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

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The physician that manages the ongoing care of the patient with diabetes should be aware of the patient's dilated eye examination and severity of retinopathy to manage the ongoing diabetes care. Such communication is important in assisting the physician to better manage the diabetes. Several studies have shown that better management of diabetes is directly related to lower rates of development of diabetic eye disease (Diabetes Control and Complications Trial – DCCT, UK Prospective Diabetes Study – UKPDS).

The ophthalmologist should communicate examination results to the physician who is managing ongoing diabetes care. (A:III) (AAO, 2008)

Higher score indicates better quality

American Academy of Ophthalmology. Preferred Practice Pattern: Diabetic Retinopathy. 2008.

Communication – May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (eg, verbally, by letter) with the clinician managing the patient’s diabetic care OR a copy of a letter in the medical record to the clinician managing the patient’s diabetic care outlining the findings of the dilated macular or fundus exam.

Findings - Includes level of severity of retinopathy (eg, mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema.

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 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.

TBD

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

Equals Initial Patient Population who had a dilated macular or fundus exam performed

None

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

Not Applicable

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

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.