CMS131v8 – Diabetes: Eye Exam

Patients 18-75 years of age with diabetes with a visit during the measurement period.

– NUMERATOR

Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:

• Diabetic with a diagnosis of retinopathy that overlaps the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period
• Diabetic with no diagnosis of retinopathy overlapping 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

– DENOMINATOR EXCLUSIONS

Exclude patients whose hospice care overlaps the measurement period.

Exclude patients 66 and older who are living long term in an institution for more than 90 days during the measurement period.

Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.

For Denominator:

Patient 18-75 years of age with a visit during the measurement period and with an active diagnosis of diabetes is included in the denominator of this measure. Navigate to Patient > Provider Note > Diagnosis to record diabetes.

Visits codes are added through eSuperbills or charges. The documentation of the first encounter takes place when one visit code gets attached with the patient’s eSuperbill/ charge. To record an encounter, navigate to Patient > Provider Note > eSuperbill.

For Numerator:

Patients with an eye screening for diabetic retinal disease are included in the Numerator of this measure. This includes diabetic patients who had one of the following:

1. Diabetic with a diagnosis of retinopathy that overlaps the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period (Patient > Clinical > Evaluations)
2. Diabetic with no diagnosis of retinopathy overlapping 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

To learn more about how to add Evaluations, click here.

For Denominator Exclusions:

Exclude patients whose hospice care overlaps the measurement period.