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Percent of Diabetic Medicare Enrollees Receiving Appropriate Management, by Race and Type of Screening
(Race: Overall; Type of Screening: Blood Lipids Test; Year: 2014)
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    • YEAR:
    • Race:
    • Type of Screening:
    • Region Type:

      • FOOTNOTES:
      • Measures of the quality of diabetic care for Medicare beneficiaries age 65-75 are not adjusted. Because every diabetic patient in this cohort should receive these tests, regardless of age, sex or race, statistical adjustments to correct for underlying population differences are not relevant.

      • DENOMINATOR DEFINITION:
      • Non-HMO Medicare enrollees age 65 - 75 (on December 31) with Parts A & B eligibility, 20% sample with diagnosis of diabetes.

        Diabetes diagnosis: two face-to-face encounters with different dates of service in an ambulatory setting or nonacute inpatient setting or one face-to-face encounter in an acute inpatient or emergency room setting during measurement year or prior year.

        Diabetes definition: ICD-9 codes: 250xx, 357.2x, 362.0x, 366.41, 648.0x: DRGs 294, 295; for Q4, MS-DRG codes 637, 638, 639.

        Outpatient/non-acute inpatient CPT codes: 92002-92014, 99201-99205, 99211-99215, 99217-99220, 99241-99245, 99341-99345, 99347-99350, 99384-99387, 99394-99397, 99401-99404, 99411-99412, 99420, 99429, 99455, 99456, 99499, 99301-99313, 99315, 99316, 99318, 99321-99328, 99331-99337.

        Acute inpatient/emergency department CPT codes: 99221-99223, 99231-99233, 99238, 99239, 99251-99255, 99261-99263, 99291, 99281-99285.

        Outpatient/non-acute inpatient revenue center codes: 051x, 052x, 057x-059x, 077x, 082x-085x, 088x, 0982, 0983, 0118, 0128, 0138, 0148, 0158, 019x, 055x, 066x.

        Acute inpatient/emergency department revenue center codes: 010x, 0110-0114, 0119, 0120-0124, 0129, 0130-0134, 0139, 0140-0144, 0149, 0150-0154, 0159, 016x, 020x-022x, 072x, 080x, 0987, 045x, 0981.

      • NUMERATOR DEFINITION:
      • Hemoglobin A1c testing: CPT codes 83036, 83037; CPT II codes 3046F, 3047F.

        Blood lipids testing: CPT codes 80061, 83700, 83701, 83704, 83715, 83716, 83721; CPT II codes 3048F, 3049F, 3050F.

        Eye examination: a retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year*; or a negative retinal exam (no evidence of retinopathy: ICD-9 codes 250.50-250.53, 362.01-362.07) by an eye care professional in the year prior to the measurement year (specialty codes: 18=ophthalmology, 41=optometry).

        *ICD-9 procedure codes 14.1-14.59, 14.9, 95.02-95.04, 95.11, 95.12, 95.16; CPT codes 67028, 67038-67040, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260, 99203-99205, 99213-99215, 99242-99245; CPT II codes 2022F, 2024F, 2026F, 3072F; HCPCS codes S0625, S3000.




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