Diabetes: Eye Exam

Last updated: May 4, 2017

CMS Measure ID: CMS131v4
Version: 4
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
Measure Score: Proportion
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.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.

Logic

  • Added ophthalmology codes to the initial population to allow more providers to report the measure.
  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Replaced 'ORs' with 'Union of' operator.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.

Value Sets

  • Value set Diabetes (OID 2.16.840.1.113883.3.464.1003.103.12.1001): Added 54 ICD10CM codes.
  • Value set Ophthalmological Services (OID 2.16.840.1.113883.3.526.3.1285): Added to measure.

External Resources