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Diabetes: Eye Exam

Updated: 08/19/2020
Views: 944

Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period.

Denominator: All patients aged 18-75 years of age with diabetes with a visit during the measurement period.
  • Patient’s age is calculated based on the patient’s Date of Birth, which is entered when you created the patient’s account.
  • The diagnosis of "Diabetes" and/or "Diabetic Retinopathy" is entered in the patient’s Problem List.
  • Make sure to add a Start Date to the problem.
  • Create a note detailing the patient’s office visit.
Denominator Exclusions: Exclude patients whose hospice care overlaps the measurement period.
  • Hospice Care is documented under Procedures & Hospitalizations.
Numerator: Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal or dilated exam (no evidence of retinopathy) by an eye care professional in 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:
  • Complete the note and make sure to include an E/M Codes or CPT/HCPCS Codes on the Superbill.
    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.
  • Sign the note.

Once all steps have been completed, the measure will be added to the Quality 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.
Quality ID: 117
CMS Measure ID: CMS131
Measure type: Process
High Priority Measure: No
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