Follow-up from (CQM-7981) - 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
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      Thank you for your inquiry about CMS131v13 (performance period 2025). As stated in the guidance section of the header, to meet criteria for artificial intelligence (AI), there must be evidence that fundus photography results were read by a system that provides an AI interpretation. The measure is not prescriptive on what AI equipment brand needs to be used.

      The new verbiage of "More than mild Diabetic retinopathy not detected" is still 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. The language provided from the reading cannot confirm if there was no retinopathy or if there was a minimal amount.
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      Thank you for your inquiry about CMS131v13 (performance period 2025). As stated in the guidance section of the header, to meet criteria for artificial intelligence (AI), there must be evidence that fundus photography results were read by a system that provides an AI interpretation. The measure is not prescriptive on what AI equipment brand needs to be used. The new verbiage of "More than mild Diabetic retinopathy not detected" is still 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. The language provided from the reading cannot confirm if there was no retinopathy or if there was a minimal amount.
    • CMS0131v13
    • Highly impacts meeting the numerator for this measure.

      This is related to first issue logged: (CQM-7981) CMS131v13 - Diabetes Eye Exam clarifying question related to no diagnosis of retinopathy. This issue is closed now. 

      We have a follow up question after your first response with some more context:  We are using the FDA approved LuminetcsCore equipment that utilizes AI to read the images and we would like to know if the new verbiage is still not sufficient.  Last response from (CQM-7981) - "The new verbiage of "More than mild Diabetic retinopathy not detected" is not sufficient to categorize a patient in the numerator for "no retinopathy".

      **Question is: Knowing we will be using the "FDA approved LuminetcsCore equipment that utilizes AI to read the images" would this response still stand from a CMS standpoint? **

      From (CQM-7981) ONC Solution: 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.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Tara Allred
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