Diabetes: Eye Exam

Denominator: Patients 18-75 years of age with diabetes and a visit during the performance period.

• Exclusion: Patients who were in Hospice care during the measurement year.

Numerator: Patients in the denominator who had at least one of the following:

1. A retinal or dilated eye exam by an eye care professional in the performance period. A “retinal or dilated examination” is an encounter where the Fundus test is used to document at least one value.
2. A negative retinal exam (i.e., no evidence of retinopathy) by an eye care professional < 12 months prior to the performance period.
   • “No evidence of retinopathy” is a Fundus test where both the following are true for both eyes:
     • “Diab Ret Grd” is “None”; and 

     • “DME Y/N” is “N.”
     • See Example 

Notes:

• "Visit" is an encounter with at least one service from the following list of CPT codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99337, 99385, 99386, 99387, 99395, 99396, 99397, 92002, 92004, 92012, 92014, G0438, G0439.
• "Patients who were in Hospice care during the measurement year” is a patient with a SNOMED code of 385763009 – Hospice care (regime/therapy) or 385765002 – Hospice care management (procedure).
• “Diabetes” ICD codes can be found in Appendix A.

Video Discussion