117. Diabetes: Eye Exam

Document denominator exclusions:

1. Open the Ocular Exam.
2. Select an exam.
3. Select MIPS as the diagnosis and MIPS Quality as the plan.
4. Tap the Diabetes tab.
5. Select a condition from the smartQuality 117 (Denominator) drop-down and tap Done.
6. Document the rest of the exam and Finalize.

Screen the patient for diabetes:

1. Open the Ocular Exam.
2. Select a dilated eye exam.
3. Select a diabetes diagnosis from Impressions.
4. Select a counseling Plan. Select the plan options and tap Done.
5. Tap Special Plans and select All Tests.
6. Select the Fundus Photos plan.
7. Document the rest of the exam and Finalize.

   This renders favorable only if the patient has retinopathy.

Alternatively, code quality with a special plan:

1. Open the Ocular Exam.
2. Select the MIPS diagnosis and MIPS Quality plan.
3. Tap the Diabetes tab.
4. Select the appropriate condition from the smartQuality 117 drop-down.
5. Tap Done.
6. Document the rest of the exam and Finalize.

• Registry
• AAO IRIS

This topic describes how points are calculated for this measure. To learn more about scoring, go to Scoring.

Benchmarks are displayed here as both a chart and a table. The chart gives you a visual representation and helps you quickly compare benchmarks across different reporting methods. The table lists the specific benchmark criteria for each available reporting method.

This measure is capped at a maximum of 7 points based on performance.

 

Submission Method	3rd Decile	4th Decile	5th Decile	6th Decile	7th Decile	8th Decile	9th Decile	10th Decile
Registry	96.46– 99.20	99.21– 99.99	—	—	—	—	—	100
AAO IRIS	96.46– 99.20	99.21– 99.99	—	—	—	—	—	100

Patients 18 to 75 years of age on the date of the encounter;

AND is diagnosed with diabetes:

AND who had a visit during the measurement period:

Denominator Exclusions

Patient is using hospice services any time during the measurement period:

Patient is using palliative care services any time during the measurement period:

Patient age 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 for more than 90 days during the measurement period:

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period:

Patient 66 years of age and older and has at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period:

Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:

• A diagnosis of retinopathy during the measurement period and a retinal or dilated eye exam by an eyecare professional in the measurement period
• Diabetic with no diagnosis of retinopathy during the measurement period and a retinal or dilated eye exam by an eyecare professional in the measurement period or the year prior to the measurement period

The eye exam must be performed or reviewed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. Alternatively, results may be read by a qualified reading center that operates under the direction of a medical director who is a retinal specialist.

Performance Met

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (AI) interpretation documented and reviewed; with evidence of retinopathy:

OR Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (AI) interpretation documented and reviewed; without evidence of retinopathy:

OR seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy:

OR seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy:

OR eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed; with evidence of retinopathy:

OR eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed; without evidence of retinopathy:

OR low risk for retinopathy—no evidence of retinopathy in the prior year (this code may only be counted if the encounter occurred during the performance period):

Performance Not Met

Dilated eye exam was not performed, reason not otherwise specified: