Mount Carmel Health Partners HEDIS Tip Sheets | Page 19

HEDIS Tip Sheet
Diabetes -- HbA1c Control
Definition: Percentage of members ages 18-75 whose most recent HbA1c is less than 8.
Service Needed: HbA1c test and result from January 1 – December 31 of the measurement year.
Coding:
CPT 2 Level <7.0%
CPT4
Level 7.0-9.0%
Level >9.0%
83036-83037
3044F
3045F
3046F
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:
• HbA1c tests are usually found in the “Laboratory” section of the chart.
• Minimally, diabetic patients should have an HbA1c every year (usually physicians will order it more frequently, at
least every 6 months if controlled or every 3 months if uncontrolled).
• You may review correspondence for letter/progress note from endocrinologist (specialist) noting a recent
HbA1c.
• You may review the progress notes and history for exclusion criteria (polycystic ovaries or gestational or steroid
induced diabetes).
• If patient meets any of the exclusion criteria, please note for future reference.
Member Outreach Tips:
• Ask patients if they have had an HbA1c test this year before reminding them they are due.
• If patients have not had an HbA1c this year, encourage them to schedule a visit with their PCP.
• If the HbA1c is greater than 8, encourage patients to attend available educational offerings and determine any
barriers to medication or dietary adherence.
Supplemental Data Tips
• For the patient to meet the measure, the most recent HbA1c must be less than 8.
• It is helpful to have the most recent HbA1c result recorded, even if it is not less than 8.
• The test date, name of the test, and test result must be documented to meet the measure.
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