Denominator: All patients aged 18 years and older with an active diagnosis of diabetic retinopathy who had an office visit and dilated macular or fundus exam performed during the performance period.
- An exception is available when a medical or patient reason is documented for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.
Numerator: Patients with documentation, at least once within the performance period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care.
- “Office visit” is an encounter with at least one service with CPT code: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 92002, 92004, 92012, 92014.
- “Dilated macular or fundus exam performed” requires use of the Fundus test to document the following for at least one eye: “Diab Ret Grd” , “DME Y/N.”
- “Diab Ret Grd” cannot be “None” as this represents an inconsistency between the active diagnosis diabetic retinopathy (in Diagnosis History) and the clinical findings. In cases where active retinopathy is not present, the diagnosis should be resolved prior to signing the encounter.
- “Communication” requires:
- Use of the “Communicate” button on the screen header bar within the encounter where the dilated macular or fundus exam was performed to start a letter. See Example
- Use of any of the following templates for the letter:
- The designated recipient to be a “Provider” or “External Provider.” See Example
- Included diabetic retinopathy ICD codes can be found in Appendix G.
- Allowed medical reason exception SNOMED codes can be found in Appendix H.
- Allowed patient reason exception SNOMED codes can be found in Appendix I.