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Percent of Diabetic Medicare Enrollees Receiving Appropriate Management, by Race and Type of Screening
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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; Region Levels: State)
    Massachusetts 85.7%
    Florida 85.4%
    New Jersey 84.6%
    Hawaii 83.6%
    Wisconsin 83.4%
    Delaware 83.4%
    New York 83.3%
    North Carolina 82.7%
    Tennessee 82.3%
    Virginia 82.3%
    New Hampshire 82.2%
    Rhode Island 82.2%
    South Carolina 82.1%
    Pennsylvania 81.9%
    Connecticut 81.9%
    Kentucky 81.3%
    Texas 81.1%
    Alabama 81.1%
    Illinois 80.9%
    Maryland 80.5%
    Maine 80.0%
    Iowa 80.0%
    Georgia 79.8%
    North Dakota 79.3%
    West Virginia 79.3%
    Missouri 79.2%
    Minnesota 79.1%
    California 78.9%
    Michigan 78.8%
    Louisiana 78.5%
    Ohio 78.5%
    Indiana 77.7%
    Arkansas 77.4%
    Washington 76.9%
    Mississippi 76.7%
    Oregon 76.6%
    Nevada 76.2%
    Arizona 75.8%
    Vermont 75.6%
    Kansas 74.8%
    Utah 74.5%
    South Dakota 74.0%
    Nebraska 73.8%
    Colorado 73.3%
    District of Columbia 72.6%
    Idaho 71.8%
    Oklahoma 71.5%
    Montana 69.0%
    New Mexico 65.6%
    Alaska 65.6%
    Wyoming 59.7%
    National Average 80.3%
    90th Percentile 83.4%
    50th Percentile 79.2%
    10th Percentile 71.5%
        • 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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