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  2. CQM-6045

2023 CMS131v11 Diabetes: Eye Exam- Numerator Query

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      ​Thank you for your questions regarding CMS131v11, Diabetes: Eye Exam. The definitions identified in your question, 'Retinal Exam in Measurement Period' and 'Retinal Exam in Measurement Period or Year Prior', requires documentation via QDM version 5.6 datatype "Physical Exam, Performed" with any codes listed in the "Retinal or Dilated Eye Exam" value set (2.16.840.1.113883.3.464.1003.115.12.1088). Thus, in the scenario presented, the glaucoma specialist would be able to report this measure despite not performing the retinal dilated exam as long as they document the findings and use the appropriate codes within the patient chart.

      For additional information on eCQM specifications, please refer to the eCQI resource center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0. Thank you.
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      ​Thank you for your questions regarding CMS131v11, Diabetes: Eye Exam. The definitions identified in your question, 'Retinal Exam in Measurement Period' and 'Retinal Exam in Measurement Period or Year Prior', requires documentation via QDM version 5.6 datatype "Physical Exam, Performed" with any codes listed in the "Retinal or Dilated Eye Exam" value set (2.16.840.1.113883.3.464.1003.115.12.1088). Thus, in the scenario presented, the glaucoma specialist would be able to report this measure despite not performing the retinal dilated exam as long as they document the findings and use the appropriate codes within the patient chart. For additional information on eCQM specifications, please refer to the eCQI resource center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0 . Thank you.
    • CMS0131v11

      Query on Numerator section of CMS131v11

      Numerator states:

      • ( "Diabetic Retinopathy Overlapping Measurement Period"
        and exists ( "Retinal Exam in Measurement Period" )
        )
        or ( not ( "Diabetic Retinopathy Overlapping Measurement Period" )
        and exists ( "Retinal Exam in Measurement Period or Year Prior" )

      • Retinal Exam in Measurement Period *

      • ["Physical Exam, Performed": "Retinal or Dilated Eye Exam"] RetinalExam
        where Global."NormalizeInterval" ( RetinalExam.relevantDatetime, RetinalExam.relevantPeriod ) during day of "Measurement Period" 

      • Retinal Exam in Measurement Period or Year Prior *

      • ["Physical Exam, Performed": "Retinal or Dilated Eye Exam"] RetinalExam
        where Global."NormalizeInterval" ( RetinalExam.relevantDatetime, RetinalExam.relevantPeriod ) during day of Interval[start of "Measurement Period" - 1 year,
        end of "Measurement Period"]

      Scenario: Patient was seen by a MIPS eligible provider (glaucoma specialist) during the measurement period. Another provider (retina specialist) saw the patient a few days prior and performed the retinal dilated exam. 

      Can the glaucoma specialist still able to report this measure despite not performing the retinal dilated exam as long as they document the findings and appropriate codes within the patient chart? Please advise. Thank you. 

            edave Mathematica EC eCQM Team
            jtuazon Jhoie Linn
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