CMS 131 - Diabetes: Eye Exam

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Updated: 08/23/2021
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CMS 131 / Quality ID #117

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy overlapping 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 overlapping 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:	All patients aged 18-75 years of age at the start 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 Problem List with a Start Date.
Denominator Exclusions:	If patient was in Hospice during the measurement period: Hospice is documented under Hospitalizations/Procedures in History. These patients will be excluded from the denominator. Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period: Long Term Care is documented under Long Term Care Facility in History. These patients will be excluded from the denominator. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured: 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.
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. And, 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. 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:	Enter Procedure Codes including E/M Codes or HCPCS Codes on the Superbill. Complete and sign the note. Note: Select "Not Completed" for Diabetic Eye Exam (Age 18-75): Eye exam performed in the Care Checklist when the follow up plan was not completed by the provider. Once all steps have been completed, the measure will be added to the Quality Measures Report.
Guidance:	Only patients with Type 1 or Type 2 diabetes will be included. Patients with a diagnosis of secondary diabetes due to another condition will not be included. The eye exam must be performed by an ophthalmologist or optometrist.
Measure type:	Process
High Priority Measure:	No
Telehealth Eligible:	Yes