Measure: CMS142
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS142v12 |
2024 |
12.0.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v11 |
2023 |
11 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v10 |
2022 |
10.0.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v9 |
2021 |
9.2.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v8 |
2020 |
8.1.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v7 |
2019 |
7.1.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v6 |
2018 |
6.0.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
| CMS142v5 |
2017 |
5.2.000 |
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
Description
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months
Guidance
The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.
The communication of results to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible professionals or eligible clinicians reporting on this measure should note that all data for the reporting year is to be submitted by the deadline established by CMS. Therefore, eligible professionals or eligible clinicians who see patients towards the end of the reporting period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS.
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | All patients aged 18 years and older with a diagnosis of diabetic retinopathy | Webchart Instructions |
| Denominator | Equals Initial Population who had a dilated macular or fundus exam performed | Webchart Instructions |
| Denominator Exclusions | None | |
| 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 | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | 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. | Webchart Instructions |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS142v9 |
142 |
2021 |
9.2.000 |
Not Applicable |
53d6d7c3-43fb-4d24-8099-17e74c022c05 |
| Steward |
Developer |
Endorsed By |
| American Medical Association (AMA) |
PCPI(R) Foundation (PCPI[R]) |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic Retinopathy is a key indicator of systemic complications of diabetes (Zhang, 2010). Coordination of care between the eye care specialist and the physician managing a patient’s ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient’s diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey, Murchison, Pizzi, Hark, Dai, Leiby & Haller, 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014).
Clinical Recommendation Statement
The ophthalmologist should refer patients with diabetes to a primary care physician for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient's ongoing diabetes care (III; Good Quality; Strong Recommendation) (American Academy of Ophthalmology, 2017).
Ophthalmologists should communicate the ophthalmologic findings and level of retinopathy with the primary care physician as well as the need for optimizing metabolic control (III; Good Quality; Strong Recommendation) (American Academy of Ophthalmology, 2017).
Close partnership with the primary care physician is important to make sure that the care of the patient is optimized (III; Good Quality; Strong Recommendation) (American Academy of Ophthalmology, 2017).
Definition
Communication - May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam.
Findings - Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema.
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| Communication, Not Performed |
Level of Severity of Retinopathy Findings |
2.16.840.1.113883.3.526.3.1283 |
| Communication, Not Performed |
Macular Edema Findings Present |
2.16.840.1.113883.3.526.3.1320 |
| Communication, Performed |
Level of Severity of Retinopathy Findings |
2.16.840.1.113883.3.526.3.1283 |
| Communication, Performed |
Macular Edema Findings Present |
2.16.840.1.113883.3.526.3.1320 |
| Diagnosis |
Diabetic Retinopathy |
2.16.840.1.113883.3.526.3.327 |
| Diagnostic Study, Performed |
Macular Exam |
2.16.840.1.113883.3.526.3.1251 |
| Encounter, Performed |
Care Services in Long-Term Residential Facility |
2.16.840.1.113883.3.464.1003.101.12.1014 |
| Encounter, Performed |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Ophthalmological Services |
2.16.840.1.113883.3.526.3.1285 |
| Encounter, Performed |
Outpatient Consultation |
2.16.840.1.113883.3.464.1003.101.12.1008 |
| Patient Characteristic Ethnicity |
Ethnicity |
2.16.840.1.114222.4.11.837 |
| Patient Characteristic Payer |
Payer |
2.16.840.1.114222.4.11.3591 |
| Patient Characteristic Race |
Race |
2.16.840.1.114222.4.11.836 |
| Patient Characteristic Sex |
ONC Administrative Sex |
2.16.840.1.113762.1.4.1 |
References
Aiello, L. P., & DCCT/EDIC Research Group (2014). Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes care, 37(1), 17–23. doi:10.2337/dc13-2251
American Academy of Ophthalmology. (2017). Diabetic retinopathy Preferred Practice Pattern. San Francisco, CA: American Academy of Ophthalmology.
Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., & Haller, J. A. Impact of physician communication on diabetic eye examination adherence: Results from a Retrospective Cohort Analysis. Retina. 2016 Jan;36(1):20-7. doi:10.1097/IAE.0000000000000652
Zhang, X., Saaddine, J. B., Chou, C. F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., … Klein, R. (2010). Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA, 304(6), 649–656. doi:10.1001/jama.2010.1111
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms142v9