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CMS 131 - Diabetes: Eye Exam

Updated: 06/13/2023|Views: 1481

CMS 131 / Quality ID #117

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period.

Denominator: Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period.
  • Patient’s age is calculated based on the patient’s Date of Birth, which was entered when you created the patient’s account.
  • Create a note detailing the patient’s office visit.
  • The diagnosis of "Diabetes" and/or "Diabetic Retinopathy" is entered in the patient’s Problems with a Start Date.
Denominator Exclusions: Exclude patients who are in hospice care for any part of the measurement period.
  • Hospice is documented under Hospice in History. These patients will be excluded from the denominator.

Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.

  • Long Term Care is documented under Long Term Care Facility in History. These patients will be excluded from the denominator.
  • Patient’s age is calculated based on the patient’s Date of Birth.

Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:

  1. Advanced illness with two outpatient encounters during the measurement period or the year prior, OR
  2. Advanced illness with one inpatient encounter during the measurement period or the year prior, OR
  3. Taking dementia medications during the measurement period or the year prior
  • Patient’s age is calculated based on the patient’s Date of Birth.
  • "Advanced Illness" and "Frailty" is documented under Problems with a Start Date.
  • “Dementia Medications” are documented under Medications.

Exclude patients receiving palliative care for any part of the measurement period.

  • Palliative Care is documented under Problems with a Start Date.
Numerator: Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:
  1. Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period
  2. Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period
  • On the date of service, click on Care Checklist from within the note.
  • Select "Completed" for Diabetic Eye Exam (Age 18-75): Eye exam performed. This step must be completed on the date that it was discussed with the patient which should be the date of the note.
Office Visit Documentation:

Once all steps have been completed, the measure will be added to the Quality Measures Report.

Measure type: Process
High Priority Measure: No
Telehealth Eligible: Yes
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