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.
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