NQF 0055: Diabetes: Eye Exam

Measure: Record percentage of patients 18 -75 years of age with Diabetes (type 1 or type 2) who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of Retinopathy) in the 12 months prior to the measurement period.
Numerator: Patients who meet the denominator criteria that had an eye screening for Diabetic Retinal Disease. This includes Diabetics who had one of the following:
A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal exam (no evidence of Retinopathy) by an eye care professional in the year prior to the measurement period.
Denominator: All patients 18-75 years of age with Diabetes with a visit during the measurement period and do not meet one or more of the exclusions.
Exclusion: Patients with a diagnosis of Gestational Diabetes during the measurement period.
NQS Domain: Clinical Process / Effectiveness

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient (age 18 to 75) 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, Home Healthcare Service, Annual Wellness Visit, Preventive Care Service or Ophthalmological Service
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
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.
99341 Home visit for the evaluation and management of a new 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 of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342 Home 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; 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, 30 minutes are spent face-to-face with the patient and/or family.
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed 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, 45 minutes are spent face-to-face with the patient and/or family.
99344 Home visit for the evaluation and management of a new 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 high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347 Home visit for the evaluation and management of an established 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 presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348 Home visit for the evaluation and management of an established 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 presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349 Home visit for the evaluation and management of an established 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 presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to 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. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99385 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
99386 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
99387 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
99397 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
G0438 ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT
G0439 ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT

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)
• Diabetes Diagnosis Code (with attached SNOMED) that occurs before or during the measurement period
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
250.41 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 Type 2 diabetes mellitus without complications
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)
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)

Required Data Elements for the Numerator:

One of the following: 

• Retinal Exam or Dilated Eye Exam Finding Code with Negative Finding result within 12 months prior to the start of the measurement period
Retinal or Dilated Eye Exam Finding Codes:
SNOMED:   
Code Description
410453006 Binocular indirect ophthalmoscopy (procedure)
314971001 Camera fundoscopy (procedure)
252788000 Chromatic electroretinography (procedure)
252780007 Dark adapted single bright flash electroretinography (procedure)
308110009 Direct fundoscopy following mydriatic (procedure)
252789008 Early receptor potential electroretinography (procedure)
6615001 Electroretinography with medical evaluation (procedure)
427478009 Evaluation of retina (procedure)
274795007 Examination of optic disc (procedure)
274798009 Examination of retina (procedure)
252784003 Flicker electroretinography (procedure)
252790004 Focal electroretinography (procedure)
314972008 Indirect fundoscopy following mydriatic (procedure)
410451008 Indirect ophthalmoscopy (procedure)
410452001 Monocular indirect ophthalmoscopy (procedure)
420213007 Multifocal electroretinography (procedure)
252782004 Photopic electroretinography (procedure)
252781006 Pre-dark-adapted single bright flash electroretinography (procedure)
252783009 Scotopic rod electroretinography (procedure)
252779009 Single bright white flash electroretinography (procedure)
410455004 Slit lamp fundus examination (procedure)
425816006 Ultrasonic evaluation of retina (procedure)
 Negative Finding Codes:
SNOMED:    
Code Description
442225006 Negative measurement finding (finding)
• Retinal Exam or Dilated Eye Exam Performed Code during the measurement period
SNOMED:   
Code Description
410453006 Binocular indirect ophthalmoscopy (procedure)
314971001 Camera fundoscopy (procedure)
252788000 Chromatic electroretinography (procedure)
252780007 Dark adapted single bright flash electroretinography (procedure)
308110009 Direct fundoscopy following mydriatic (procedure)
252789008 Early receptor potential electroretinography (procedure)
6615001 Electroretinography with medical evaluation (procedure)
427478009 Evaluation of retina (procedure)
274795007 Examination of optic disc (procedure)
274798009 Examination of retina (procedure)
252784003 Flicker electroretinography (procedure)
252790004 Focal electroretinography (procedure)
314972008 Indirect fundoscopy following mydriatic (procedure)
410451008 Indirect ophthalmoscopy (procedure)
410452001 Monocular indirect ophthalmoscopy (procedure)
420213007 Multifocal electroretinography (procedure)
252782004 Photopic electroretinography (procedure)
252781006 Pre-dark-adapted single bright flash electroretinography (procedure)
252783009 Scotopic rod electroretinography (procedure)
252779009 Single bright white flash electroretinography (procedure)
410455004 Slit lamp fundus examination (procedure)
425816006 Ultrasonic evaluation of retina (procedure)

 

EXCLUSION DETAILS:

Exclusion includes patients with a diagnosis of Gestational Diabetes during the measurement period.  In order to meet the requirements for this exclusion, the appropriate information must be documented in the chart:

• Gestational Diabetes Diagnosis Code (with attached SNOMED) that is active before or during the measurement period
ICD-10:    
Code Description
O24.410 Gestational diabetes mellitus in pregnancy, diet controlled
O24.414 Gestational diabetes mellitus in pregnancy, insulin controlled
O24.419 Gestational diabetes mellitus in pregnancy, unspecified control
O24.420 Gestational diabetes mellitus in childbirth, diet controlled
O24.424 Gestational diabetes mellitus in childbirth, insulin controlled
O24.429 Gestational diabetes mellitus in childbirth, unspecified control
O24.430 Gestational diabetes mellitus in the puerperium, diet controlled
O24.434 Gestational diabetes mellitus in the puerperium, insulin controlled
O24.439 Gestational diabetes mellitus in the puerperium, unspecified control
SNOMED:    
Code Description
11687002 Gestational diabetes mellitus (disorder)
46894009 Gestational diabetes mellitus, class A>2< (disorder)
71546005 Gestational diabetes mellitus, class B>1< (disorder)
75022004 Gestational diabetes mellitus, class A>1< (disorder)
420491007 Gestational diabetes mellitus, class H (disorder)
420738003 Gestational diabetes mellitus, class T (disorder)
420989005 Gestational diabetes mellitus, class R (disorder)
421223006 Gestational diabetes mellitus, class F (disorder)
421389009 Gestational diabetes mellitus, class C (disorder)
421443003 Gestational diabetes mellitus, class D (disorder)
422155003 Gestational diabetes mellitus, class B (disorder)

ADDITIONAL INFORMATION:

•  The Eye Exam FINDING code should be used if the exam was performed outside of your office.  It should be linked to a procedure code marked as result in the procedure properties.

•   The Eye Exam PERFORMED code should be used if the exam was performed in your office.  It should be linked to a procedure code.

•   The eye exam must be performed by an ophthalmologist or optometrist.

•   Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.

•   There are no valid ICD-9 codes for Gestational Diabetes, therefore a valid ICD-10 with an attached SNOMED code should be used instead.

•   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

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