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 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
Guidance
Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.
The eye exam must be performed by an ophthalmologist or optometrist.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | Patients 18-75 years of age with diabetes with a visit during the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients whose hospice care overlaps the measurement period.
Exclude patients 66 and older who are living long term in an institution for more than 90 days during the measurement period.
Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured. | 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 that overlaps 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 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 | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS131v8 |
131 |
2020 |
8.4.000 |
Not Applicable |
d90bdab4-b9d2-4329-9993-5c34e2c0dc66 |
| Steward |
Developer |
Endorsed By |
| National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year and affects more than 30 million Americans (9.4 percent of the U.S. population) (Centers for Disease Control and Prevention [CDC], 2017a, 2017b ). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2017c). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death (CDC, 2016).
In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018a).
Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2015).
Clinical Recommendation Statement
American Diabetes Association (2018b):
- Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B)
- Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B)
-If there is no evidence of retinopathy for one or more annual eye exam and glycemia is well controlled, then exams every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B)
Definition
None
Transmission Format
TBD
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 |
Care Services in Long-Term Residential Facility |
2.16.840.1.113883.3.464.1003.101.12.1014 |
| Encounter, Performed |
ED |
2.16.840.1.113883.3.464.1003.101.12.1085 |
| 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 |
Nonacute Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1084 |
| Encounter, Performed |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
| 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 |
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 |
| Intervention, Order |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
| Intervention, Performed |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
| 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
American Diabetes Association. (2018a). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
American Diabetes Association. (2018b). 10. Microvascular complications and foot care: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41(Suppl. 1), S105-S118.
Centers for Disease Control and Prevention. (2017a). Health, United States, 2016: With chartbook on long-term trends in health. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf
Centers for Disease Control and Prevention. (2017b). National diabetes statistics report, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Centers for Disease Control and Prevention. (2017c). About diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
Centers for Disease Control and Prevention. (2016). At a glance 2016: Diabetes—Working to reverse the U.S. epidemic. Atlanta, GA: Author.
Centers for Disease Control and Prevention. (2015). Common eye disorders: Diabetic retinopathy. Retrieved from https://www.cdc.gov/visionhealth/basics/ced/index.html
Disclaimer
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms131v8