Clinical Quality Measure
CMS167v2 (NQF 0088) - Additional Measure

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

NQS DOMAIN:   Clinical Process/Effectiveness




Description and Implementation within the EMR software

Denominator: All patients 18 years or older with at least 2 encounters having one of the following ICD-10 codes selected in ASSESSMENT/DIAGNOSIS section on the ENCOUNTER form:
E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359

Numerator: Patients in the above mentioned list who had a dilated macular or fundus exam performed. UniCharts looks for the custom code QM088A: [Quality Measure] Dilated macular/fundus exam performed including edema/retinopathy documentation (2021F) within the PROCEDURES/SERVICES section on the ENCOUNTER form as the required documentation.

Exceptions: UniCharts looks for the custom code QM088E: [Exception] Action specified in CMS167v2 not performed due to medical, patient, or system reasons within the PROCEDURES/SERVICES section on the ENCOUNTER form as the required documentation.

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