Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Comprehensive Diabetes Care

In this blog post we will explore the Comprehensive Diabetes Care HEDIS measure. .

What is New for 2020?

New measure Kidney Health Evaluation for Patient with Diabetes measure was added in 2020. This is a new measure. It evaluates the percent of members that are between 18 and 85 years of age that have diabetes and who received a kidney health evaluation, including estimated glomerular filtration gate test (eGFR) and a urine albumin-creating ration.

What is Comprehensive Diabetes Care Measure?

Measure that evaluates percentage of adult members between ages of 18 and 75 years of age (looks at both type 1 and type 2 diabetes) and who had each of the following:

  1. HbA1c testing
  2. HbA1c poor control (>9%)
  3. HbA1c control of (<8%)
  4. Retinal Eye Exam performed
  5. Blood Pressure Control (<140/90 mm/Hg)\

Documentation:

Record your efforts: document results of, all of the above mentioned test, in the patient’s medical record.


How to meet this measure?

  • Provide reminders to patients for upcoming appointments and screenings.
  • Draw labs in your office if available or refer patients to a local lab for screenings.
  • Refer patients to participating eye professionals for annual retinal eye exams.
  • Follow up on lab test, eye exams and specialist referrals and document in your chart.
  • Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
  • Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
  • Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).

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HEDIS Measure: Cervical Cancer Screening

Description:

Cervical cancer screening is measured by the percentage of women, 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women 21 to 64 years of age who had cervical cytology performed within the last 3 years.
  • Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
  • Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.

Note: Evidence of hrHPV testing within the past five years also captures patients who had co-testing; therefore, additional methods to identify co-testing are not necessary.


Documentation:

  1. For women age 24-64 as of Dec. 31 of the measurement year who had cervical cytology
    during the measurement year or the two years prior to the measurement year, documentation
    in the medical record must include both of the following:
    o A note indicating the date when the cervical cytology was performed
    o The result or finding

2. For women age 30-64 as of Dec. 31 of the measurement year who: 1) had cervical hrHPV
testing during the measurement year or the four years prior to the measurement years, and 2)
were 30 years or older as of the date of testing, documentation must include both:
o A note indicating the date the hrHPV test was performed; generic documentation stating
HPV test counts as evidence of hrHPV test
o The results or findings

Documentation that will not be accepted for this measure:

  1. Biopsies do not count
  2. Lab results that state the sample was inadequate or that no cervical cells were present are
    not acceptable unless it is also stated this finding is consistent with a hysterectomy
  3. Documenting hysterectomy is not sufficient; should note if the hysterectomy resulted in the
    loss of the cervix and include terms like total, complete or radical hysterectomy

Codes that apply to this HEDIS Measure

Exclusions:

1.Women who have had a total, complete or radical vaginal or abdominal hysterectomy with no
residual cervix, cervical agenesis or acquired absence of cervix; prior to Dec. 31 of the
measurement year
2. Hospice or palliative care during measurement years
3. Documentation of vaginal hysterectomy meets criteria for documentation of hysterectomy with
no residual cervix



HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
All summaries of the measures contained herein are reproduced w ith permission from HEDIS MY2020 and MY2021, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


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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:


Documentation:

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.


Important!

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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