Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (NQF 0088)
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Initial Patient Population =
- AND: "Patient Characteristic: birth date" >= 18 year(s) starts before start of "Measurement period"
- AND: "Diagnosis, Active: Diabetic Retinopathy" starts before or during
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
- AND: Count >= 2 of:
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
-
Denominator =
- AND: "Initial Patient Population"
-
Denominator Exclusions =
-
Numerator =
- AND: Count >= 1 of:"Procedure, Performed: Macular or Fundus Exam" during
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
- AND:
- AND: "Physical Exam, Finding: Macular Edema Findings" starts before or during
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
- AND: "Physical Exam, Finding: Level of Severity of Retinopathy Findings" starts before or during
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
-
Denominator Exceptions =
- AND:
- OR: "Procedure, Performed not done: Medical reason" for "Macular or Fundus Exam SNOMED-CT Value Set"
- OR: "Procedure, Performed not done: Patient reason" for "Macular or Fundus Exam SNOMED-CT Value Set"
- during
- OR: "Encounter: Encounter Domiciliary"
- OR: "Encounter: Encounter Nursing Facility"
- OR: "Encounter: Encounter Office & Outpatient Consult"
- OR: "Encounter: Encounter Ophthalmological Services"
- during "Measurement period"
-
"Diagnosis, Active: Diabetic Retinopathy" using "Diabetic Retinopathy Value Set GROUPING (2.16.840.1.113883.3.526.03.327)"
-
"Encounter: Encounter Domiciliary" using "Encounter Domiciliary CPT Value Set (2.16.840.1.113883.3.526.02.110)"
-
"Encounter: Encounter Nursing Facility" using "Encounter Nursing Facility CPT Value Set (2.16.840.1.113883.3.526.02.28)"
-
"Encounter: Encounter Office & Outpatient Consult" using "Encounter Office & Outpatient Consult CPT Value Set (2.16.840.1.113883.3.526.02.99)"
-
"Encounter: Encounter Ophthalmological Services" using "Encounter Ophthalmological Services CPT Value Set (2.16.840.1.113883.3.526.02.111)"
-
"Patient Characteristic: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
-
"Physical Exam, Finding: Level of Severity of Retinopathy Findings" using "Level of Severity of Retinopathy Findings SNOMED-CT Value Set (2.16.840.1.113883.3.526.02.154)"
-
"Physical Exam, Finding: Macular Edema Findings" using "Macular Edema Findings SNOMED-CT Value Set (2.16.840.1.113883.3.526.02.155)"
-
"Procedure, Performed: Macular or Fundus Exam" using "Macular or Fundus Exam SNOMED-CT Value Set (2.16.840.1.113883.3.526.02.152)"
-
"Procedure, Performed not done: Medical reason" using "Medical reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.02.313)"
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"Procedure, Performed not done: Patient reason" using "Patient reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.02.311)"
- "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"
- "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)"