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Measure: CMS131

Diabetes: Eye Exam

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS131v12 2024 12.0.000 Diabetes: Eye Exam
CMS131v11 2023 11 Diabetes: Eye Exam
CMS131v10 2022 10.0.000 Diabetes: Eye Exam
CMS131v9 2021 9.2.000 Diabetes: Eye Exam
CMS131v8 2020 8.4.000 Diabetes: Eye Exam
CMS131v7 2019 7.2.000 Diabetes: Eye Exam
CMS131v6 2018 6.2.000 Diabetes: Eye Exam
CMS131v5 2017 5.0.000 Diabetes: Eye Exam

Description

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of 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 in any part of 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.

Guidance

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients who are in hospice care for any part of the measurement period. Exclude patients with a diagnosis or past history of total colectomy or colorectal cancer. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period.Webchart Instructions
NumeratorPatients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: Diabetic with a diagnosis of retinopathy in any part of 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 in any part of 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 periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS131v11 131 2023 11 0055 d90bdab4-b9d2-4329-9993-5c34e2c0dc66
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance None
Scoring Method Measure Type Stratification Risk Adjustment
Proportion Process None None

Rate Aggregation

None

Improvement Notation

Higher score indicates better quality

Rationale

Clinical Recommendation Statement


Definition

Transmission Format

Applicable Value Sets

Category Value Set OID
Diagnosis Diabetes 2.16.840.1.113883.3.464.1003.103.12.1001
Diagnosis Diabetic Retinopathy 2.16.840.1.113883.3.526.3.327
Diagnosis Frailty Diagnosis 2.16.840.1.113883.3.464.1003.113.12.1074
Encounter, Performed Acute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1083
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Emergency Department Visit 2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Frailty Encounter 2.16.840.1.113883.3.464.1003.101.12.1088
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Hospice Encounter 2.16.840.1.113883.3.464.1003.1003
Encounter, Performed Nonacute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1084
Encounter, Performed Observation 2.16.840.1.113883.3.464.1003.101.12.1086
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 2.16.840.1.113883.3.464.1003.101.12.1087
Encounter, Performed Palliative Care Encounter 2.16.840.1.113883.3.464.1003.101.12.1090
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed Telephone Visits 2.16.840.1.113883.3.464.1003.101.12.1080
Intervention, Order Hospice Care Ambulatory 2.16.840.1.113883.3.526.3.1584
Intervention, Performed Hospice Care Ambulatory 2.16.840.1.113883.3.526.3.1584
Intervention, Performed Palliative Care Intervention 2.16.840.1.113883.3.464.1003.198.12.1135
Medication, Active Dementia Medications 2.16.840.1.113883.3.464.1003.196.12.1510
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
Physical Exam, Performed Retinal or Dilated Eye Exam 2.16.840.1.113883.3.464.1003.115.12.1088
Symptom Frailty Symptom 2.16.840.1.113883.3.464.1003.113.12.1075

References


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Source: https://ecqi.healthit.gov/ecqm/measures/cms131v1