CQM Measure CMS123v5 Diabetes: Foot Exam

CQM Measure CMS123v5 Diabetes: Foot Exam

NQS Domain: Clinical Process/Effectiveness

Description: Percentage of patients 18-75 years of age with diabetes who had a foot exam during the measurement period.

Denominator Logic

Patient was >= 18 years old on or before the start of measurement period.


AND Patient was < 75 years old on or before the start of measurement period.


AND Patient had active patient problem Diabetes (CQM ValueSet: 2.16.840.1.113883.3.464.1003.103.12.1001) recorded during measurement period.

AND Patient had one or more appointment scheduled during measurement period, with CPT code in [99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397] or HCPCS code in [G0438, G0439] entered.

Exclusions Logic

OR Patient had active patient problem Bilateral Amputee (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1056) recorded during measurement period

OR
        Patient had active active patient problem Right Unilateral Amputation Above or Below Knee (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1057) or Unilateral Amputation Below or Above Knee, Unspecified Laterality (anatomical location site: Right)" (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1059) recorded during measurement period
        Patient had active active patient problem Left Unilateral Amputation Above or Below Knee (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1058) or Unilateral Amputation Below or Above Knee, Unspecified Laterality (anatomical location site: Left)" (CQM ValueSet: 2.16.840.1.113883.3.464.1003.113.12.1059) recorded during measurement period

Numerator Logic

OR Patient had appointment scheduled during measurement period with HCPCS code 2028F entered.

OR
        Patient had Physical Exam Visual Exam of Foot (CQM ValueSet: 2.16.840.1.113883.3.464.1003.103.12.1013) performed during measurement period
        AND Patient had Physical Exam Sensory Exam of Foot (CQM ValueSet: 2.16.840.1.113883.3.464.1003.103.12.1014) performed during measurement period
        AND Patient had Physical Exam Pulse Exam of Foot (CQM ValueSet: 2.16.840.1.113883.3.464.1003.103.12.1015) performed during measurement period

 

For more information, please visit the CMS website here.

How To (Website) 

Step 1: Ensure that “Diabetes” is cataloged for the patient in the “Problem List” area of the patient record.

Step 2: Ensure that the patient had one or more appointment scheduled during the measurement period with one of the above CPT codes (indicated in the denominator fields) entered.

Step 3: Ensure that the patient had an appointment scheduled during the measurement period with HCPCS code 2028F entered.

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