Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Last updated: October 25, 2017

CMS Measure ID: CMS167v6
Version: 6
NQF Number: 0088
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 which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months

Initial Patient Population:

All patients aged 18 years and older with a diagnosis of diabetic retinopathy

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

None

Numerator Statement:

Patients who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy AND the presence or absence of macular edema during one or more office visits within 12 months

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of medical reason(s) for not performing a dilated macular or fundus examination.

Documentation of patient reason(s) for not performing a dilated macular or fundus examination.

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Effective Clinical Care
Previous Version: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
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.

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