| eCQM / NQF #: | CMS167v6 / 0088 |
| Measure: | 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. |
| Numerator: | Patients 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. |
| Denominator: | All patients aged 18 years and older with a diagnosis of diabetic retinopathy. |
| Exception: | Documentation of medical reason(s) for not performing a dilated macular or fundus examination.
Documentation of patient reason(s) for not performing a dilated macular or fundus examination. |
| Domain: | Effective Clinical Care |
In ChartMaker Clinical:
In order to qualify for this measure, the provider must have seen the patient, age 18 years or older, at least one time during the reporting period and have the appropriate information documented in the chart:
Required Data Elements for the Denominator:
• Office Visit Encounter, Face-to-Face Interaction Code, Outpatient Consultation, Care Services in Long-Term Residential Facility, Nursing Care Facility or Ophthalmological Service
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This is captured by adding a procedure with a valid CPT and/or SNOMED code using the procedure widget in a note.
Valid Office Encounter Codes:
| CPT: | |
| Code | Description |
| 92002 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient |
| 92004 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits |
| 92012 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient |
| 92014 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits |
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 99241 | Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99242 | Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 99243 | Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 99244 | Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| 99245 | Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family. |
| 99304 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99305 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99306 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99307 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99308 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99309 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit. |
| 99310 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit. |
Valid Patient Provider Interaction and Face-to- Face Interaction Codes:
| SNOMED: | |
| Code | Description |
| 12843005 | Subsequent hospital visit by physician (procedure) |
| 18170008 | Subsequent nursing facility visit (procedure) |
| 19681004 | Nursing evaluation of patient and report (procedure) |
| 87790002 | Follow-up inpatient consultation visit (procedure) |
| 90526000 | Initial evaluation and management of healthy individual (procedure) |
| 185349003 | Encounter for "check-up" (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185465003 | Weekend visit (procedure) |
| 207195004 | History and physical examination with evaluation and management of nursing facility patient (procedure) |
| 270427003 | Patient-initiated encounter (procedure) |
| 270430005 | Provider-initiated encounter (procedure) |
| 308335008 | Patient encounter procedure (procedure) |
| 390906007 | Follow-up encounter (procedure) |
| 406547006 | Urgent follow-up (procedure) |
| 439708006 | Home visit (procedure) |
• Diabetic Retinopathy Diagnosis Code (with attached SNOMED) that occurs before or during the Encounter
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This is captured by adding a diagnosis with a valid ICD10/ICD9 or SNOMED code using the Diagnosis widget in a note.
| ICD-9: | |
| Code | Description |
| 250.00 | Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled |
| 250.01 | Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled |
| 250.02 | Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled |
| 250.03 | Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled |
| 250.10 | Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled |
| 250.11 | Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled |
| 250.12 | Diabetes with ketoacidosis, type II or unspecified type, uncontrolled |
| 250.13 | Diabetes with ketoacidosis, type I [juvenile type], uncontrolled |
| 250.20 | Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled |
| 250.21 | Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled |
| 250.22 | Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled |
| 250.23 | Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled |
| 250.30 | Diabetes with other coma, type II or unspecified type, not stated as uncontrolled |
| 250.31 | Diabetes with other coma, type I [juvenile type], not stated as uncontrolled |
| 250.32 | Diabetes with other coma, type II or unspecified type, uncontrolled |
| 250.33 | Diabetes with other coma, type I [juvenile type], uncontrolled |
| 250.40 | Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled |
| 250.41 | Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled |
| 250.42 | Diabetes with renal manifestations, type II or unspecified type, uncontrolled |
| 250.43 | Diabetes with renal manifestations, type I [juvenile type], uncontrolled |
| 250.50 | Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled |
| 250.51 | Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled |
| 250.52 | Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled |
| 250.53 | Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled |
| 250.60 | Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled |
| 250.61 | Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled |
| 250.62 | Diabetes with neurological manifestations, type II or unspecified type, uncontrolled |
| 250.63 | Diabetes with neurological manifestations, type I [juvenile type], uncontrolled |
| 250.70 | Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled |
| 250.71 | Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled |
| 250.72 | Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled |
| 250.73 | Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled |
| 250.80 | Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled |
| 250.81 | Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled |
| 250.82 | Diabetes with other specified manifestations, type II or unspecified type, uncontrolled |
| 250.83 | Diabetes with other specified manifestations, type I [juvenile type], uncontrolled |
| 250.90 | Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled |
| 250.91 | Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled |
| 250.92 | Diabetes with unspecified complication, type II or unspecified type, uncontrolled |
| 250.93 | Diabetes with unspecified complication, type I [juvenile type], uncontrolled |
| 357.2 | Polyneuropathy in diabetes |
| 362.01 | Background diabetic retinopathy |
| 362.02 | Proliferative diabetic retinopathy |
| 362.03 | Nonproliferative diabetic retinopathy NOS |
| 362.04 | Mild nonproliferative diabetic retinopathy |
| 362.05 | Moderate nonproliferative diabetic retinopathy |
| 362.06 | Severe nonproliferative diabetic retinopathy |
| 362.07 | Diabetic macular edema |
| 366.41 | Diabetic cataract |
| 648.00 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable |
| 648.01 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition |
| 648.02 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication |
| 648.03 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication |
| 648.04 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication |
| ICD-10: | |
| Code | Description |
| E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma |
| E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma |
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy |
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication |
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E10.321 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E10.329 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E10.331 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E10.339 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E10.341 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E10.349 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E10.351 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E10.359 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E10.36 | Type 1 diabetes mellitus with diabetic cataract |
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication |
| E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified |
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E10.59 | Type 1 diabetes mellitus with other circulatory complications |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy |
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy |
| E10.620 | Type 1 diabetes mellitus with diabetic dermatitis |
| E10.621 | Type 1 diabetes mellitus with foot ulcer |
| E10.622 | Type 1 diabetes mellitus with other skin ulcer |
| E10.628 | Type 1 diabetes mellitus with other skin complications |
| E10.630 | Type 1 diabetes mellitus with periodontal disease |
| E10.638 | Type 1 diabetes mellitus with other oral complications |
| E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma |
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia |
| E10.69 | Type 1 diabetes mellitus with other specified complication |
| E10.8 | Type 1 diabetes mellitus with unspecified complications |
| E10.9 | Type 1 diabetes mellitus without complications |
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma |
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E11.321 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E11.329 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E11.331 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E11.339 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E11.341 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E11.349 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E11.351 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E11.359 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication |
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication |
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E11.59 | Type 2 diabetes mellitus with other circulatory complications |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy |
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis |
| E11.621 | Type 2 diabetes mellitus with foot ulcer |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer |
| E11.628 | Type 2 diabetes mellitus with other skin complications |
| E11.630 | Type 2 diabetes mellitus with periodontal disease |
| E11.638 | Type 2 diabetes mellitus with other oral complications |
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| E11.69 | Type 2 diabetes mellitus with other specified complication |
| E11.8 | Type 2 diabetes mellitus with unspecified complications |
| E11.9 | Type 2 diabetes mellitus without complications |
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma |
| E13.10 | Other specified diabetes mellitus with ketoacidosis without coma |
| E13.11 | Other specified diabetes mellitus with ketoacidosis with coma |
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication |
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E13.321 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E13.329 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E13.331 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E13.339 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E13.341 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E13.349 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E13.351 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E13.359 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E13.36 | Other specified diabetes mellitus with diabetic cataract |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication |
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified |
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication |
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E13.59 | Other specified diabetes mellitus with other circulatory complications |
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy |
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathy |
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis |
| E13.621 | Other specified diabetes mellitus with foot ulcer |
| E13.622 | Other specified diabetes mellitus with other skin ulcer |
| E13.628 | Other specified diabetes mellitus with other skin complications |
| E13.630 | Other specified diabetes mellitus with periodontal disease |
| E13.638 | Other specified diabetes mellitus with other oral complications |
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma |
| E13.649 | Other specified diabetes mellitus with hypoglycemia without coma |
| E13.65 | Other specified diabetes mellitus with hyperglycemia |
| E13.69 | Other specified diabetes mellitus with other specified complication |
| E13.8 | Other specified diabetes mellitus with unspecified complications |
| E13.9 | Other specified diabetes mellitus without complications |
| O24.011 | Pre-existing diabetes mellitus, type 1, in pregnancy, first trimester |
| O24.012 | Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester |
| O24.013 | Pre-existing diabetes mellitus, type 1, in pregnancy, third trimester |
| O24.019 | Pre-existing diabetes mellitus, type 1, in pregnancy, unspecified trimester |
| O24.02 | Pre-existing diabetes mellitus, type 1, in childbirth |
| O24.03 | Pre-existing diabetes mellitus, type 1, in the puerperium |
| O24.111 | Pre-existing diabetes mellitus, type 2, in pregnancy, first trimester |
| O24.112 | Pre-existing diabetes mellitus, type 2, in pregnancy, second trimester |
| O24.113 | Pre-existing diabetes mellitus, type 2, in pregnancy, third trimester |
| O24.119 | Pre-existing diabetes mellitus, type 2, in pregnancy, unspecified trimester |
| O24.12 | Pre-existing diabetes mellitus, type 2, in childbirth |
| O24.13 | Pre-existing diabetes mellitus, type 2, in the puerperium |
| O24.311 | Unspecified pre-existing diabetes mellitus in pregnancy, first trimester |
| O24.312 | Unspecified pre-existing diabetes mellitus in pregnancy, second trimester |
| O24.313 | Unspecified pre-existing diabetes mellitus in pregnancy, third trimester |
| O24.319 | Unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester |
| O24.32 | Unspecified pre-existing diabetes mellitus in childbirth |
| O24.33 | Unspecified pre-existing diabetes mellitus in the puerperium |
| O24.811 | Other pre-existing diabetes mellitus in pregnancy, first trimester |
| O24.812 | Other pre-existing diabetes mellitus in pregnancy, second trimester |
| O24.813 | Other pre-existing diabetes mellitus in pregnancy, third trimester |
| O24.819 | Other pre-existing diabetes mellitus in pregnancy, unspecified trimester |
| O24.82 | Other pre-existing diabetes mellitus in childbirth |
| O24.83 | Other pre-existing diabetes mellitus in the puerperium |
| SNOMED: | |
| Code | Description |
| 4783006 | Maternal diabetes mellitus with hypoglycemia affecting fetus OR newborn (disorder) |
| 9859006 | Insulin-resistant diabetes mellitus AND acanthosis nigricans (disorder) |
| 23045005 | Insulin dependent diabetes mellitus type IA (disorder) |
| 28032008 | Insulin dependent diabetes mellitus type IB (disorder) |
| 44054006 | Diabetes mellitus type 2 (disorder) |
| 46635009 | Diabetes mellitus type 1 (disorder) |
| 75682002 | Diabetes mellitus due to insulin receptor antibodies (disorder) |
| 76751001 | Diabetes mellitus in mother complicating pregnancy, childbirth AND/OR puerperium (disorder) |
| 81531005 | Diabetes mellitus type 2 in obese (disorder) |
| 190330002 | Diabetes mellitus, juvenile type, with hyperosmolar coma (disorder) |
| 190331003 | Diabetes mellitus, adult onset, with hyperosmolar coma (disorder) |
| 190368000 | Type I diabetes mellitus with ulcer (disorder) |
| 190369008 | Type I diabetes mellitus with gangrene (disorder) |
| 190372001 | Type I diabetes mellitus maturity onset (disorder) |
| 190389009 | Type II diabetes mellitus with ulcer (disorder) |
| 190390000 | Type II diabetes mellitus with gangrene (disorder) |
| 199223000 | Diabetes mellitus during pregnancy, childbirth and the puerperium (disorder) |
| 199225007 | Diabetes mellitus during pregnancy - baby delivered (disorder) |
| 199226008 | Diabetes mellitus in the puerperium - baby delivered during current episode of care (disorder) |
| 199227004 | Diabetes mellitus during pregnancy - baby not yet delivered (disorder) |
| 199228009 | Diabetes mellitus in the puerperium - baby delivered during previous episode of care (disorder) |
| 199229001 | Pre-existing diabetes mellitus, insulin-dependent (disorder) |
| 199230006 | Pre-existing diabetes mellitus, non-insulin-dependent (disorder) |
| 237599002 | Insulin-treated non-insulin-dependent diabetes mellitus (disorder) |
| 237618001 | Insulin-dependent diabetes mellitus secretory diarrhea syndrome (disorder) |
| 237626009 | Pregnancy and insulin-dependent diabetes mellitus (disorder) |
| 237627000 | Pregnancy and non-insulin-dependent diabetes mellitus (disorder) |
| 313435000 | Type I diabetes mellitus without complication (disorder) |
| 313436004 | Type II diabetes mellitus without complication (disorder) |
| 314771006 | Type I diabetes mellitus with hypoglycemic coma (disorder) |
| 314772004 | Type II diabetes mellitus with hypoglycemic coma (disorder) |
| 314893005 | Type I diabetes mellitus with arthropathy (disorder) |
| 314894004 | Type I diabetes mellitus with neuropathic arthropathy (disorder) |
| 314902007 | Type II diabetes mellitus with peripheral angiopathy (disorder) |
| 314903002 | Type II diabetes mellitus with arthropathy (disorder) |
| 314904008 | Type II diabetes mellitus with neuropathic arthropathy (disorder) |
| 359642000 | Diabetes mellitus type 2 in nonobese (disorder) |
| 359939009 | Maternal diabetes mellitus (disorder) |
| 105401000119101 | Diabetes mellitus due to pancreatic injury (disorder) |
| 106281000119103 | Pre-existing diabetes mellitus in mother complicating childbirth (disorder) |
| 10754881000119104 | Diabetes mellitus in mother complicating childbirth (disorder) |
| 111552007 | Diabetes mellitus without complication (disorder) |
| 127012008 | Lipoatrophic diabetes (disorder) |
| 1481000119100 | Diabetes mellitus type 2 without retinopathy (disorder) |
| 190330002 | Type 1 diabetes mellitus with hyperosmolar coma (disorder) |
| 190331003 | Type 2 diabetes mellitus with hyperosmolar coma (disorder) |
| 190368000 | Type I diabetes mellitus with ulcer (disorder) |
| 190369008 | Type I diabetes mellitus with gangrene (disorder) |
| 190372001 | Type I diabetes mellitus maturity onset (disorder) |
| 190389009 | Type II diabetes mellitus with ulcer (disorder) |
| 190390000 | Type II diabetes mellitus with gangrene (disorder) |
| 190406000 | Malnutrition-related diabetes mellitus with ketoacidosis (disorder) |
| 190407009 | Malnutrition-related diabetes mellitus with renal complications (disorder) |
| 190410002 | Malnutrition-related diabetes mellitus with peripheral circulatory complications (disorder) |
| 190411003 | Malnutrition-related diabetes mellitus with multiple complications (disorder) |
| 190412005 | Malnutrition-related diabetes mellitus without complications (disorder) |
| 199223000 | Diabetes mellitus during pregnancy, childbirth and the puerperium (disorder) |
| 199225007 | Diabetes mellitus during pregnancy - baby delivered (disorder) |
| 199226008 | Diabetes mellitus in the puerperium - baby delivered during current episode of care (disorder) |
| 199227004 | Diabetes mellitus during pregnancy - baby not yet delivered (disorder) |
| 199228009 | Diabetes mellitus in the puerperium - baby delivered during previous episode of care (disorder) |
| 199229001 | Pre-existing type 1 diabetes mellitus (disorder) |
| 199230006 | Pre-existing type 2 diabetes mellitus (disorder) |
| 199231005 | Pre-existing malnutrition-related diabetes mellitus (disorder) |
| 23045005 | Insulin dependent diabetes mellitus type IA (disorder) |
| 237599002 | Insulin treated type 2 diabetes mellitus (disorder) |
| 237600004 | Malnutrition-related diabetes mellitus - fibrocalculous (disorder) |
| 237604008 | Maturity onset diabetes of the young, type 2 (disorder) |
| 237613005 | Hyperproinsulinemia (disorder) |
| 237618001 | Insulin-dependent diabetes mellitus secretory diarrhea syndrome (disorder) |
| 237619009 | Diabetes-deafness syndrome maternally transmitted (disorder) |
| 237627000 | Pregnancy and type 2 diabetes mellitus (disorder) |
| 2751001 | Fibrocalculous pancreatic diabetes (disorder) |
| 28032008 | Insulin dependent diabetes mellitus type IB (disorder) |
| 31321000119102 | Diabetes mellitus type 1 without retinopathy (disorder) |
| 313435000 | Type I diabetes mellitus without complication (disorder) |
| 313436004 | Type II diabetes mellitus without complication (disorder) |
| 314771006 | Type I diabetes mellitus with hypoglycemic coma (disorder) |
| 314893005 | Type I diabetes mellitus with arthropathy (disorder) |
| 314902007 | Type II diabetes mellitus with peripheral angiopathy (disorder) |
| 314903002 | Type II diabetes mellitus with arthropathy (disorder) |
| 314904008 | Type II diabetes mellitus with neuropathic arthropathy (disorder) |
| 33559001 | Pineal hyperplasia AND diabetes mellitus syndrome (disorder) |
| 359642000 | Diabetes mellitus type 2 in nonobese (disorder) |
| 426705001 | Diabetes mellitus associated with cystic fibrosis (disorder) |
| 426875007 | Latent autoimmune diabetes mellitus in adult (disorder) |
| 427089005 | Diabetes mellitus due to cystic fibrosis (disorder) |
| 42954008 | Diabetes mellitus associated with receptor abnormality (disorder) |
| 44054006 | Diabetes mellitus type 2 (disorder) |
| 445260006 | Posttransplant diabetes mellitus (disorder) |
| 446641003 | Renal cysts and diabetes syndrome (disorder) |
| 46635009 | Diabetes mellitus type 1 (disorder) |
| 4783006 | Maternal diabetes mellitus with hypoglycemia affecting fetus OR newborn (disorder) |
| 51002006 | Diabetes mellitus associated with pancreatic disease (disorder) |
| 57886004 | Protein-deficient diabetes mellitus (disorder) |
| 59079001 | Diabetes mellitus associated with hormonal etiology (disorder) |
| 5969009 | Diabetes mellitus associated with genetic syndrome (disorder) |
| 609561005 | Maturity-onset diabetes of the young (disorder) |
| 609562003 | Maturity onset diabetes of the young, type 1 (disorder) |
| 609563008 | Pre-existing diabetes mellitus in pregnancy (disorder) |
| 609564002 | Pre-existing type 1 diabetes mellitus in pregnancy (disorder) |
| 609566000 | Pregnancy and type 1 diabetes mellitus (disorder) |
| 609567009 | Pre-existing type 2 diabetes mellitus in pregnancy (disorder) |
| 609568004 | Diabetes mellitus due to genetic defect in beta cell function (disorder) |
| 609569007 | Diabetes mellitus due to genetic defect in insulin action (disorder) |
| 609570008 | Maturity-onset diabetes of the young, type 3 (disorder) |
| 609571007 | Maturity-onset diabetes of the young, type 4 (disorder) |
| 609572000 | Maturity-onset diabetes of the young, type 5 (disorder) |
| 609573005 | Maturity-onset diabetes of the young, type 6 (disorder) |
| 609574004 | Maturity-onset diabetes of the young, type 7 (disorder) |
| 609575003 | Maturity-onset diabetes of the young, type 8 (disorder) |
| 609576002 | Maturity-onset diabetes of the young, type 9 (disorder) |
| 609577006 | Maturity-onset diabetes of the young, type 10 (disorder) |
| 609578001 | Maturity-onset diabetes of the young, type 11 (disorder) |
| 70694009 | Diabetes mellitus AND insipidus with optic atrophy AND deafness (disorder) |
| 709147009 | Gingivitis co-occurrent with diabetes mellitus (disorder) |
| 716362006 | Gingival disease co-occurrent with diabetes mellitus (disorder) |
| 71791000119104 | Peripheral neuropathy co-occurrent and due to type 1 diabetes mellitus (disorder) |
| 719216001 | Hypoglycemic coma co-occurrent and due to diabetes mellitus type II (disorder) |
| 75524006 | Malnutrition related diabetes mellitus (disorder) |
| 75682002 | Diabetes mellitus caused by insulin receptor antibodies (disorder) |
| 76751001 | Diabetes mellitus in mother complicating pregnancy, childbirth AND/OR puerperium (disorder) |
| 81531005 | Diabetes mellitus type 2 in obese (disorder) |
| 91352004 | Diabetes mellitus due to structurally abnormal insulin (disorder) |
| 9859006 | Type 2 diabetes mellitus with acanthosis nigricans (disorder) |
Required Data Elements for the Numerator:
This is captured by adding a procedure with a valid LOINC code using the procedure widget in a note.
| LOINC: | |
| Code | Description |
| 32451-7 | Physical findings of Macula |
This is captured by adding a procedure with a valid SNOMED code using the procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 312903003 | Mild non-proliferative diabetic retinopathy (disorder) |
| 312904009 | Moderate nonproliferative diabetic retinopathy (disorder) |
| 59276001 | Proliferative diabetic retinopathy (disorder) |
| 312905005 | Severe nonproliferative diabetic retinopathy (disorder) |
| 399876000 | Very severe nonproliferative diabetic retinopathy (disorder) |
This is captured by adding a procedure with a valid SNOMED code for presence or absence using the procedure widget in a note.
Macular Edema Findings Absent
| SNOMED: | |
| Code | Description |
| 428341000124108 | Macular edema absent (situation) |
Macular Edema Findings Present
| SNOMED: | |
| Code | Description |
| 193350004 | Advanced diabetic maculopathy (disorder) |
| 312921000 | Autosomal dominant cystoid macular edema (disorder) |
| 312911008 | Clinically significant macular edema (disorder) |
| 193387007 | Cystoid macular edema (disorder) |
| 312912001 | Diabetic macular edema (disorder) |
| 399864000 | Diabetic macular edema not clinically significant (disorder) |
| 232020009 | Diabetic maculopathy (disorder) |
| 314010006 | Diffuse diabetic maculopathy (disorder) |
| 420486006 | Exudative maculopathy associated with type I diabetes mellitus (disorder) |
| 421779007 | Exudative maculopathy associated with type II diabetes mellitus (disorder) |
| 314011005 | Focal diabetic maculopathy (disorder) |
| 314014002 | Ischemic diabetic maculopathy (disorder) |
| 37231002 | Macular retinal edema (disorder) |
| 314015001 | Mixed diabetic maculopathy (disorder) |
| 432789001 | Noncystoid edema of macula of retina (disorder) |
| 312920004 | Postoperative cystoid macular edema (disorder) |
| 312922007 | Uveitis related cystoid macular edema (disorder) |
EXCEPTION DETAILS:
This measure makes an exception for patients who did not have a dilated macular or fundus examination due to Medical, Patient or System reasons. In order to meet the requirements for this exception, the appropriate information must be documented in the chart (at least one of the following):
This is captured by adding a procedure with a valid LOINC code and attaching a valid SNOMED code for the reason not done using the procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 31438003 | Drug resistance (disorder) |
| 35688006 | Complication of medical care (disorder) |
| 59037007 | Drug intolerance (disorder) |
| 62014003 | Adverse reaction to drug (disorder) |
| 79899007 | Drug interaction (finding) |
| 183932001 | Procedure contraindicated (situation) |
| 183964008 | Treatment not indicated (situation) |
| 183966005 | Drug treatment not indicated (situation) |
| 216952002 | Failure in dosage (event) |
| 266721009 | Absent response to treatment (situation) |
| 269191009 | Late effect of medical and surgical care complication (disorder) |
| 274512008 | Drug therapy discontinued (situation) |
| 371133007 | Treatment modification (procedure) |
| 397745006 | Medical contraindication (finding) |
| 407563006 | Treatment not tolerated (situation) |
| 410534003 | Not indicated (qualifier value) |
| 410536001 | Contraindicated (qualifier value) |
| 416098002 | Drug allergy (disorder) |
| 416406003 | Procedure discontinued (situation) |
| 428119001 | Procedure not indicated (situation) |
| 445528004 | Treatment changed (situation) |
This is captured by adding a procedure with a valid LOINC code and attaching a valid SNOMED code for the reason not done using the procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 105480006 | Refusal of treatment by patient (situation) |
| 160932005 | Financial problem (finding) |
| 160934006 | Financial circumstances change (finding) |
| 182890002 | Patient requests alternative treatment (finding) |
| 182895007 | Drug declined by patient (situation) |
| 182897004 | Drug declined by patient - side effects (situation) |
| 182900006 | Drug declined by patient - patient beliefs (situation) |
| 182902003 | Drug declined by patient - cannot pay script (situation) |
| 183944003 | Procedure refused (situation) |
| 183945002 | Procedure refused for religious reason (situation) |
| 184081006 | Patient has moved away (finding) |
| 185479006 | Patient dissatisfied with result (finding) |
| 185481008 | Dissatisfied with doctor (finding) |
| 224187001 | Variable income (finding) |
| 225928004 | Patient self-discharge against medical advice (procedure) |
| 713247000 | Procedure discontinued by patient (situation) |
| 266710000 | Drugs not taken/completed (situation) |
| 266966009 | Family illness (situation) |
| 275694009 | Patient defaulted from follow-up (finding) |
| 275936005 | Patient noncompliance - general (situation) |
| 281399006 | Did not attend (finding) |
| 310343007 | Further opinion sought (finding) |
| 373787003 | Treatment delay - patient choice (finding) |
| 385648002 | Rejected by recipient (qualifier value) |
| 406149000 | Medication refused (situation) |
| 408367005 | Patient forgets to take medication (finding) |
| 413310006 | Patient non-compliant - refused access to services (situation) |
| 413311005 | Patient non-compliant - refused intervention / support (situation) |
| 413312003 | Patient non-compliant - refused service (situation) |
| 416432009 | Procedure not wanted (situation) |
| 423656007 | Income insufficient to buy necessities (finding) |
| 424739004 | Income sufficient to buy only necessities (finding) |
| 443390004 | Refused (qualifier value) |
ADDITIONAL INFORMATION:
• The patient must be at least 18 years of age prior to the start of the measurement period.
• The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.
• The Macular Examination LOINC code must be attached to a procedure code. The procedure code MUST be identified as a result in the procedure properties.
• The Level of Severity and the Macular Edema Finding SNOMED codes required for the numerator MUST be attached to the procedure code that is linked with the Macular Examination LOINC code.
• The Patient or Medical Reason SNOMED code required for the exception MUST be attached to the procedure code that is linked with the Macular Examination LOINC code. That procedure must be indicated as not performed by using the check box on the procedure dialogue screen.
• The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.