CMS131v13 - Diabetes Eye Exam clarifying question related to no diagnosis of retinopathy

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry about CMS131v13 (performance period 2025). The new verbiage of "More than mild Diabetic retinopathy not detected" is not sufficient to categorize a patient in the numerator for "no retinopathy". If a patient has any level of retinopathy present, even if it is mild, this is an indication that an eye exam needs to be performed annually. As a reminder, the EHR must reflect evidence of the retinal or dilated eye exam including the date of the exam and the result. The documentation must also include evidence that the exam was performed by an eye care professional.

      If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs.
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      Thank you for your inquiry about CMS131v13 (performance period 2025). The new verbiage of "More than mild Diabetic retinopathy not detected" is not sufficient to categorize a patient in the numerator for "no retinopathy". If a patient has any level of retinopathy present, even if it is mild, this is an indication that an eye exam needs to be performed annually. As a reminder, the EHR must reflect evidence of the retinal or dilated eye exam including the date of the exam and the result. The documentation must also include evidence that the exam was performed by an eye care professional. If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .
    • CMS0131v13
    • Impact will be huge on meeting the numerator in this measure if unable to map the results dropped from our Vendor from the Digital Diagnostics source.

      Our vendor is changing their verbiage that indicates a negative Result for the retinal eye exam results that drops from a Digital Diagnostics source for each patient in the EMR.  Current verbiage states, "No Diabetic Retinopathy Detected"    New Verbiage states, “More than mild Diabetic retinopathy not detected"   We understand per CMS131 specification "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 prior to the measurement period". Would this new verbiage of "More than mild Diabetic retinopathy not detected" be sufficient to meet the numerator as qualifying for "No diagnosis of retinopathy"?   Thank you for your guidance. 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Tara Allred
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