Thank you for your inquiry on CMS142v11, Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. The measure's denominator is comprised of the "Initial Population", which is defined as patients aged 18 years and older from start of measurement period with a diabetic retinopathy encounter.   The measure specifies “Diabetic Retinopathy Encounter” as a qualifying encounter during the measurement period such that the diabetic retinopathy prevalence period overlaps with the qualifying encounter. The patient should only be included in the denominator if there is an active diabetic retinopathy diagnosis code and a macular exam performed. Diagnosis needs to be made inactive in the EHR, otherwise, it will exist as active. Please consult with your EHR vendor to ensure that patients’ diabetic retinopathy diagnoses are properly documented.