Last updated: May 17, 2016
|CMS Measure ID:||CMS142v4|
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
Equals Initial Population who had a dilated macular or fundus exam performed
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
|Measure Steward:||American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)|
|Domain:||Effective Clinical Care|
|Next Version:||Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care|
|Previous Version:||Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care|
Higher score indicates better quality
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 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 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 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.
- Clinical Recommendation Statement updated.
- Copyright updated.
- Disclaimer updated.
- eMeasure version number incremented.
- Guidance updated.
- Measure Developer updated.
- Rationale updated.
- Reference updated.
- Changed data type of 'result' or 'finding' to 'performed'.
- Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
- 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.
- Introduced variable $EyeCareEncounters to allow re-use of logical expressions and reduce redundancy/complexity.
- Removed extraneous AND from Numerator.
- Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
- Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
- The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.
- Value set Patient Reason (OID 2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMED code (30164005).