CMS 131 - Diabetes: Eye Exam

Overview

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

Identifiers

CMS eCQM ID	NQF eCQM ID	NQF	MIPS Quality ID
CMS131v10	–	0055	117

*MIE only supports data collection and reporting using eCQM specifications

Definitions

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
Initial Patient Population	Patients 18-75 years of age with diabetes with a visit during the measurement period
Denominator	Equals 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.
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
Numerator Exclusions	–
Denominator Exceptions	–

Additional Information

Measure Type	Process measure
Measure Scoring	Proportion measure
Granularity	Patient
Improvement Notation	Higher score indicates better quality
Domain	Effective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

2. 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

Name	Value Set
Diagnosis: Diabetes	2.16.840.1.113883.3.464.1003.103.12.1001
Encounter, Performed: Annual Wellness Visit	2.16.840.1.113883.3.526.3.1240
Encounter, Performed: Home Healthcare Services	2.16.840.1.113883.3.464.1003.101.12.1016
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: 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

Denominator Exclusions

Name	Value Set
Assessment, Performed: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)	LOINC Code 71007-9
Device, Applied: Frailty Device	2.16.840.1.113883.3.464.1003.118.12.1300
Device, Order: Frailty Device	2.16.840.1.113883.3.464.1003.118.12.1300
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: Care Services in Long-Term Residential Facility	2.16.840.1.113883.3.464.1003.101.12.1014
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: 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: 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
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)
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
Symptom: Frailty Symptom	2.16.840.1.113883.3.464.1003.113.12.1075

Numerator

Name	Value Set
Diagnosis: Diabetic Retinopathy	2.16.840.1.113883.3.526.3.327
Physical Exam, Performed: Retinal or Dilated Eye Exam	2.16.840.1.113883.3.464.1003.115.12.1088

Source(s)

eCQI CMS131