Mount Carmel Health Partners HEDIS Tip Sheets - Page 20

HEDIS Tip Sheet Diabetes – Medical Attention for Nephropathy Definition: Percentage of members ages 18 - 75 who have had a screening test for nephropathy OR evidence of nephropathy (see list under “Service Needed”). Service Needed: A nephropathy screening test or evidence of nephropathy from January 1 - December 31 of the measurement year. Evidence of nephropathy includes: • ACE/ARB therapy. • At least one ACE inhibitor or ARB dispensing event. • Diagnosis of stage 4 chronic kidney disease, end stage renal disease (ESRD), chronic or acute renal failure, renal insufficiency, or diabetic nephropathy. • Documentation of kidney transplant or dialysis, hemodialysis or peritoneal dialysis. • A visit with a nephrologist. • A urine microalbumin or albumin or protein test in which laboratory data indicates a positive result (“trace” urine microalbumin test results are not considered numerator compliant). Coding: CPT 2 Positive microalbuminuria test documented/reviewed 3060F Negative microalbuminuria test documented/reviewed 3061F Positive macro albuminuria test documented/reviewed 3062F Nephropathy treatment documentation 3066F, 4010F CPT 4: 81000 - 81005 82042 - 81044 84156 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. • If patient meets any of the exclusion criteria, please note for future reference. • Hospice care in the measurement year. Chart Review Tips: • Urine tests for nephropathy screening or monitoring are usually found in the “Laboratory” section of the chart. Any of the following meet the criteria: •Urine microalbumin. •24-hour urine for albumin or protein. 20