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Diabetes: Medical Attention for Nephropathy

General eCQM Information

CMS Measure ID CMS134v10
NQF Number Not Applicable
Measure Description

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period

Initial Population Patients 18-75 years of age with diabetes with a visit during the measurement period
Denominator Statement

Equals Initial Population

Denominator Exclusions

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.

Exclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:

- Advanced illness with two outpatient encounters during the measurement period or the year prior

- OR advanced illness with one inpatient encounter during the measurement period or the year prior

- OR taking dementia medications during the measurement period or the year prior

Exclude patients receiving palliative care during the measurement period.

Numerator Statement

Patients with a screening for nephropathy or evidence of nephropathy during the measurement period

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward National Committee for Quality Assurance
Domain Effective Clinical Care
Measure Scoring Proportion
Measure Type Process
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.

This eCQM is a patient-based measure.

 

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Quality ID 119
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the rationale to align with current evidence.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the clinical recommendation statement to align with current clinical recommendations.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Replaced 'overlaps' or 'overlapping' in the denominator exclusions with plain language to clarify the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the advanced illness and frailty denominator exclusion to clarify the intent of the exclusion criteria.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the Denominator Exclusions to add an exclusion for palliative care.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Revised the advanced illness and frailty denominator exclusion to align with the header and adhere to QDMv5.5 standards.​

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised the Nephropathy Screenings definition to group the procedures, interventions and lab tests separately from the encounters to align timing requirements for each screening data type.

    Measure Section: Multiple Sections

    Source of Change: Annual Update

  • Added telephone visits as appropriate encounter based on the increased use of telehealth services.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated Denominator Exclusions definition and added PalliativeCare.Palliative Care in the Measurement Period definition to add an exclusion for palliative care.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Removed the Vascular Access for Dialysis value set from the Renal Procedures definition to streamline existing value sets and reduce redundancies.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

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

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Update Adult Outpatient Encounters CQL library to 2.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated Advanced Illness and Frailty Exclusions CQL Library to version 6.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated Hospice CQL Library to version 3.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Added PalliativeCareExclusion CQL library version 1.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

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 ACE Inhibitor or ARB or ARNI (2.16.840.1.113883.3.526.3.1139): Deleted 9 RxNorm codes (199622, 199707, 199708, 199709, 199816, 199817, 411434, 858921, 199937) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Urine Protein Tests (2.16.840.1.113883.3.464.1003.109.12.1024): Added 6 LOINC codes (89998-9, 89999-7, 90000-1, 93746-6, 95232-5, 95233-3) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Kidney Transplant (2.16.840.1.113883.3.464.1003.109.12.1012): Added 13 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 35 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 4 CPT codes (50300, 50320, 50340, 50370) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Diabetic Nephropathy (2.16.840.1.113883.3.464.1003.109.12.1004): Added 9 SNOMED CT codes (71701000119105, 792926007, 90721000119101, 90731000119103, 90741000119107, 90751000119109, 90761000119106, 90771000119100, 96441000119101) based on terminology update. Deleted 4 SNOMED CT codes (236499007, 236500003, 420514000, 421305000) based on terminology update and updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set Vascular Access for Dialysis (2.16.840.1.113883.3.464.1003.109.12.1011) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hypertensive Chronic Kidney Disease (2.16.840.1.113883.3.464.1003.109.12.1017): Added 3 SNOMED CT codes (302910002, 431431000124100, 45281005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Kidney Failure (2.16.840.1.113883.3.464.1003.109.12.1028): Added 3 5 ICD-10-CM codes (N18.5,N18.6, N18.30, N18.31, N18.32) based on terminology update. Deleted 1 SNOMED CT code (711000119100) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Glomerulonephritis and Nephrotic Syndrome (2.16.840.1.113883.3.464.1003.109.12.1018): Added 95 SNOMED CT codes and deleted 15 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Added 8 ICD-10-CM codes (N00.A, N01.A, N02.A, N03.A, N04.A, N05.A, N06.A, N07.A) based on terminology update.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Dialysis Services (2.16.840.1.113883.3.464.1003.109.12.1013): Added 3 CPT codes (99512, 90997, 90999) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 5 CPT codes (1019320, 90940, 90957, 90958, 90959) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 1 HCPCS code (S9339) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 37 SNOMED CT codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 12 SNOMED CT codes (421920002, 4783006, 75682002, 76751001, 769219006, 190388001, 190390000, 395204000, 421750000, 422014003, 703138006, 781000119106) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Advanced Illness (2.16.840.1.113883.3.464.1003.110.12.1082): Added 34 ICD-10-CM codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations or terminology updates. Added 179 SNOMED CT codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations, and based on terminology updates.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set ED (2.16.840.1.113883.3.464.1003.101.12.1085) with value set Emergency Department Visit (2.16.840.1.113883.3.464.1003.101.12.1010) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087): Added 11 SNOMED CT codes (185463005, 185464004, 185465003, 281036007, 30346009, 37894004, 3391000175108, 439740005, 77406008, 444971000124105, 84251009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300): Added 124 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 22 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088): Deleted 1 SNOMED CT code (413467001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075): Added 13 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 69 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Frailty Diagnosis (2.16.840.1.113883.3.464.1003.113.12.1074): Added 14 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 13 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Added 166 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Dementia Medications (2.16.840.1.113883.3.464.1003.196.12.1510): Added 4 RxNorm codes (1599803, 1599805, 1805420, 1805425) based on change in measure requirements/measure specification. Deleted 3 RxNorm codes (1858970, 996572, 996624) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083): Added 10 SNOMED CT codes (10378005, 18083007, 183452005, 19951005, 2252009, 73607007, 305339001, 50699000, 74857009, 78680009) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (71007-9) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (71007-9) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jul 08, 2021