revolutionehr.com 2019 Clinical Quality Measure Scoring Guide

Size: px

Start display at page:

Download "revolutionehr.com 2019 Clinical Quality Measure Scoring Guide"

Marcia Allen
5 years ago
Views:

revolutionehr.com 2019 Clinical Quality Measure Scoring Guide Clinical quality measures, or CQMs, are statistics that seek to quantify the quality of services performed by health care providers.

1 revolutionehr.com 2019 Clinical Quality Measure Scoring Guide Clinical quality measures, or CQMs, are statistics that seek to quantify the quality of services performed by health care providers. These statistics involve data related to a provider s ability to deliver certain services or their compliance with long-term health care goals. Electronic versions of these measures, known as ecqms, are automatically tracked by certified EHR technology based on actions a provider might take within the system. ecqms represent an efficient and more accurate way to submit data for the Quality performance category of the Merit-based Incentive Payment System (MIPS). The purpose of this document is to describe how each of the measures tracked by RevolutionEHR is scored. To locate the MIPS - Quality scorecard, navigate to Reports > Administration > Providers > MIPS Quality:

2 Table of Contents Diabetes: Eye Exam (CMS131v7)... 3 Closing the Referral Loop: Receipt of Specialist Report (CMS50v7)... 4 Documentation of Current Medications in the Medical Record (CMS68v8)... 5 Use of High-Risk Medications in the Elderly (CMS156v7)... 6 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Surgery (CMS133v7)... 7 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (CMS132v7)... 9 POAG: Optic Nerve Evaluation (CMS143v7) Diabetic Retinopathy: Communication with Physician Managing Diabetes Care (CMS142v7) 12 Appendix A: ICD Codes Included in Diabetes: Eye Exam Appendix B: High-Risk Medications for the Elderly Appendix C: High-Risk Medications for the Elderly with Days Supply Criteria Appendix D: SNOMED Codes for Cataract Surgery Appendix E: SNOMED Codes for Operative Procedures Related to Cataract Surgery Complications Appendix F: ICD Codes Included in POAG: Optic Nerve Head Evaluation Appendix G: ICD Codes Included in Diabetic Retinopathy Measure Appendix H: Clinical Exception Codes: Medical Reason Appendix I: Clinical Exception Codes: Patient Reason Clinical Quality Measure Scoring Guide December 12,

Diabetes: Eye Exam (CMS131v7) Denominator: Patients 18-75 years of age with diabetes and a visit during the performance period.

3 Diabetes: Eye Exam (CMS131v7) Denominator: Patients years of age with diabetes and a visit during the performance period. Exclusion: patients who were in Hospice care during the measurement year Numerator: Patients in the denominator who had at least one of the following: 1. A retinal or dilated eye exam by an eye care professional in the performance period A retinal or dilated examination is an encounter where the Fundus test is used to document at least one value 2. A negative retinal exam (no evidence of retinopathy) by an eye care professional < 12 months prior to the performance period No evidence of retinopathy is a Fundus test where both the following are true for both eyes: Diab Ret Grd is None ; and DME Y/N is N Notes: Visit is an encounter with at least one service from the following list of CPT codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99337, 99385, 99386, 99387, 99395, 99396, 99397, 92002, 92004, 92012, 92014, G0438, G0439 Patients who were in Hospice care during the measurement year is a patient with a SNOMED code of Hospice care (regime/therapy) or Hospice care management (procedure) Diabetes ICD codes can be found in Appendix A 2019 Clinical Quality Measure Scoring Guide December 12,

4 Closing the Referral Loop: Receipt of Specialist Report (CMS50v7) Denominator: Number of patients who were both referred by one provider to another during the performance period as documented in the Referrals component and who had a visit during the performance period. Numerator: Number of patients in denominator for whom the referring provider received a report from the provider to whom the patient was referred Received a report requires the Report Received box in the Referrals component to be checked Notes Visit is an encounter with at least one service with CPT code: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99385, 99386, 99387, 99381, 99382, 99383, 99384, 92002, 92004, 92012, Clinical Quality Measure Scoring Guide December 12,

Documentation of Current Medications in the Medical Record (CMS68v8) Denominator: All visits occurring during the 12-month performance period for patients aged 18 years and older.

5 Documentation of Current Medications in the Medical Record (CMS68v8) Denominator: All visits occurring during the 12-month performance period for patients aged 18 years and older. An exception is available for medical reasons where the patient is in an urgent or emergent situation where time is of the essence and the delay of treatment would jeopardize the patient s health status. Numerator: Eligible professional attests to documenting, updating or reviewing the patient's current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosages, frequency and route of administration Attests to documenting requires the provider to select Review on the Medications screen in the encounter prior to signing Notes Visit is an encounter with at least one service with CPT code: 90791, 90792, 90832, 90834, 90837, 90839, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 92541, 92542, 92544, 92545, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92585, 92588, 92626, 96116, 96150, 96151, 96152, 97001, 97002, 97003, 97004, 97532, 97802, 97803, 97804, 98960, 98961, 98962, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99495, 99496, 59400, 59510, 59610, 59618, 99024, 99221, 99222, 99223, 99281, 99282, 99283, 99284, 99285, G0101, G0108, G0270, G0402, G0438, G0439, G0515 Allowed Clinical Exception SNOMED codes: Procedure contraindicated (situation) Medical contraindication (finding) Treatment not tolerated (situation) Procedure not indicated (situation) 2019 Clinical Quality Measure Scoring Guide December 12,

6 Use of High-Risk Medications in the Elderly (CMS156v7) Denominator: Patients 65 years and older who had a visit during the performance period. Exclusion: patients who were in Hospice care during the measurement year Numerator 1: Patients with an order for at least one high-risk medication during the performance period OR an order for at least one high-risk medication with days supply criteria with a cumulative medication duration > 90 days during the performance period. Numerator 2: Patients with at least two orders for the same high-risk medication during the performance period OR at least two orders for the same high-risk medication with days supply criteria with a cumulative medication duration > 90 days during the performance period. Notes: A lower score indicates better quality Measure pertains to medications prescribed by the doctor being measured, not those medications prescribed by others Visit is an encounter with at least one service with CPT code: 92002, 92012, 92004, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99337, 99385, 99386, 99387, 99395, 99396, 99397, 92002, 92004, 92012, 92014, G0438, G0439 Cumulative medication duration is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. Example: a patient has an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period. Patients who were in Hospice care during the measurement year is a patient with a SNOMED code of Hospice care (regime/therapy) or Hospice care management (procedure) High-risk medications are listed in Appendix B High-risk medications with days supply criteria are listed in Appendix C 2019 Clinical Quality Measure Scoring Guide December 12,

7 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Surgery (CMS133v7) Denominator: All patients aged 18 years and older who had cataract surgery during but greater than 92 days prior to the end of the performance period as documented within the Surgery History component. Exclusions: o Patients with significant ocular conditions that impact the visual outcome of surgery o Cataract procedures performed during October 1 December 31 Numerator: Patients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following cataract surgery. Notes Cataract surgery is a surgery with SNOMED code from Appendix D logged in Surgery History: Significant ocular conditions that impact the visual outcome or surgery must start prior to surgical date and be active on day of surgery. They include: Acute and Subacute Iridocyclitis, Pathologic Myopia, Retinal Detachment with Retinal Defect, Retinal Vascular Occlusion, Purulent Endophthalmitis, Certain Types of Iridocyclitis, Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes, Chronic Iridocyclitis, Choroidal Degenerations, Optic Neuritis, Other Background Retinopathy and Retinal Vascular Changes, Other Corneal Deformities, Cloudy Cornea, Other Retinal Disorders, Prior Penetrating Keratoplasty, Other and Unspecified forms of Chorioretinitis and Retinochoroiditis, Amblyopia, Corneal Edema, Nystagmus and other Irregular Eye Movements, Moderate or Severe Impairment, Better Eye, Profound Impairment Lesser Eye, Hereditary Choroidal Dystrophies, Hereditary Retinal Dystrophies, Burn Confined to Eye and Adnexa, Scleritis and Episcleritis, Other Disorders of Sclera, Focal Chorioretinitis and Focal Retinochoroiditis, Degenerative Disorders of Globe, Degeneration of Macula and Posterior Pole, Disseminated Chorioretinitis and Disseminated Retinochoroiditis, Diabetic Macular Edema, Uveitis, Profound Impairment, Both Eyes, Other Proliferative Retinopathy, Cataract Secondary to Ocular Disorders, Disorders of Visual 2019 Clinical Quality Measure Scoring Guide December 12,

8 Cortex, Choroidal Detachment, Disorders of Optic Chiasm, Injury to Optic Nerve and Pathways, Choroidal Hemorrhage and Rupture, Other Disorders of Optic Nerve, Glaucoma, Chorioretinal Scars, Hereditary Corneal Dystrophies, Central Corneal Ulcer, Corneal Opacity and other Disorders of Cornea, Optic Atrophy, Open Wound of Eyeball, Other Endophthalmitis, Separation of Retinal Layers, Diabetic Retinopathy, Visual Field Defects Visual acuity of 20/40 or better is an encounter where the VA of OU, OD, or OS is 20/40 or better in any of the following tests: Final Refraction with Prism Refraction - Distance Refraction - Nearpoint Technical Refraction Aided Visual Acuity Uncorrected Visual Acuity Per CMS guidance: This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. To account for this, RevolutionEHR will only score the measure for the provider appearing in the patient s Demographics if he/she is also the provider listed as the surgeon in the Surgery History component. This will prevent the measure from being scored for ODs Clinical Quality Measure Scoring Guide December 12,

9 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (CMS132v7) Denominator: All patients aged 18 years and older who had cataract surgery during the performance period as documented in the Surgery History component and no significant ocular conditions impacting the surgical complication rate. Exclusion: patients with any one of a specified list of significant ocular conditions that impact the surgical complication rate Numerator: Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence as documented in the Surgery History component. Notes A lower score indicates better quality Cataract surgery is a surgery with a SNOMED code from Appendix D logged in Surgery History: Surgical procedures that count in the numerator for retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence refer to procedures with a SNOMED code from Appendix E logged in Surgery History Significant ocular conditions that impact the surgical complication rate that count toward denominator exclusions include any of the following: o Diagnoses made prior to and still active on day of surgery: Acute and Subacute Iridocyclitis, Adhesions and Disruptions of Iris and Ciliary Body, Central Corneal Ulcer, Burn Confined to Eye and Adnexa, Pseudoexfoliation Syndrome, Senile Cataract, Hypotony of Eye, Cataract Secondary to Ocular Disorders, High Hyperopia, Injury to Optic Nerve and Pathways, Cataract (congenital), Cysts of Iris, Ciliary Body, and Anterior Chamber, Glaucoma, Cataract, Mature or Hypermature, 2019 Clinical Quality Measure Scoring Guide December 12,

10 Traumatic Cataract, Cataract, Posterior Polar, Pathologic Myopia, Open Wound of Eyeball, Certain Types of Iridocyclitis, Vascular Disorders of Iris and Ciliary Body, Hereditary Corneal Dystrophies, Enophthalmos, Uveitis, Chronic Iridocyclitis, Corneal Opacity and other Disorders of Cornea, Cloudy Cornea, Posterior Lenticonus, Aphakia and other Disorders of Lens, Corneal Edema, Retrolental Fibroplasias, Anomalies of Pupillary Function. o Medication Rx written prior to surgical date and active on day of surgery: RxNORM Code Description Doxazosin 1 MG Oral Tablet Doxazosin 2 MG Oral Tablet Doxazosin 4 MG Oral Tablet Doxazosin 8 MG Oral Tablet Prazosin 5 MG Oral Capsule Prazosin 1 MG Oral Tablet Prazosin 2 MG Oral Tablet Prazosin 5 MG Oral Tablet Terazosin 10 MG Oral Capsule Polythiazide 0.5 MG / Prazosin 1 MG Oral Capsule Polythiazide 0.5 MG / Prazosin 2 MG Oral Capsule Polythiazide 0.5 MG / Prazosin 5 MG Oral Capsule Prazosin 1 MG Oral Capsule Prazosin 2 MG Oral Capsule Terazosin 1 MG Oral Capsule Terazosin 2 MG Oral Capsule Terazosin 5 MG Oral Capsule HR Doxazosin 4 MG Extended Release Oral Tablet HR Doxazosin 8 MG Extended Release Oral Tablet HR Alfuzosin hydrochloride 10 MG Extended Release Oral Tablet Phenoxybenzamine Hydrochloride 10 MG Oral Capsule Tamsulosin hydrochloride 0.4 MG Oral Capsule Dutasteride 0.5 MG / Tamsulosin hydrochloride 0.4 MG Oral Capsule o Surgery with SNOMED code (Mechanical vitrectomy by pars plana approach) prior to cataract surgery Per CMS guidance: This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. To account for this, RevolutionEHR will only score the measure for the provider appearing in the patient s Demographics if he/she is also the provider listed as the surgeon in the Surgery History component. This will prevent the measure from being scored for ODs Clinical Quality Measure Scoring Guide December 12,

POAG: Optic Nerve Evaluation (CMS143v7) Denominator: All patients aged 18 years and older with an active diagnosis of primary open-angle glaucoma and one or more office visits during the performance

11 POAG: Optic Nerve Evaluation (CMS143v7) Denominator: All patients aged 18 years and older with an active diagnosis of primary open-angle glaucoma and one or more office visits during the performance period. An exception is available when a medical reason is provided for not performing an optic nerve head evaluation Numerator: Patients who have an optic nerve head evaluation during one or more office visits within the performance period Notes Office visit is an encounter with at least one service with CPT code: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 92002, 92004, 92012, Optic nerve evaluation requires use of the Optic Nerve test to document each of the following for at least one eye: Vert C/D, NR Rim, Color, Margins Included primary open-angle glaucoma ICD codes can be found in Appendix F Allowed medical reason exception SNOMED codes can be found in Appendix G 2019 Clinical Quality Measure Scoring Guide December 12,

Diabetic Retinopathy: Communication with Physician Managing Diabetes Care (CMS142v7) Denominator: All patients aged 18 years and older with an active diagnosis of diabetic retinopathy who had an

An exception is available when a medical or patient reason is documented for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the

12 Diabetic Retinopathy: Communication with Physician Managing Diabetes Care (CMS142v7) Denominator: All patients aged 18 years and older with an active diagnosis of diabetic retinopathy who had an office visit and dilated macular or fundus exam performed during the performance period. An exception is available when a medical or patient reason is documented for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes Numerator: Patients with documentation, at least once within the performance period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care. Notes Office visit is an encounter with at least one service with CPT code: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 92002, 92004, 92012, Dilated macular or fundus exam performed requires use of the Fundus test to document the following for at least one eye: Diab Ret Grd, DME Y/N Diab Ret Grd cannot be None as this represents an inconsistency between the active diagnosis diabetic retinopathy (in Diagnosis History) and the clinical findings. In cases where active retinopathy is not present, the diagnosis should be resolved prior to signing the encounter. Communication requires: o use of the Comm button on the screen header bar within the encounter where the dilated macular or fundus exam was performed to start a letter: 2019 Clinical Quality Measure Scoring Guide December 12,

o use of any of the following templates for the letter: Diabetes Encounter Summary for PCP Vision Source Diabetes

template marked for inclusion in the measure through Admin (available for any Flex template that has been converted

can be found in Appendix G Allowed medical reason exception SNOMED codes can be found in Appendix H Allowed patient

13 o use of any of the following templates for the letter: Diabetes Encounter Summary for PCP Vision Source Diabetes Encounter Summary for PCP Vision Source Diabetes and Glaucoma Encounter Summary for PCP Any other communication template marked for inclusion in the measure through Admin (available for any Flex template that has been converted to HTML) o the designated recipient to be a Clinician or External Provider Included diabetic retinopathy ICD codes can be found in Appendix G Allowed medical reason exception SNOMED codes can be found in Appendix H Allowed patient reason exception SNOMED codes can be found in Appendix I 2019 Clinical Quality Measure Scoring Guide December 12,

14 Appendix A: ICD Codes Included in Diabetes: Eye Exam Code Description Code System Diabetes mellitus without mention of complication, type II or unspecified type, not ICD9CM stated as uncontrolled Diabetes mellitus without mention of complication, type I [juvenile type], not ICD9CM stated as uncontrolled Diabetes mellitus without mention of complication, type II or unspecified type, ICD9CM uncontrolled Diabetes mellitus without mention of complication, type I [juvenile type], ICD9CM uncontrolled Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled ICD9CM Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled ICD9CM Diabetes with ketoacidosis, type II or unspecified type, uncontrolled ICD9CM Diabetes with ketoacidosis, type I [juvenile type], uncontrolled ICD9CM Diabetes with hyperosmolarity, type II or unspecified type, not stated as ICD9CM uncontrolled Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled ICD9CM Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled ICD9CM Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled ICD9CM Diabetes with other coma, type II or unspecified type, not stated as uncontrolled ICD9CM Diabetes with other coma, type I [juvenile type], not stated as uncontrolled ICD9CM Diabetes with other coma, type II or unspecified type, uncontrolled ICD9CM Diabetes with other coma, type I [juvenile type], uncontrolled ICD9CM Diabetes with renal manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled Diabetes with renal manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with renal manifestations, type II or unspecified type, uncontrolled ICD9CM Diabetes with renal manifestations, type I [juvenile type], uncontrolled ICD9CM Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled ICD9CM Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled ICD9CM Diabetes with neurological manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled Diabetes with neurological manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with neurological manifestations, type II or unspecified type, uncontrolled ICD9CM Diabetes with neurological manifestations, type I [juvenile type], uncontrolled ICD9CM Diabetes with peripheral circulatory disorders, type II or unspecified type, not ICD9CM stated as uncontrolled Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with peripheral circulatory disorders, type II or unspecified type, ICD9CM uncontrolled Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled ICD9CM 2019 Clinical Quality Measure Scoring Guide December 12,

15 Diabetes with other specified manifestations, type II or unspecified type, not stated ICD9CM as uncontrolled Diabetes with other specified manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with other specified manifestations, type II or unspecified type, ICD9CM uncontrolled Diabetes with other specified manifestations, type I [juvenile type], uncontrolled ICD9CM Diabetes with unspecified complication, type II or unspecified type, not stated as ICD9CM uncontrolled Diabetes with unspecified complication, type I [juvenile type], not stated as ICD9CM uncontrolled Diabetes with unspecified complication, type II or unspecified type, uncontrolled ICD9CM Diabetes with unspecified complication, type I [juvenile type], uncontrolled ICD9CM Polyneuropathy in diabetes ICD9CM Background diabetic retinopathy ICD9CM Proliferative diabetic retinopathy ICD9CM Nonproliferative diabetic retinopathy NOS ICD9CM Mild nonproliferative diabetic retinopathy ICD9CM Moderate nonproliferative diabetic retinopathy ICD9CM Severe nonproliferative diabetic retinopathy ICD9CM Diabetic macular edema ICD9CM Diabetic cataract ICD9CM Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, unspecified as to episode of care or not applicable Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, delivered, with or without mention of antepartum condition Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, delivered, with mention of postpartum complication Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, antepartum condition or complication Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, postpartum condition or complication 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 E Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema E Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12,

16 E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12,

17 E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye E10.36 Type 1 diabetes mellitus with diabetic cataract 2019 Clinical Quality Measure Scoring Guide December 12,

18 E10.37X1 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye E10.37X2 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye E10.37X3 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral E10.37X9 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye 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 E Type 1 diabetes mellitus with diabetic neuropathic arthropathy E Type 1 diabetes mellitus with other diabetic arthropathy E Type 1 diabetes mellitus with diabetic dermatitis E Type 1 diabetes mellitus with foot ulcer E Type 1 diabetes mellitus with other skin ulcer E Type 1 diabetes mellitus with other skin complications E Type 1 diabetes mellitus with periodontal disease E Type 1 diabetes mellitus with other oral complications E Type 1 diabetes mellitus with hypoglycemia with coma E 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 hyperglycemichyperosmolar coma (NKHHC) E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma E11.10 Type 2 diabetes mellitus with ketoacidosis without coma E11.11 Type 2 diabetes mellitus with ketoacidosis 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 E Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema E Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12,

19 E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12,

20 E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12,

21 E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye E11.36 Type 2 diabetes mellitus with diabetic cataract E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye E11.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye E11.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral E11.37X9 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye 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 E Type 2 diabetes mellitus with diabetic neuropathic arthropathy E Type 2 diabetes mellitus with other diabetic arthropathy E Type 2 diabetes mellitus with diabetic dermatitis E Type 2 diabetes mellitus with foot ulcer E Type 2 diabetes mellitus with other skin ulcer E Type 2 diabetes mellitus with other skin complications E Type 2 diabetes mellitus with periodontal disease E Type 2 diabetes mellitus with other oral complications E Type 2 diabetes mellitus with hypoglycemia with coma E 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 E Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema E Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye 2019 Clinical Quality Measure Scoring Guide December 12,

22 E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye 2019 Clinical Quality Measure Scoring Guide December 12,

23 E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12,

2017 Clinical Quality Measures

2017 Clinical Quality Measures Clinical quality measures, or CQMs, are statistics that seek to quantify the quality of services performed by health care providers. These statistics involve data related