Comprehensive Diabetes Care

Percentage of individuals 18-75 years of age with diabetes (type 1 and 2) who had each of the following:
1. HbA1c Testing - An HbA1c test performed during the measurement year as identified by claim/encounter or automated laboratory data.

2. HbA1c Poor Control >9% - Use automated lab data to identify the most recent HbA1c test during the measurement year. The member is numerator compliant if the most recent automated HbA1c level is >9.0% or is missing a result, or if an HbA1c test was not done during the measurement year. The member is not numerator compliant if the automated result for the most recent HbA1c test during the measurement year is =9.0%.

An organization that uses CPT Category II codes to identify numerator compliance for this indicator must search for all codes and use the most recent code during the measurement year to evaluate whether the member is numerator compliant.

Note: For this indicator, a lower rate indicates better performance (i.e., low rates of poor control indicate better care).

3. HbA1c Control <8% - Use automated laboratory data to identify the most recent HbA1c test during the measurement year. The member is numerator compliant if the most recent automated HbA1c level is <8.0%. The member is not numerator compliant if the automated result for the most recent HbA1c test is =8.0% or is missing a result, or if an HbA1c test was not done during the measurement year.

An organization that uses CPT Category II codes to identify numerator compliance for this indicator must search for all codes and use the most recent code during the measurement year to evaluate whether the member is numerator compliant.

4. HbA1c Control <7% - Use automated laboratory data to identify the most recent HbA1c test during the measurement year. The member is numerator compliant if the most recent automated HbA1c level is <7.0%. The member is not numerator compliant if the automated result for the most recent HbA1c test is =7.0% or is missing a result, or if an HbA1c test was not done during the measurement year.

An organization that uses CPT Category II codes to identify numerator compliance for this indicator must search for all codes and use the most recent code during the measurement year to evaluate whether the member is numerator compliant.

Note: This indicator uses the eligible population with additional eligible population criteria (e.g., removing members with required exclusions).

5. Eye Exam - An eye screening for diabetic retinal disease as identified by administrative data. This includes diabetics who had one of the following:
- A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year, OR
- A negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year

Refer to codes to identify eye exams. For exams performed in the year prior to the measurement year, a result must be available.

6. LDL-C Screening - An LDL-C test performed during the measurement year, as identified by claim/encounter or automated laboratory data. The organization may use a calculated or direct LDL for LDL-C screening and control indicators.

7. LDL-C Control <100 mg/dL - Use automated laboratory data to identify the most recent LDL-C test during the measurement year. The member is numerator compliant if the most recent automated LDL-C level is <100 mg/dL. If the automated result for the most recent LDL-C test during the measurement year is =100 mg/dL or is missing, or if an LDL-C test was not done during the measurement year, the member is not numerator compliant.

An organization that uses CPT Category II codes to identify numerator compliance for this indicator must search for all codes and use the most recent code during the measurement year to evaluate whether the member is numerator compliant.

8. Medical Attention for Nephropathy - A nephropathy screening test or evidence of nephropathy, as documented through administrative data.

9. BP Control <140/90 mmHg - Use automated data to identify the most recent BP reading during the measurement year. The member is numerator compliant if the most recent automated BP level is <140/90 mm Hg. The member is not compliant if the BP is =140/90 mm Hg or if there is no automated BP reading during the measurement year. If there are multiple BPs on the same date of service, use the lowest systolic and lowest diastolic BP on that date as the representative BP.

An organization that uses CPT Category II codes to identify numerator compliance for this indicator must search for all codes and use the most recent codes during the measurement year to evaluate whether the member is numerator compliant for both systolic and diastolic levels.

11. Smoking status: Patients with documentation of smoking status (i.e. non-smoker, smoker, not known) AND date of cessation counseling, OR treatment during the measurement year if the patient is a tobacco smoker.