Diabetic Measure 117 Help Needed

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: High
    • Component/s: None
    • None
    • Ariel Bernard
    • Solinsky Eye Care
    • Hide
      Thank you for your inquiry about CMS131v13 (performance period 2025). Patients who declined dilation is currently not an exclusion for this measure. The measure looks for diabetic patients aged 18-75 who had an outpatient visit during the measurement period and received a retinal or dilated eye exam, based on whether they had retinopathy diagnosed during the period or within the previous year. As stated in the guidance section of the header, to meet criteria for AI, there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. The measure is not prescriptive on what AI equipment brand needs to be used. We do not provide prescriptive guidance on mapping the value sets. Equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit.

      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.
      Show
      Thank you for your inquiry about CMS131v13 (performance period 2025). Patients who declined dilation is currently not an exclusion for this measure. The measure looks for diabetic patients aged 18-75 who had an outpatient visit during the measurement period and received a retinal or dilated eye exam, based on whether they had retinopathy diagnosed during the period or within the previous year. As stated in the guidance section of the header, to meet criteria for AI, there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. The measure is not prescriptive on what AI equipment brand needs to be used. We do not provide prescriptive guidance on mapping the value sets. Equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit. 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
    • Hide
      Team is unclear on how to document quality measure 117 for diabetic pts who declined dilation and had an Optos instead. This is creating many unfavorable patients for this measure at our practice as well as pts referred for eyelid evals where dilated exams are not required.
      Show
      Team is unclear on how to document quality measure 117 for diabetic pts who declined dilation and had an Optos instead. This is creating many unfavorable patients for this measure at our practice as well as pts referred for eyelid evals where dilated exams are not required.

      Hi,
      Currently we have many unfavorable patients for Quality Measure 117: Diabetes Mellitus Dilated Eye Exam using our Modmed system because staff are unclear on how to document new patients who declined dilation (either because they are pregnant, had to go to work, did not feel safe to drive etc.) and had an Optos taken instead. We would like to know if we can use 2033F "eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy" to override unfavorable patients who had an Optos and were not dilated. If not, are there any menu items for 117 we can use for Optos patients so they are not considered unfavorable?

      Additionally, we have diabetic patients who are referred to us (from their diabetic managing eye doctor) to see our oculoplastic doctor for eyelid evaluations that do not require a dilated exam and are populating as unfavorable since they are not being dilated. Is there an option, and if so what is it, to exclude these patients so they are not counted against us since we are not the eye care professional following their diabetic eye exams and their visit does not require dilation?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Ariel
            Votes:
            0 Vote for this issue
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: