NQF 0088: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Measure:

Record the 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:

The number of 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:

The number of 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.

NQS 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, Provider Interaction, or Face-to-Face Encounter Code during the measurement period
Valid Office Encounter Codes: 
CPT: 
CodeDescription
92002Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92004Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
92012Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92014Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
99201Office 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.
99202Office 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.
99203Office 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.
99204Office 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.
99205Office 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.
99212Office 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.
99213Office 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.
99214Office 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.
99215Office 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.
99241Office 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.
99242Office 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.
99243Office 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.
99244Office 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.
99245Office 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.
99304Initial 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.
99305Initial 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.
99306Initial 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.
99307Subsequent 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.
99308Subsequent 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.
99309Subsequent 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.
99310Subsequent 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: 
CodeDescription
12843005Subsequent hospital visit by physician (procedure)
18170008Subsequent nursing facility visit (procedure)
19681004Nursing evaluation of patient and report (procedure)
87790002Follow-up inpatient consultation visit (procedure)
90526000Initial evaluation and management of healthy individual (procedure)
185349003Encounter for "check-up" (procedure)
185463005Visit out of hours (procedure)
185465003Weekend visit (procedure)
207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
270427003Patient-initiated encounter (procedure)
270430005Provider-initiated encounter (procedure)
308335008Patient encounter procedure (procedure)
390906007Follow-up encounter (procedure)
406547006Urgent follow-up (procedure)
439708006Home visit (procedure)
• Diabetic Retinopathy Diagnosis Code (with attached SNOMED) that occurs before or during the Encounter
ICD-9: 
CodeDescription
362.01Background diabetic retinopathy
362.02Proliferative diabetic retinopathy
362.03Nonproliferative diabetic retinopathy NOS
362.04Mild nonproliferative diabetic retinopathy
362.05Moderate nonproliferative diabetic retinopathy
362.06Severe nonproliferative diabetic retinopathy
ICD-10: 
CodeDescription
E08.311Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
E08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
E08.321Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema
E08.329Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema
E08.331Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema
E08.339Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema
E08.341Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema
E08.349Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema
E08.351Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema
E08.359Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema
E09.311Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema
E09.319Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
E09.321Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E09.329Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E09.331Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E09.339Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E09.341Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E09.349Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E09.351Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema
E09.359Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema
E10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E10.329Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E10.331Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E10.339Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E10.341Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E10.349Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E10.351Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.329Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E11.331Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E11.339Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E11.341Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E11.349Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E11.351Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
E13.319Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema
E13.321Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E13.329Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E13.331Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E13.339Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E13.341Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E13.349Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E13.351Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
E13.359Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema
SNOMED: 
CodeDescription
4855003Diabetic retinopathy (disorder)
25412000Diabetic retinal microaneurysm (disorder)
59276001Proliferative diabetic retinopathy (disorder)
193349004Preproliferative diabetic retinopathy (disorder)
193350004Advanced diabetic maculopathy (disorder)
232020009Diabetic maculopathy (disorder)
232021008Proliferative diabetic retinopathy with new vessels on disc (disorder)
232022001Proliferative diabetic retinopathy with new vessels elsewhere than on disc (disorder)
232023006Diabetic traction retinal detachment (disorder)
311782002Advanced diabetic retinal disease (disorder)
312903003Mild non-proliferative diabetic retinopathy (disorder)
312904009Moderate nonproliferative diabetic retinopathy (disorder)
312905005Severe nonproliferative diabetic retinopathy (disorder)
312906006Proliferative diabetic retinopathy - non high risk (disorder)
312907002Proliferative diabetic retinopathy - high risk (disorder)
312908007Proliferative diabetic retinopathy - quiescent (disorder)
312909004Proliferative diabetic retinopathy - iris neovascularization (disorder)
312912001Diabetic macular edema (disorder)
314010006Diffuse diabetic maculopathy (disorder)
314011005Focal diabetic maculopathy (disorder)
314014002Ischemic diabetic maculopathy (disorder)
314015001Mixed diabetic maculopathy (disorder)
390834004Nonproliferative diabetic retinopathy (disorder)
399862001Proliferative diabetic retinopathy - high risk with no macular edema (disorder)
399863006Very severe nonproliferative diabetic retinopathy with no macular edema (disorder)
399864000Diabetic macular edema not clinically significant (disorder)
399865004Very severe proliferative diabetic retinopathy (disorder)
399866003Diabetic retinal venous beading (disorder)
399868002Diabetic intraretinal microvascular anomaly (disorder)
399869005High risk proliferative diabetic retinopathy not amenable to photocoagulation (disorder)
399870006Non-high-risk proliferative diabetic retinopathy with no macular edema (disorder)
399871005Visually threatening diabetic retinopathy (disorder)
399872003Severe nonproliferative diabetic retinopathy with clinically significant macular edema (disorder)
399873008Severe nonproliferative diabetic retinopathy with no macular edema (disorder)
399874002Proliferative diabetic retinopathy - high risk with clinically significant macular edema (disorder)
399875001Non-high-risk proliferative diabetic retinopathy with clinically significant macular edema (disorder)
399876000Very severe nonproliferative diabetic retinopathy (disorder)
399877009Very severe nonproliferative diabetic retinopathy with clinically significant macular edema (disorder)
420486006Exudative maculopathy associated with type I diabetes mellitus (disorder)
420789003Diabetic retinopathy associated with type I diabetes mellitus (disorder)
421779007Exudative maculopathy associated with type II diabetes mellitus (disorder)
422034002Diabetic retinopathy associated with type II diabetes mellitus (disorder)

Required Data Elements for the Numerator*: 

• Macular Examination (LOINC) Code
LOINC: 
CodeDescription
32451-7Physical findings of Macula
• Level of Severity of Retinopathy Finding (SNOMED) Code
SNOMED:  
CodeDescription
312903003Mild non-proliferative diabetic retinopathy (disorder)
312904009Moderate nonproliferative diabetic retinopathy (disorder)
59276001Proliferative diabetic retinopathy (disorder)
312905005Severe nonproliferative diabetic retinopathy (disorder)
399876000Very severe nonproliferative diabetic retinopathy (disorder)
• Macular Edema Findings Present or Absent (SNOMED) Code

Macular Edema Findings Absent

SNOMED:  
CodeDescription
428341000124108Macular edema absent (situation)

 

Macular Edema Findings Present

SNOMED:  
CodeDescription
193350004Advanced diabetic maculopathy (disorder)
312921000Autosomal dominant cystoid macular edema (disorder)
312911008Clinically significant macular edema (disorder)
193387007Cystoid macular edema (disorder)
312912001Diabetic macular edema (disorder)
399864000Diabetic macular edema not clinically significant (disorder)
232020009Diabetic maculopathy (disorder)
314010006Diffuse diabetic maculopathy (disorder)
420486006Exudative maculopathy associated with type I diabetes mellitus (disorder)
421779007Exudative maculopathy associated with type II diabetes mellitus (disorder)
314011005Focal diabetic maculopathy (disorder)
314014002Ischemic diabetic maculopathy (disorder)
37231002Macular retinal edema (disorder)
314015001Mixed diabetic maculopathy (disorder)
432789001Noncystoid edema of macula of retina (disorder)
312920004Postoperative cystoid macular edema (disorder)
312922007Uveitis 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):

• Medical Reason Exception (SNOMED) Code
SNOMED: 
CodeDescription
31438003Drug resistance (disorder)
35688006Complication of medical care (disorder)
59037007Drug intolerance (disorder)
62014003Adverse reaction to drug (disorder)
79899007Drug interaction (finding)
161590003History of drug allergy (situation)
183932001Procedure contraindicated (situation)
183964008Treatment not indicated (situation)
183966005Drug treatment not indicated (situation)
216952002Failure in dosage (event)
266721009Absent response to treatment (situation)
269191009Late effect of medical and surgical care complication (disorder)
274512008Drug therapy discontinued (situation)
371133007Treatment modification (procedure)
397745006Medical contraindication (finding)
407563006Treatment not tolerated (situation)
410534003Not indicated (qualifier value)
410536001Contraindicated (qualifier value)
416098002Drug allergy (disorder)
416406003Procedure discontinued (situation)
428119001Procedure not indicated (situation)
445528004Treatment changed (situation)
• Patient Reason Exception (SNOMED) Code
SNOMED: 
CodeDescription
5015009Economic problem (finding)
105480006Refusal of treatment by patient (situation)
160932005Financial problem (finding)
160934006Financial circumstances change (finding)
182890002Patient requests alternative treatment (finding)
182895007Drug declined by patient (situation)
182897004Drug declined by patient - side effects (situation)
182900006Drug declined by patient - patient beliefs (situation)
182902003Drug declined by patient - cannot pay script (situation)
183944003Procedure refused (situation)
183945002Procedure refused for religious reason (situation)
184081006Patient has moved away (finding)
185479006Patient dissatisfied with result (finding)
185481008Dissatisfied with doctor (finding)
224187001Variable income (finding)
225928004Patient self-discharge against medical advice (procedure)
258147002Stopped by patient (situation)
266710000Drugs not taken/completed (situation)
266966009Family illness (situation)
275694009Patient defaulted from follow-up (finding)
275936005Patient noncompliance - general (situation)
281399006Did not attend (finding)
310343007Further opinion sought (finding)
373787003Treatment delay - patient choice (finding)
385648002Rejected by recipient (qualifier value)
406149000Medication refused (situation)
408367005Patient forgets to take medication (finding)
413310006Patient non-compliant - refused access to services (situation)
413311005Patient non-compliant - refused intervention / support (situation)
413312003Patient non-compliant - refused service (situation)
416432009Procedure not wanted (situation)
423656007Income insufficient to buy necessities (finding)
424739004Income sufficient to buy only necessities (finding)
443390004Refused (qualifier value)

*ADDITIONAL INFORMATION:

•  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 patient must be at least 18 years of age prior to the start of the measurement period.

•  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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