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.
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