117. Diabetes: Eye Exam

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.
5. Select the appropriate condition from the Quality 117 drop-down.
6. Document the rest of the exam and Finalize.

Alternatively, code quality with a special plan:

1. Open the Ocular Exam.
2. Select a Diagnosis and Plan.
3. Tap Special Plans and select MIPS.
4. From Popular Plans, select MIPS Quality.
5. Tap the Diabetes tab.
6. Select the appropriate condition from the Quality 117 drop-down.
7. Tap Done.
8. Document the rest of the exam and Finalize.

Screen the patient for diabetes:

1. In a patient’s exam record in ExamWRITER, record the office visit.
2. Click the Exam - Special Tests tab.
3. Click the Examination category bar.
4. Select the Retina - Vascular check box and click Process.
5. On the Retina/Vascular window, select the check boxes that correspond to the patient’s condition, select an eye, and click Process:
   • DFE performed (Diabetic Patient)
6. On the Impression/Retna-Vascular window, select the check boxes that correspond to the patient’s condition and click Process:
   • DM, Type I w/ Complications
   • Diabetes, Type II w/ Complications
   • Low Risk Retinopathy
7. Click Process.

Eyefinity products and documentation refer to the MIPS quality numbers. Other measure numbering systems are listed here for your reference.

Quality	117
NQF	0055
CMS	131

• EHR (ExamWRITER only)
• Registry (Eyefinity EHR only)
• AAO IRIS

Reporting methods vary by measure and EHR system. For more information about how different measures and reporting methods are scored, refer to the topic that corresponds with your EHR:

• Eyefinity EHR Quality Scoring and Benchmarking
• ExamWRITER Quality Scoring and Benchmarking

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
EHR (ExamWRITER only)	12.0– 20.54	20.55– 30.68	30.69– 44.81	44.82– 69.39	69.4– 94.16	94.17– 98.42	98.43– 99.92	≥ 99.93
Registry (Eyefinity EHR only)	89.93– 96.67	96.68– 98.85	98.86– 99.69	99.7– 99.99	—	—	—	100
AAO IRIS	89.93– 96.67	96.68– 98.85	98.86– 99.69	99.7– 99.99	—	—	—	100

Patients 18 to 75 years of age on date of 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 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 that overlaps the measurement period and a retinal or dilated eye exam by an eyecare professional in the measurement period
• Diabetic with no diagnosis of retinopathy overlapping 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

Performance Met

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed:

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

OR eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed:

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: