CMS142v8 – Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

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

– DENOMINATOR

All patients aged 18 years and older with a diagnosis of diabetic retinopathy and who had a dilated macular or fundus exam performed.

– NUMERATOR

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.

-DENOMINATOR EXCEPTION

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

For Initial Population:

All patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period are included in this measure. The diagnosis can be added by navigating to Patient > Clinical > Diagnosis.

The documentation of the first encounter takes place when one visit code gets attached with the patient’s eSuperbill/ charge. To add a record, navigate to Patient > Provider Notes > eSuperbill.

For Denominator:

Patient who met following criteria are added in the denominator.

• All patients aged 18 years and older having at least one visit code attached with the patient’s eSuperbill/ charge
• Has a diagnosis of diabetic retinopathy
• Has a dilated macular or fundus exam performed (Pateint > Clinical > Evaluations)

For Numerator:

“All patients, from denominator/initial population, who have a documentation of communication of the results of either dilated macular or fundus exam with the physician who manage the patient’s diabetic care are qualified for numerator. The communication should be documented within the reporting period”

The communication of results of Dilated Macular or Fundus Exam can be documented by navigating to evaluations.

For Denominator Exception:

Included are all patient for whom following documentation are done.

• 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.
• 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.