000119101, 16745891000119105, 16745931000119102, 368711000119106, 769183005, 769184004, 16749781000119101, 16749661000119102, 16748741000119101, 16748141000119100, 16747901000119104, 16747741000119100, 1501000119109, 1306700005, 1306699009, 232021008, 232022001, 312906006, 312907002, 312908007, 312909004, 368721000119104, 399862001, 399865004, 399869005, 399870006, 399874002, 399875001, 60971000119101, 677741000119109, 770766000, 816961009, 816962002, 97341000119105, 769191001, 770765001) based on SME/expert recommendations.

Terminology

Annual Update

Value Set 'Macular Edema Findings Present' (2.16.840.1.113883.3.526.3.1320): Added 15 SNOMEDCT codes (870421009, 335551000119103, 341161000119105, 346421000119104, 1217634001, 15639131000119107, 15639181000119108, 15639231000119102, 232042005, 232045007, 769221001, 769222008, 97331000119101, 399872003, 399877009) based on SME/expert recommendations.

Terminology

Annual Update

Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback.

Terminology

Annual Update

Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards.

Terminology

Standards/Technical Update

Value Set 'Patient Reason' (2.16.840.1.113883.3.526.3.1008): Added 1 SNOMEDCT code (1296859006) based on code system/terminology updates. Added 1 SNOMEDCT code (31021000119100) based on public comment/implementer feedback. Deleted 2 SNOMEDCT codes (281399006, 105480006) based on code system/terminology updates.

Terminology

Annual Update

Last Updated: May 07, 2025