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Adult(s) with diabetes mellitus that had a serum creatinine in last 12 reported months.

CBE ID
0604
Endorsement Status
1.1 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
1.3 Measure Description

This measure identifies adults with diabetes mellitus that had a serum creatinine test in last 12 reported months.

        • 1.14 Numerator

          Was there a test for serum creatinine (code set PR0081, LC0033) or an ACE/ARB therapeutic monitoring test (code set PR0272) during the following time period: 12 months report period through 90 days after the end of the report period?

          Time Window: 12 months prior to the end of the report period through 90 days after the end of the report period

        • 1.15 Denominator

          For condition confirmation, the following criteria must be met:
          1. All males or females 18-75 years of age at the end of the report period
          2. Patient must have been continuously enrolled:
          Medical benefits throughout the 12 months prior to the end of the report period
          AND
          Pharmacy benefit plan for 6 months prior to the end of the report period
          Note: The standard enrollment break logic allows unlimited breaks of no more than 45 days and no breaks greater than 45 days.

          3. Either one of the following criteria (A or B):
          A. The patient is listed on the Disease Registry Input File for this condition, if a Disease Registry Input File is available.
          OR
          B. During the 24 months prior to the end of the report period, did the patient meet any of the following criteria:

          Patient has 2 or more outpatient or nonacute inpatient encounters (HEDIS) (code set PR0199, RV0199, PR0195, RV0195), where the diagnosis is Diabetes (HEDIS) (code set DX0227)
          OR
          Patient has 1 or more acute inpatient or emergency department encounters (HEDIS) (code set PR0330, RV0330, PR0194, RV0194), where the diagnosis is Diabetes (HEDIS) (code set DX0227)
          OR
          Patient has 1 or more prescriptions for Insulin or Oral Hypoglycemics/Antihyperglycemics (HEDIS) (code set RX0221)

          Time Window: 24 months prior to the end of the report period

        • Exclusions

          During the 12 months prior to the end of the report period, did the patient have 1 or more of the following services or events, where the diagnosis was Polycystic Ovaries (code set DX0312), Gestational Diabetes (DX0313), or Steroid-induced Diabetes (DX0314):
          ? Professional Encounter Code Set (code set PR0107, RV0107)
          ? Professional Supervision (code set PR0108)
          ? Facility Event – Confinement/Admission
          ? Facility Event – Emergency Room
          ? Facility Event – Outpatient Surgery

        • Most Recent Endorsement Activity
          Measure Retired and Endorsement Removed Endocrine Endorsement Maintenance Project
          Initial Endorsement
          Last Updated
          Removal Date