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Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

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eCQMs for 2020 Performance Period

CMS2v9
CMS22v8
CMS50v8
CMS56v8
CMS66v8
CMS68v9
CMS69v8
CMS74v9
CMS75v8
CMS90v9
CMS117v8
CMS122v8
CMS124v8
CMS125v8
CMS127v8
CMS128v8
CMS129v9
CMS130v8
CMS131v8
CMS133v8
CMS134v8
CMS135v8
CMS136v9
CMS137v8
CMS138v8
CMS139v8
CMS142v8
CMS143v8
CMS144v8
CMS145v8
CMS146v8
CMS147v9
CMS149v8
CMS153v8
CMS154v8
CMS155v8
CMS156v8
CMS157v8
CMS159v8
CMS161v8
CMS165v8
CMS177v8
CMS249v2
CMS347v3
CMS349v2
CMS645v3
CMS771v1

General eCQM Information

CMS Measure ID CMS142v8
NQF Number 0089e
Measure 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 macular or fundus exam at least once within 12 months
Initial Population All patients aged 18 years and older with a diagnosis of diabetic retinopathy
Denominator Statement

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

None
Numerator Statement

Patients with documentation, at least once within 12 months, 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 exam to the physician who manages the ongoing care of the patient with diabetes.
Measure Steward PCPI(R) Foundation (PCPI[R])
Domain Communication and Care Coordination
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality
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 ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

The communication of results to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible professionals or eligible clinicians reporting on this measure should note that all data for the reporting year is to be submitted by the deadline established by CMS. Therefore, eligible professionals or eligible clinicians who see patients towards the end of the reporting period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS.
Quality ID 19
Meaningful Measure Transfer of Health Information and Interoperability
Telehealth Eligible Yes
Next Version
CMS142v9
Specifications
Attachment Size
CMS142v8.html 58.06 KB
CMS142v8.zip 65.04 KB
CMS142v8-TRN.xlsx 21.02 KB

Data Element Repository

Release Notes

CMS142v8-TRN.xlsx

Header

  • Updated eCQM version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Added 'e' to NQF number.

    Measure Section: NQF Number

    Source of Change: Standards Update

  • 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 align with current guideline.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated reference.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Merged Quality Data Mode (QDM) Communication Datatypes to a single Datatype 'Communication, Performed' and added attributes of ‘sender’ and ‘recipient’ to align with previous construct that the communication should occur between providers.

    Measure Section: Numerator

    Source of Change: Standards Update

  • Merged Quality Data Model (QDM) Communication Datatypes to a single Datatype 'Communication, Not Performed.'

    Measure Section: Denominator Exceptions

    Source of Change: Standards Update

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with CQL Style Guide.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MAT) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards 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.

  • Value set Ophthalmological Services (2.16.840.1.113883.3.526.3.1285): Added SNOMED CT extensional value set (2.16.840.1.113883.3.526.2.1771) including 4 codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added direct reference code SNOMED CT codes (223366009, 158965000, 422234006, 28229004, 309343006).

    Measure Section: Terminology

    Source of Change: Standards Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Macular Edema Findings Absent (2.16.840.1.113883.3.526.3.1284) with direct reference code SNOMED CT code (428341000124108).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Standardized purpose statement language in value sets across eCQMs. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Dec 18, 2020