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Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Last updated: May 9, 2019

CMS Measure ID: CMS142v8
Version: 8
NQF Number: 89e
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 Populationinfo-icon 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:
Measure Scoring: Proportion
Measure Type: Process
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 specificityinfo-icon (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 professionalinfo-icon or eligible clinicianinfo-icon 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 professionalsinfo-icon or eligible cliniciansinfo-icon 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 numeratorinfo-icon. 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: 019
Meaningful Measure: Transfer of Health Information and Interoperability

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Added 'e' to NQFinfo-icon 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: Numeratorinfo-icon

    Source of Change: Standards Update

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

    Measure Section: Denominator Exceptionsinfo-icon

    Source of Change: Standards Update

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

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) 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 Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • 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 eCQMsinfo-icon. 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

External Resources