Mount Carmel Health Partners HEDIS Tip Sheets - Page 17

HEDIS Tip Sheet Diabetes—Eye Exam Definition: Percentage of members ages 18 - 75 who have had an eye screening test for diabetic retinal disease. Service Needed: One of the following: • A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year. • A negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to or during the measurement year. Coding: CPT 2 Diabetic Retinal Screening with Eye Care Professional: Diabetic Retinal Screening Negative: 2022F*, 2023F*, 2024F*, 2025F*, 2026F*, 2033F* 3072F *2022F(Revised)-Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed: with evidence of retinopathy (DM)2 *2023F(New)- Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed: without evidence of retinopathy (DM)2 *2024F-(Revised)-7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM)2 *2025F(New)- 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy (DM)2 *2026F(Revised)-Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (DM)2 *2033F(New)- Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy (DM)2 Exclusions: • One of the following: • A diagnosis of polycystic ovaries, in any setting, any time during the member’s history through December 31 of the measurement year. • A diagnosis of gestational diabetes or steroid-induced diabetes, in any setting, during the measurement year or year prior. • Hospice care in the measurement year. Chart Review Tips: • Dilated eye exams are usually found either in the “Correspondence” or “Progress notes” sections of the chart. • Retina photography such as from Optimap, dated and reviewed by optometrist or ophthalmologist usually found in the "Correspondence" sections of the chart. • If patient meets any of the exclusion criteria, please note for future reference. 17