Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Last updated: October 25, 2017

CMS Measure ID: CMS142v6
Version: 6
NQF Number: 0089
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 Patient 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
Previous Version: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
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 (ie, 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.

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.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated Reference.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated Guidance.

    Measure Section: Guidance

    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 Patient Reason (2.16.840.1.113883.3.526.3.1008): Added 1 SNOMEDCT code (713247000) and deleted 1 SNOMEDCT code (258147002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

External Resources