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 Population | Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period | Webchart Instructions |
Denominator | Equals Initial Population | Webchart Instructions |
Denominator Exclusions | Exclude 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 |
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 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 period | Webchart Instructions |
Numerator Exclusions | Not Applicable | Webchart Instructions |
Denominator Exceptions | None | |
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
Disclaimer
Copyright
Source:
https://ecqi.healthit.gov/ecqm/measures/cms131v1