• Measure 18 (NQF# 0088): Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy


    eMeasure Identifier: CMS167v5

    Reporting Options: 

    • IRIS Registry EHR
    • EHR through your vendor
    • IRIS Registry group reporting

    IRIS Registry EHR Reporting

    Instructions: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

    These are the required elements to be documented at least once a year to meet the measure performance requirements.  

    • Documentation of the level of severity of retinopathy AND
      • Mild NPDR
      • Moderate NPDR
      • Severe NPDR
      • Very Severe NPDR
      • Proliferative DR
    • Documentation of whether macular edema was present or absent

    Macular edema: Acceptable synonyms for macular edema include intraretinal thickening, serous detachment of the retina, or pigment epithelial detachment

    Denominator exceptions

    • Documentation of medical reason(s) for not performing a dilated macular or fundus examination
    • Documentation of patient reason(s) for not performing a dilated macular or fundus examination

    How CMS Scores Your Performance

    • If you report this measure for at least 50 percent of applicable patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. For example, if your performance rate falls in decile 4, you earn 4 points on that measure.
    • If you successfully report a measure for less than 50 percent of your patients, you will earn 3 points.
    • You can also earn bonus points for electronically reporting this measure.
    Decile/Points Benchmark
    3 31.69 - 41.32
    4 41.33 - 49.99
    5 50.00 - 56.97
    6 56.98 - 64.17
    7 64.18 - 70.58
    8 70.59 - 76.97
    9 76.98 - 85.15
    10 >= 85.16