CMS 131 - Diabetes: Eye Exam

Overview

CMS131v8 (2020)
CMS131v9 (2021)
CMS131v10 (2022)

Identifiers

CMS eCQM IDNQF eCQM IDNQFMIPS Quality ID
CMS131v10โ€“0055117
*MIE only supports data collection and reporting using eCQM specifications

Definitions

DescriptionPercentage 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
Initial Patient PopulationPatients 18-75 years of age with diabetes with a visit during the measurement period
DenominatorEquals Initial Population
Denominator Exclusions
  • Exclude patients who are in hospice care for any part of the measurement period.

  • Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.

  • Exclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:

    • Advanced illness with two outpatient encounters during the measurement period or the year prior

    • Advanced illness with one inpatient encounter during the measurement period or the year prior

    • Taking dementia medications during the measurement period or the year prior

  • Exclude patients receiving palliative care during the measurement period.

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 period

Numerator Exclusionsโ€“
Denominator Exceptionsโ€“

Additional Information

Measure TypeProcess measure
Measure ScoringProportion measure
GranularityPatient
Improvement NotationHigher score indicates better quality
DomainEffective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

  1. Ensure all diabetic patients aged 18-75 have been screened for diabetic retinal disease. Use the Past Procedures section of the encounter to record a previous dilated or negative retinal exam, or use the Preventive Care section of the encounter to document the last Retinal Screening; otherwise, document a recognized eye exam by scanning and indexing an established document type (e.g., RETINAL) configured with the appropriate Concept ID.

    1. Option 1: Document in the Past Procedures section

      1. Open the Past Procedures section
      2. Using the Procedure autocomplete, begin typing the name of the diagnostic procedure (e.g., Dilated Fundus Evaluation, Retinal Screening, etc.) with the appropriate Concept ID (e.g., LOINC).
      3. Add the Date and any relevant Notes.
      4. Click the Next button, or close the section
    2. Option 2: Document in the Preventive Care section

      1. Open the Preventive Care section
      2. Provide the date of the last reported procedure in the Enter New Date field (e.g., 01-17-2020). This date is the Last Reported Date
      3. Click the Next button, or close the section
    • Option 3: Scan/Index or Upload an accepted Document

      1. Using WebScan , scan and index the appropriate document type configured with the necessary LOINC.

Evidence

Initial Patient Population

NameValue Set
Diagnosis: Diabetes2.16.840.1.113883.3.464.1003.103.12.1001
Encounter, Performed: Annual Wellness Visit2.16.840.1.113883.3.526.3.1240
Encounter, Performed: Home Healthcare Services2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Office Visit2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Ophthalmological Services2.16.840.1.113883.3.526.3.1285
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed: Telephone Visits2.16.840.1.113883.3.464.1003.101.12.1080

Denominator Exclusions

NameValue Set
Assessment, Performed: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)LOINC Code 71007-9
Device, Applied: Frailty Device2.16.840.1.113883.3.464.1003.118.12.1300
Device, Order: Frailty Device2.16.840.1.113883.3.464.1003.118.12.1300
Diagnosis: Frailty Diagnosis2.16.840.1.113883.3.464.1003.113.12.1074
Encounter, Performed: Acute Inpatient2.16.840.1.113883.3.464.1003.101.12.1083
Encounter, Performed: Care Services in Long-Term Residential Facility2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed: Emergency Department Visit2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed: Encounter Inpatient2.16.840.1.113883.3.666.5.307
Encounter, Performed: Frailty Encounter2.16.840.1.113883.3.464.1003.101.12.1088
Encounter, Performed: Nonacute Inpatient2.16.840.1.113883.3.464.1003.101.12.1084
Encounter, Performed: Nursing Facility Visit2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed: Observation2.16.840.1.113883.3.464.1003.101.12.1086
Encounter, Performed: Outpatient2.16.840.1.113883.3.464.1003.101.12.1087
Encounter, Performed: Palliative Care Encounter2.16.840.1.113883.3.464.1003.101.12.1090
Intervention, Order: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15)
Intervention, Performed: Palliative Care Intervention2.16.840.1.113883.3.464.1003.198.12.1135
Medication, Active: Dementia Medications2.16.840.1.113883.3.464.1003.196.12.1510
Symptom: Frailty Symptom2.16.840.1.113883.3.464.1003.113.12.1075

Numerator

NameValue Set
Diagnosis: Diabetic Retinopathy2.16.840.1.113883.3.526.3.327
Physical Exam, Performed: Retinal or Dilated Eye Exam2.16.840.1.113883.3.464.1003.115.12.1088

Source(s)

eCQI CMS131


Enterprise Health Documentation

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