COMPREHENSIVE DIABETES CARE
Measure definition:Percentage of patients with diabetes (type 1 & 2) ages 18-75 years old in compliance with HbA1c, retinal eye exam, and medical attention for nephropathy.
HbA1c
- Medicare patients: HbA1c must be less than or equal to 9%
- Commercial patients: HbA1c must be less than 8%
Best practices and tips for talking to patients
- All lab values for HbA1c should be documented in the medical record as they provide valuable quality information and directly impact patient care.
- Submit CPT Category II Codes to ensure results are documented.
- Outreach to patients to schedule follow-up appointments and lab tests.
Retinal eye exam
One of the following must be met for compliance for a retinal eye exam:
- Retinal or dilated eye exam in 2021
- Negative retinal or dilated eye exam (negative for retinopathy) in 2020
- Bilateral eye enucleation any time during the patient’s history through December 31, 2021
Best practices and tips for talking to patients
- Talk to patients regarding the importance of an annual retinal eye exam, as diabetes can cause impaired vision.
- Discuss with your patients what to expect at the eye exam screening.
- Ensure the patient shares their diabetes diagnosis with their eye care professional.
Nephropathy screening
- A urine test for albumin or protein
- Evidence of treatment for nephropathy or ACE/ARB therapy
- Evidence of stage 4 chronic kidney disease
- Evidence of end-stage renal disease or dialysis
- Evidence of nephrectomy or kidney transplant
- A visit with a nephrologist
- At least one ACE inhibitor or ARB dispensing event
Best practices and tips for talking to patients
- Coordinate care with a specialist such as an endocrinologist, nephrologist, or cardiologist.
Exclusions
- Patients who do not have a diagnosis of diabetes, in any setting, in 2020 or 2021 and have a diagnosis of polycystic ovarian syndrome, gestational diabetes, or steroid-induced diabetes, in any setting, in 2020 or 2021
- Patients on palliative care or in hospice care/services in 2021
- Age 66 or older with advanced illness and a frailty diagnosis in 2021
HbA1c CPT Category II codes
3044F
HbA1c level less than 7.0
3051F
HbA1c level ≤ to 7.0 and > 8.0
3052F
HbA1c level ≤ to 8.0 and ≥ 9.0
3046F
HbA1c level greater than 9.0
CPT Category II codes for retinal screening with an eye care professional
2022F
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed during 2021; with evidence of retinopathy
2023F
Dilated retinal eye exam with interpretation during 2021; without evidence of retinopathy
2024F
Seven standard field stereoscopic retinal photos with interpretation; with evidence of retinopathy
2025F
Seven standard field stereoscopic retinal photos with interpretation; without evidence of retinopathy
2026F
Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy
2033F
Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy
CPT Category II codes for retinal screenings negative for retinopathy
3072F
Low risk for retinopathy (no evidence of retinopathy in the prior year)
Nephropathy screening CPT Category II codes & CPT codes
3066F, 4010F
Identifies nephropathy treatment
81000-81005, 82042-82044, 84156
Identifies nephropathy screening
Nephropathy screening ICD-10 CM codes
N18.4
Identifies stage 4 chronic kidney disease
N18.5, N18.6, Z99.2
Identifies end-stage renal disease
Nephropathy treatment ICD-10 CM codes
E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22, E11.29, E13.21, E13.22, E13.29, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I15.1, N00.0 – N08, N14.0 – N14.4, N17.0 – N19, N25.0 – N25.9, N26.1 – N26.9, Q60.0 – Q60.6, Q61.00 – Q61.02, Q61.11, Q61.19, Q61.2 – Q61.9, R80.0 – R80.9