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:
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)... 11 Diabetic Retinopathy: Communication with Physician Managing Diabetes Care (CMS142v7) 12 Appendix A: ICD Codes Included in Diabetes: Eye Exam... 14 Appendix B: High-Risk Medications for the Elderly... 26 Appendix C: High-Risk Medications for the Elderly with Days Supply Criteria... 38 Appendix D: SNOMED Codes for Cataract Surgery... 39 Appendix E: SNOMED Codes for Operative Procedures Related to Cataract Surgery Complications... 41 Appendix F: ICD Codes Included in POAG: Optic Nerve Head Evaluation... 44 Appendix G: ICD Codes Included in Diabetic Retinopathy Measure... 46 Appendix H: Clinical Exception Codes: Medical Reason... 55 Appendix I: Clinical Exception Codes: Patient Reason... 56 2019 Clinical Quality Measure Scoring Guide December 12, 2018 2
Diabetes: Eye Exam (CMS131v7) Denominator: Patients 18-75 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 385763009 Hospice care (regime/therapy) or 385765002 Hospice care management (procedure) Diabetes ICD codes can be found in Appendix A 2019 Clinical Quality Measure Scoring Guide December 12, 2018 3
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, 92014 2019 Clinical Quality Measure Scoring Guide December 12, 2018 4
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: 183932001 Procedure contraindicated (situation) 397745006 Medical contraindication (finding) 407563006 Treatment not tolerated (situation) 428119001 Procedure not indicated (situation) 2019 Clinical Quality Measure Scoring Guide December 12, 2018 5
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 385763009 Hospice care (regime/therapy) or 385765002 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, 2018 6
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, 2018 7
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. 2019 Clinical Quality Measure Scoring Guide December 12, 2018 8
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, 2018 9
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 197625 Doxazosin 1 MG Oral Tablet 197626 Doxazosin 2 MG Oral Tablet 197627 Doxazosin 4 MG Oral Tablet 197628 Doxazosin 8 MG Oral Tablet 198141 Prazosin 5 MG Oral Capsule 199797 Prazosin 1 MG Oral Tablet 199798 Prazosin 2 MG Oral Tablet 199799 Prazosin 5 MG Oral Tablet 260376 Terazosin 10 MG Oral Capsule 312481 Polythiazide 0.5 MG / Prazosin 1 MG Oral Capsule 312482 Polythiazide 0.5 MG / Prazosin 2 MG Oral Capsule 312483 Polythiazide 0.5 MG / Prazosin 5 MG Oral Capsule 312593 Prazosin 1 MG Oral Capsule 312594 Prazosin 2 MG Oral Capsule 313215 Terazosin 1 MG Oral Capsule 313217 Terazosin 2 MG Oral Capsule 313219 Terazosin 5 MG Oral Capsule 636360 24 HR Doxazosin 4 MG Extended Release Oral Tablet 636361 24 HR Doxazosin 8 MG Extended Release Oral Tablet 861132 24 HR Alfuzosin hydrochloride 10 MG Extended Release Oral Tablet 861402 Phenoxybenzamine Hydrochloride 10 MG Oral Capsule 863669 Tamsulosin hydrochloride 0.4 MG Oral Capsule 996097 Dutasteride 0.5 MG / Tamsulosin hydrochloride 0.4 MG Oral Capsule o Surgery with SNOMED code 87021001 (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. 2019 Clinical Quality Measure Scoring Guide December 12, 2018 10
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, 92014 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, 2018 11
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, 92014 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, 2018 12
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, 2018 13
Appendix A: ICD Codes Included in Diabetes: Eye Exam Code Description Code System 250.00 Diabetes mellitus without mention of complication, type II or unspecified type, not ICD9CM stated as uncontrolled 250.01 Diabetes mellitus without mention of complication, type I [juvenile type], not ICD9CM stated as uncontrolled 250.02 Diabetes mellitus without mention of complication, type II or unspecified type, ICD9CM uncontrolled 250.03 Diabetes mellitus without mention of complication, type I [juvenile type], ICD9CM uncontrolled 250.10 Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled ICD9CM 250.11 Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled ICD9CM 250.12 Diabetes with ketoacidosis, type II or unspecified type, uncontrolled ICD9CM 250.13 Diabetes with ketoacidosis, type I [juvenile type], uncontrolled ICD9CM 250.20 Diabetes with hyperosmolarity, type II or unspecified type, not stated as ICD9CM uncontrolled 250.21 Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled ICD9CM 250.22 Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled ICD9CM 250.23 Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled ICD9CM 250.30 Diabetes with other coma, type II or unspecified type, not stated as uncontrolled ICD9CM 250.31 Diabetes with other coma, type I [juvenile type], not stated as uncontrolled ICD9CM 250.32 Diabetes with other coma, type II or unspecified type, uncontrolled ICD9CM 250.33 Diabetes with other coma, type I [juvenile type], uncontrolled ICD9CM 250.40 Diabetes with renal manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled 250.41 Diabetes with renal manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled 250.42 Diabetes with renal manifestations, type II or unspecified type, uncontrolled ICD9CM 250.43 Diabetes with renal manifestations, type I [juvenile type], uncontrolled ICD9CM 250.50 Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled 250.51 Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled 250.52 Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled ICD9CM 250.53 Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled ICD9CM 250.60 Diabetes with neurological manifestations, type II or unspecified type, not stated as ICD9CM uncontrolled 250.61 Diabetes with neurological manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled 250.62 Diabetes with neurological manifestations, type II or unspecified type, uncontrolled ICD9CM 250.63 Diabetes with neurological manifestations, type I [juvenile type], uncontrolled ICD9CM 250.70 Diabetes with peripheral circulatory disorders, type II or unspecified type, not ICD9CM stated as uncontrolled 250.71 Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as ICD9CM uncontrolled 250.72 Diabetes with peripheral circulatory disorders, type II or unspecified type, ICD9CM uncontrolled 250.73 Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled ICD9CM 2019 Clinical Quality Measure Scoring Guide December 12, 2018 14
250.80 Diabetes with other specified manifestations, type II or unspecified type, not stated ICD9CM as uncontrolled 250.81 Diabetes with other specified manifestations, type I [juvenile type], not stated as ICD9CM uncontrolled 250.82 Diabetes with other specified manifestations, type II or unspecified type, ICD9CM uncontrolled 250.83 Diabetes with other specified manifestations, type I [juvenile type], uncontrolled ICD9CM 250.90 Diabetes with unspecified complication, type II or unspecified type, not stated as ICD9CM uncontrolled 250.91 Diabetes with unspecified complication, type I [juvenile type], not stated as ICD9CM uncontrolled 250.92 Diabetes with unspecified complication, type II or unspecified type, uncontrolled ICD9CM 250.93 Diabetes with unspecified complication, type I [juvenile type], uncontrolled ICD9CM 357.2 Polyneuropathy in diabetes ICD9CM 362.01 Background diabetic retinopathy ICD9CM 362.02 Proliferative diabetic retinopathy ICD9CM 362.03 Nonproliferative diabetic retinopathy NOS ICD9CM 362.04 Mild nonproliferative diabetic retinopathy ICD9CM 362.05 Moderate nonproliferative diabetic retinopathy ICD9CM 362.06 Severe nonproliferative diabetic retinopathy ICD9CM 362.07 Diabetic macular edema ICD9CM 366.41 Diabetic cataract ICD9CM 648.00 Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, unspecified as to episode of care or not applicable 648.01 Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, delivered, with or without mention of antepartum condition 648.02 Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, delivered, with mention of postpartum complication 648.03 Diabetes mellitus of mother, complicating pregnancy, childbirth, or the ICD9CM puerperium, antepartum condition or complication 648.04 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 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 E10.3211 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E10.3212 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E10.3213 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E10.3219 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12, 2018 15
E10.329 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E10.3291 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E10.3292 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E10.3293 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E10.3299 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E10.331 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E10.3311 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E10.3312 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E10.3313 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E10.3319 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E10.339 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E10.3391 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E10.3392 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E10.3393 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E10.3399 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E10.341 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E10.3411 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E10.3412 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E10.3413 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E10.3419 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E10.349 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E10.3491 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E10.3492 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E10.3493 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E10.3499 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12, 2018 16
E10.351 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema E10.3511 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E10.3512 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E10.3513 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E10.3519 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E10.3521 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E10.3522 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E10.3523 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E10.3529 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E10.3531 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E10.3532 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E10.3533 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E10.3539 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E10.3541 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E10.3542 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E10.3543 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E10.3549 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E10.3551 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E10.3552 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E10.3553 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E10.3559 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye E10.359 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema E10.3591 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E10.3592 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E10.3593 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral E10.3599 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, 2018 17
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 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 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 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 E11.3211 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye E11.3212 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E11.3213 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12, 2018 18
E11.3219 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E11.3291 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E11.3299 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E11.3311 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E11.3312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E11.3313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E11.3319 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E11.3391 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E11.3392 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E11.3393 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E11.3399 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E11.3411 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E11.3412 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E11.3413 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E11.3419 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E11.3491 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye E11.3492 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E11.3493 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12, 2018 19
E11.3499 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E11.3511 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E11.3512 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E11.3519 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E11.3521 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E11.3522 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E11.3523 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E11.3529 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E11.3531 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E11.3532 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E11.3533 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E11.3539 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E11.3541 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E11.3542 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E11.3543 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E11.3549 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E11.3551 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E11.3552 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E11.3553 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E11.3559 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye E11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral 2019 Clinical Quality Measure Scoring Guide December 12, 2018 20
E11.3599 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 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 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 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 E13.3211 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye 2019 Clinical Quality Measure Scoring Guide December 12, 2018 21
E13.3212 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye E13.3213 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral E13.3219 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye E13.329 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema E13.3291 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye E13.3292 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye E13.3293 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral E13.3299 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye E13.331 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema E13.3311 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye E13.3312 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye E13.3313 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral E13.3319 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye E13.339 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema E13.3391 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye E13.3392 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye E13.3393 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral E13.3399 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye E13.341 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema E13.3411 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye E13.3412 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye E13.3413 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral E13.3419 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye E13.349 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema E13.3491 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye 2019 Clinical Quality Measure Scoring Guide December 12, 2018 22
E13.3492 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye E13.3493 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral E13.3499 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye E13.351 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema E13.3511 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye E13.3512 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye E13.3513 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral E13.3519 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye E13.3522 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye E13.3523 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral E13.3529 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye E13.3531 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye E13.3532 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye E13.3533 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral E13.3539 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye E13.3541 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye E13.3542 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye E13.3543 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral E13.3549 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E13.3551 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye E13.3552 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye E13.3553 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E13.3559 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye 2019 Clinical Quality Measure Scoring Guide December 12, 2018 23