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Diabetes: Eye Exam

CMS Measure ID
CMS131v6
Version
6
NQF Number
0055
Measure 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

Initial Population

Patients 18-75 years of age with diabetes with a visit during the measurement period

Denominator Statement
Denominator Exclusions

Exclude patients who were in hospice care during the measurement year

Numerator Statement

Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:

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

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Next Version
Measure Scoring
Measure Type
Improvement Notation

Higher score indicates better quality

Guidance

Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.

The eye exam must be performed by an ophthalmologist or optometrist.

Notes

Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Clinical Recommendation Statement to reflect updated clinical guidelines.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated References.

    Measure Section: Reference

    Source of Change: Measure Lead

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the timing logic of negative finding from

    Measure Section: Numerator

    Source of Change: JIRA (CQM-1851)

Value Set

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

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 32 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Retinal or Dilated Eye Exam (2.16.840.1.113883.3.464.1003.115.12.1088): Added 1 SNOMEDCT code (722161008).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 2 ICD10CM codes (E11.10, E11.11). Added 21 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

Last Updated: Aug 19, 2019