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Percent of Diabetic Medicare Enrollees Receiving Appropriate Management, by Race and Type of Screening
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    Region
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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: 2015; Region Levels: State)
    Alabama 81.0%
    Alaska 62.7%
    Arizona 75.1%
    Arkansas 77.8%
    California 77.2%
    Colorado 71.1%
    Connecticut 80.7%
    Delaware 82.8%
    District of Columbia 71.6%
    Florida 84.8%
    Georgia 80.3%
    Hawaii 83.7%
    Idaho 71.2%
    Illinois 79.8%
    Indiana 76.7%
    Iowa 79.4%
    Kansas 74.2%
    Kentucky 81.6%
    Louisiana 78.1%
    Maine 77.6%
    Maryland 79.9%
    Massachusetts 83.0%
    Michigan 77.9%
    Minnesota 75.2%
    Mississippi 76.6%
    Missouri 78.1%
    Montana 67.1%
    Nebraska 72.7%
    Nevada 75.7%
    New Hampshire 79.1%
    New Jersey 84.4%
    New Mexico 65.2%
    New York 82.7%
    North Carolina 82.0%
    North Dakota 77.5%
    Ohio 77.3%
    Oklahoma 71.1%
    Oregon 74.9%
    Pennsylvania 81.1%
    Rhode Island 81.1%
    South Carolina 81.7%
    South Dakota 73.0%
    Tennessee 82.4%
    Texas 80.7%
    Utah 72.5%
    Vermont 69.6%
    Virginia 82.0%
    Washington 76.3%
    West Virginia 78.2%
    Wisconsin 81.6%
    Wyoming 59.5%
    National Average 79.5%
    90th Percentile 82.8%
    50th Percentile 77.9%
    10th Percentile 69.6%
        • 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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