NQF 0055 (Additional) Diabetes: Eye Exam

Measure:  NQF 0055 (Additional Measure)

Measure Title:  Diabetes: Eye Exam

Measure Description:  The percentage of patients 18–75 years of age with Diabetes (Type 1 or Type 2) whom had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional.

*REQUIRED FOR MEANINGFUL USE (MU) ADDITIONAL MEASURE: Click here to view the Meaningful Use Criteria.

Quality Measure Documentation Workflow

In order for the Clinical Quality Measure report to generate, the following must be documented in the relevant patient's chart:

1.  The patient must be between the ages of 18 and 75 at the start of the reporting period and have at least one face-to-face SOAPnote with the provider during the reporting period.

2.  A diagnosis of Diabetes Type 1 or Type 2.  This can be recorded by using any of the ICD9 codes listed below in the patient's Summary Active Problems field or SOAPnote Assessment field.

250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04

3.  In addition, there should be documentation to record if the patient has had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional.  Inserting the shortcut code "PQRIdmEye" into the encounter Plan field will allow the user to select from a group of specific SMARText CPT codes that can be used to document for this measure: 2022F, 2024F, 2026F, 3072F (2022F-8P will not insrease the numerator).

(Any of the following CPT codes could also be entered into the Plan field using a Shift +F11 search to document that the patient had a retinal or dilated eye exam or negative retinal exam: 67028, 67030, 67031, 67036, 67038, 67039, 67040, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260,S0620, S0621, S0625, S3000.)

Measurement Calculation Details

Numerator Calculation:

The numerator for this measurement is calculated based on the following:

1.  The number of patients in the denominator that have had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional.  This should be documented using an appropriate CPT code in the encounter Plan field using "PQRIdmEye":

2022F, 2024F, 2026F, 3072F (2022F-8P will not increase the numerator).

(Any of the following CPT codes could also be entered into the Plan field using a Shift +F11 search to document that the patient had a retinal or dilated eye exam or negative retinal exam: 67028, 67030, 67031, 67036, 67038, 67039, 67040, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260,S0620, S0621, S0625, S3000.)

Denominator Calculation:

The denominator for this measurement is calculated based on the following:

1.  The number of patients that were between 18 and 75 years of age by the start of the reporting period and have at least one face-to-face encounter with the provider during the reporting period.

2.  And have a diagnosis of Diabetes Type 1 or 2 (recorded by using one of the ICD9 codes listed below) must be recorded in the patient's Summary Active Problems field or encounter Assessment field:

250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04

Report Clinical Quality Measures to CMS/States

All of the items listed in the above steps need to be documented as structured data (as detailed above) in order to allow the user to capture the numerator, denominator and percentage for this quality measure.

For information on how to export the numerator, denominator and percentage for each Clinical Quality Measure, Click here.

For more information on reporting clinical quality measures, Click here.