Posted in HEDIS Measures, Training, Updates

Proper coding for Comprehensive Diabetes Care HEDIS Measure: retinal eye exams (DRE)

Definition:  Comprehensive Diabetes Care HEDIS® Measure Retinal Eye Exam (DRE) is a percentage of patients between ages 18 to 75, with diabetes (type 1 and type 2), who had a retinal eye exam during the measurement year.

What is new?

The compliance of this measure is good for 2 years. You are allowed to bill the proper codes for the current measurement year, or prior year. This means you can submit the appropriate code at the time of the exam, and it covers both years.

New definition:

Low risk for retinopathy (no evidence of retinopathy in the prior year). The codes can be used to indicate that retinopathy was not present the previous year.

Proper Codes:


Please make sure to document the following measurements in the patient’s medical records:  HbA1c tests and results, retinal eye exam, blood pressure, urine creatinine test and the estimated glomerular filtration rate test.


DRE exams are an important component of in evaluating the overall health of diabetic patients. Providers should also strive to meet the Comprehensive Diabetes Care HEDIS measure with the following:

  • Hemoglobin A1c (HbA1c) testing
  • HbA1c poor control (>9.0%)
  • HbA1c control (<8.0%)
  • Retinal Eye exam performed
  • Blood Pressure control (<140/90 mm Hg)

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My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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