CMS131v9 – 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 consecutive 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:

All patients aged 18 – 75 years, with a diagnosis for diabetes and a visit during the measurement period, are considered for the denominator of this measure. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

• Office Visit
• Annual Wellness Visit
• Home Healthcare Services
• Preventive Care Services – Initial Office Visit, 18 and Up
• Preventive Care Services – Established Office Visit, 18 and Up
• Ophthalmological Services

To record the diabetes diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diabetes diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.

For Numerator:

Patients satisfying any of the following conditions are included in the numerator:

• Patient had a diagnosis for ‘Diabetic Retinopathy’ and a retinal exam performed during the measurement period. To record the diabetic retinopathy diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
  • To document retinal exam performed, navigate to Patient > Clinical > Evaluations. Click ‘+Evaluation’ and search for an  intervention. Select ‘Performed’ from the ‘Status’ dropdown. Then click ‘Sign’ or ‘Save’.

• Patient had a diagnosis for ‘Diabetic Retinopathy’ during the measurement period and a retinal exam performed during the measurement period or during the year prior to the measurement period. To record the diabetic retinopathy diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’. The diagnosis is added to the provider note.
  • To document retinal exam performed, navigate to Patient > Clinical > Evaluations. Click ‘+Evaluation’ and search for an  intervention. Select ‘Performed’ from the ‘Status’ dropdown. Then click ‘Sign’ or ‘Save’.

For Denominator Exclusions:

Patients satisfying any of the following criteria are excluded from the denominator:

• Patients who received hospice care during the measurement year. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations 

• Patients aged 65 years or older at the start of the measurement period who spent longer than 90 consecutive days in a long term care during the measurement period. To record the encounter, navigate to Patient > Provider Note > eSuperbill. 

• Patients 65 years of age or older with two or more outpatient encounters with advanced illness and fulfilling frailty criteria. Outpatient encounters should occur two years or less prior to the end of the measurement period. To document an outpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document an advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

• Patients 65 years of age or older having an inpatient encounter with advanced illness and fulfilling frailty criteria. Inpatient encounter should occur two years or less prior to the end of the measurement period. To document an inpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document an advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

• Patients 65 years of age or older taking dementia medication one year prior to or during the measurement period and fulfilling frailty criteria. Record the medication via the workflow Patient > Clinical > Prescription. Workflows for recording frailty criteria:
  • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
  • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
  • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
  • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill