Diabetes: Eye Exam

Last updated: July 12, 2017

CMS Measure ID: CMS131v5
Version: 5
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 Patient Population:

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

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

None

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

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version: Diabetes: Eye Exam
Previous Version: Diabetes: Eye Exam
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.

Addendum Notes: ICD-10 Value Set addition
Quality ID: 117
High Priority Measure: No
Data Submission Method: Claims,CMS Web Interface,EHR,Registry
Specialty Measure Set: Internal Medicine,Ophthalmology,General Practice/Family Medicine

Specifications

Release Notes

Header

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

Value Set

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 11 ICD9CM codes (250.40, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00).

    Section: None

    Source: None

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 156 ICD10CM codes.

    Section: None

    Source: ICD 10 Addendum

External Resources