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Eye Exam for Patients With Diabetes (EED)

HEDIS Measure

Eye Exam for Patients With Diabetes (EED)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative and Hybrid

Measure Description

The percentage of members 18–75 years of age with diabetes (types 1 and 2) who had a retinal eye exam.

Numerator Compliance

Members screened or monitored for diabetic retinal disease.

Any of the following meets compliance:

  • Retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year
  • Negative retinal or dilated eye exam (negative for retinopathy) by an eye care professional in the year prior to the measurement year
  • Bilateral eye enucleation any time during the member’s history through December 31 of the measurement year

Best Practices

  • Document date of most recent diabetic eye exam, with results, name and title of eye care provider in the medical record
  • Order a diabetes screening test every year and build care gap “alerts” in your electronic medical record
  • Follow up with patients to discuss and educate on effects of diabetes
  • Coordinate care with patients' other providers
  • Outreach patients who have not had their eye exams and ask them to schedule one as soon as possible
  • Discuss with member the importance of screening for diabetes
  • Educate the member on symptoms of new-onset diabetes
  • Educate the members about the importance of early detection and encourage screening
  • Request to have any eye exam results sent from the specialty office
  • Set care gap “alerts” in your electronic medical record
  • Prepare standing referral to ophthalmologist, assist patient in making eye specialist appointment and track referral until specialist report is obtained.
  • Conduct chart review to identify evidence of negative retinal eye exam in the year prior to the measurement year. Report previous year negative eye screening with a current calendar year date of services.

Quality Value Set Directory Coding Tips

Automated Eye Exam

CPT

  • 92229

Bilateral Modifier

Modifier

  • 50

Diabetic Retinal Screening

CPT

  • 67028
  • 67030
  • 67031
  • 67036
  • 67039
  • 67040
  • 67041
  • 67042
  • 67043
  • 67101
  • 67105
  • 67107
  • 67108
  • 67110
  • 67113
  • 67121
  • 67141
  • 67145
  • 67208
  • 67210
  • 67218
  • 67220
  • 67221
  • 67227
  • 67228
  • 92002
  • 92004
  • 92012
  • 92014
  • 92018
  • 92019
  • 92134
  • 92201
  • 92202
  • 92225
  • 92226
  • 92227
  • 92228
  • 92230
  • 92235
  • 92240
  • 92250
  • 92260
  • 99203
  • 99204
  • 99205
  • 99213
  • 99214
  • 99215
  • 99242
  • 99243
  • 99244
  • 99245

HCPCS

  • S0620
  • S0621
  • S3000

SNOMED CT US Edition

  • 274795007
  • 274798009
  • 308110009
  • 314971001
  • 314972008
  • 410451008
  • 410452001
  • 410453006
  • 410455004
  • 425816006
  • 427478009
  • 722161008

Diabetic Retinal Screening Negative In Prior Year

CPT-CAT-II

  • 3072F

Eye Exam With Evidence of Retinopathy

CPT-CAT-II

  • 2022F
  • 2024F
  • 2026F

Eye Exam Without Evidence of Retinopathy

CPT-CAT-II

  • 2023F
  • 2025F
  • 2033F

Unilateral Eye Enucleation

CPT

  • 65091
  • 65093
  • 65101
  • 65103
  • 65105
  • 65110
  • 65112
  • 65114

SNOMED CT US Edition

  • 59590004
  • 172132001
  • 205336009
  • 397800002
  • 397994004
  • 398031005

Unilateral Eye Enucleation Left

ICD10PCS

  • 08T1XZZ

Unilateral Eye Enucleation Right

ICD10PCS

  • 08T0XZZ