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:
The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation.
This eCQM is a patient-based measure.
Initial Population:
Patients 18-75 years of age at the end of the measurement period, with diabetes with a visit during the measurement period.
AND
A diabetes diagnosis.
ICD-10 Codes
E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.3211, E10.3212, E10.3213, E10.3219, E10.3291, E10.3292, E10.3293, E10.3299, E10.3311, E10.3312, E10.3313, E10.3319, E10.3391, E10.3392, E10.3393, E10.3399, E10.3411, E10.3412, E10.3413, E10.3419, E10.3491, E10.3492, E10.3493, E10.3499, E10.3511, E10.3512, E10.3513, E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539, E10.3541, E10.3542, E10.3543, E10.3549, E10.3551, E10.3552, E10.3553, E10.3559, E10.3591, E10.3592, E10.3593, E10.3599, E10.36, E10.37X1, E10.37X2, E10.37X3, E10.37X9, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.3211, E11.3212, E11.3213, E11.3219, E11.3291, E11.3292, E11.3293, E11.3299, E11.3311, E11.3312, E11.3313, E11.3319, E11.3391, E11.3392, E11.3393, E11.3399, E11.3411, E11.3412, E11.3413, E11.3419, E11.3491, E11.3492, E11.3493, E11.3499, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523, E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549, E11.3551, E11.3552, E11.3553, E11.3559, E11.3591, E11.3592, E11.3593, E11.3599, E11.36, E11.37X1, E11.37X2, E11.37X3, E11.37X9, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.3211, E13.3212, E13.3213, E13.3219, E13.3291, E13.3292, E13.3293, E13.3299, E13.3311, E13.3312, E13.3313, E13.3319, E13.3391, E13.3392, E13.3393, E13.3399, E13.3411, E13.3412, E13.3413, E13.3419, E13.3491, E13.3492, E13.3493, E13.3499, E13.3511, E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532, E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553, E13.3559, E13.3591, E13.3592, E13.3593, E13.3599, E13.36, E13.37X1, E13.37X2, E13.37X3, E13.37X9, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13, O24.311, O24.312, O24.313, O24.319, O24.32, O24.33, O24.811, O24.812, O24.813, O24.819, O24.82, O24.83
ICD-10 Codes can be entered in any of the billing or assessment sections for the patient's visit.
SNOMEDCT Diagnosis Codes
190369008, 237618001, 314771006, 314904008, 102781000119107, 104941000119109, 104961000119108, 109171000119104, 110181000119105, 138881000119106, 138891000119109, 138901000119108, 138911000119106, 138921000119104, 138941000119105, 1481000119100, 1501000119109, 1511000119107, 1551000119108, 190330002, 190331003, 190368000, 190372001, 190389009, 199229001, 199230006, 23045005, 237599002, 237604008, 28032008, 28331000119107, 31211000119101, 31321000119102, 313435000, 313436004, 314893005, 314902007, 314903002, 359642000, 368101000119109, 368521000119107, 368581000119106, 41911000119107, 420279001, 420436000, 420486006, 420789003, 420918009, 421075007, 421326000, 421365002, 421437000, 421468001, 421779007, 421847006, 421893009, 422034002, 422099009, 422166005, 427027005, 427571000, 428007007, 44054006, 46635009, 60951000119105, 609562003, 609564002, 609566000, 609567009, 60961000119107, 60971000119101, 60991000119100, 691000119103, 712882000, 712883005, 713702000, 713703005, 713705003, 713706002, 71441000119104, 71721000119101, 71791000119104, 719216001, 739681000, 770098001, 81531005, 82541000119100, 82551000119103, 82571000119107, 82581000119105, 87921000119104, 97331000119101, 9859006
Both SNOMEDCT and ICD-10 codes can be entered into a patient's chart under the Problem List section.
You can search by the ICD-10 or SNOMEDCT code. Select the code and the appointment and save.
WITH
A Visit During the Measurement Period
CPT Codes:
92002, 92004, 92012, 92014, 99504, 99509, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483
HCPCS Codes:
G0402, G0438, G0439, G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1015, T1019, T1020, T1021, T1022, T1030, T1031
CPT and HCPCS codes can be entered into the billing section for the encounter. Below is an example from the appointment window.
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 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.
Denominator Exceptions
None
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 before the measurement period
SNOMEDCT codes can be entered to document the eye screening.
| SNOMEDCT | Description |
| 252779009 | Single bright white flash electroretinography (procedure) |
| 252780007 | Dark adapted single bright flash electroretinography (procedure) |
| 252781006 | Pre-dark-adapted single bright flash electroretinography (procedure) |
| 252782004 | Photopic electroretinography (procedure) |
| 252783009 | Scotopic rod electroretinography (procedure) |
| 252784003 | Flicker electroretinography (procedure) |
| 252788000 | Chromatic electroretinography (procedure) |
| 252789008 | Early receptor potential electroretinography (procedure) |
| 252790004 | Focal electroretinography (procedure) |
| 274795007 | Examination of optic disc (procedure) |
| 274798009 | Examination of retina (procedure) |
| 308110009 | Direct fundoscopy following mydriatic (procedure) |
| 314971001 | Camera fundoscopy (procedure) |
| 314972008 | Indirect fundoscopy following mydriatic (procedure) |
| 410451008 | Indirect ophthalmoscopy (procedure) |
| 410452001 | Monocular indirect ophthalmoscopy (procedure) |
| 410453006 | Binocular indirect ophthalmoscopy (procedure) |
| 410455004 | Slit lamp fundus examination (procedure) |
| 420213007 | Multifocal electroretinography (procedure) |
| 425816006 | Ultrasonic evaluation of retina (procedure) |
| 427478009 | Evaluation of retina (procedure) |
| 6615001 | Electroretinography (procedure) |
| 722161008 | Diabetic retinal eye exam (procedure) |
The SNOMED CT codes are entered in the patient's chart in the CQMs section. Select New under Physical Exam. Select +New.
You can add the exam by searching for the code or keyword. Once you have the exam, select the appointment, and click Create.
Numerator Exclusions
Not applicable