CMS 131 - Diabetes: Eye Exam

CMS131v5 (2017)

CMS131v6 (2018)

CMS131v7 (2019)

Description:  Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) 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

Numerator: Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:

  • a retinal or dilated eye exam by an eye care professional in the measurement period, or 
  • a negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period

Inverse Measure:  No

Clinical Instructions

  • 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.
    • Option 1: Document in the Past Procedures section
      • Open the Past Procedures section
      • 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).
      • Add the Date and any relevant Notes.
      • Click the Next button, or close the section
    • Option 2: Document in the Preventive Care section
      • Open the Preventive Care section
      • 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
      • Click the Next button, or close the section
    • Option 3: Scan/Index or Upload an accepted Document
      • Using WebScan, scan and index the appropriate document type configured with the necessary LOINC.

Evidence

Name Value Set
Diagnosis 2.16.840.1.113883.3.464.1003.103.12.1001
Encounter, Performed 2.16.840.1.113883.3.526.3.1240
Encounter, Performed 2.16.840.1.113883.3.666.5.307
Encounter, Performed 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed 2.16.840.1.113883.3.526.3.1285
Encounter, Performed 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed 2.16.840.1.113883.3.464.1003.101.12.1023
Intervention, Order 2.16.840.1.113762.1.4.1108.15
Intervention, Performed 2.16.840.1.113762.1.4.1108.15
Patient Characteristic Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex 2.16.840.1.113762.1.4.1
Physical Exam, Performed 2.16.840.1.113883.3.464.1003.115.12.1088

Source(s)

Medical Codify

WebChart Documentation
Last Build: Wed, 08 Sep 2021 00:25:58 EDT Legacy Documentation