June 2024
About 38 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Because symptoms can develop slowly, one in five of them don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.
Monitoring Our Members’ Care
We track Healthcare Effectiveness Data and Information Set measures from the National Committee for Quality Assurance related to diabetes care, including:
Hemoglobin A1c Control for Patients with Diabetes captures the percentage of our members ages 18 to 75 with diabetes (type 1 and type 2) whose HbA1c level during the measurement year is:
Eye Exam for Patients with Diabetes tracks members ages 18 to 75 with diabetes (type 1 and type 2) who have a retinal eye exam by an eye care professional to screen or monitor for diabetic retinal disease.
Blood Pressure Control for Patients with Diabetes captures members ages 18 to 75 with diabetes (type 1 and type 2) whose blood pressure was controlled (<140/90 mm Hg).
Kidney Health Evaluation for Patients with Diabetes tracks members ages 18 to 85 with diabetes (type 1 and type 2) who received a kidney health evaluation during the measurement year. An evaluation includes a blood test for kidney function (estimated glomerular filtration rate) and a urine test for kidney damage (urine albumin-creatinine ratio).
Statin Therapy for Patients with Diabetes tracks members ages 40 to 75 who have diabetes and do not have clinical atherosclerotic cardiovascular disease, and who received and adhered to statin therapy.
Tips To Close Gaps in Care
Resources
Information on Current Procedural Terminology (CPT®) Category II codes is available in Availity® Essentials in Payer Spaces in the Resources section. It includes information on coding for HbA1c Control for Patients with Diabetes and Blood Pressure Control for Patients with Diabetes.
We’ve created information that may help you discuss diabetes with our members. Also see our preventive care and clinical practice guidelines.