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Hemoglobin A1c Control for Patients With Diabetes (HBD)

HEDIS Measure

Hemoglobin A1c Control for Patients With Diabetes (HBD)

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) whose hemoglobin A1c (HbA1c) was at the following levels during the measurement year:

  • HbA1c control (<8.0%).
  • HbA1c poor control (>9.0%). (Inverted Measure)

Numerator Compliance

HbA1c Control <8% - The most recent HbA1c test during the measurement year with a result of <8.0%

NOTE: The member is not compliant if the result for the most recent HbA1c test is equal to or greater than 8.0%

HbA1c Poor Control >9% - The most recent HbA1c test during the measurement year with a result of >9.0%

NOTE: The member is not compliant if the result for the most recent HbA1c test is equal to or less than 9.0%

Best Practices

  • Order labs prior to members' appointments
  • Ensure documentation in the medical record includes the date when the HbA1c was performed, and the result
  • 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 lab results
  • Coordinate care with patients' other providers
  • Outreach patients who cancel appointments and reschedule them as soon as possible
  • 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 exam and lab work completed and ask them to complete as soon as possible
  • Discuss with member the Importance of screening for diabetes
  • Educate the member on symptoms of new-onset diabetes
  • Set care gap “alerts” in your electronic medical record

Quality Value Set Directory Coding Tips

HbA1c Lab Test

CPT

  • 83036
  • 83037

LOINC

  • 17856-6
  • 4548-4
  • 4549-2

SNOMED CT US Edition

  • 43396009
  • 313835008

HbA1c Level Greater Than or Equal To 7.0 and Less Than 8.0

CPT-CAT-II

  • 3051F

HbA1c Level Less Than 7.0

CPT-CAT-II

  • 3044F

SNOMED CT US Edition

  • 165679005

HbA1c Test Result or Finding

CPT-CAT-II

  • 3044F
  • 3046F
  • 3051F
  • 3052F

SNOMED CT US Edition

  • 165679005
  • 451051000124101
  • 451061000124104

HbA1c Level Greater Than 9.0

CPT-CAT-II

  • 3046F

SNOMED CT US Edition

  • 451061000124104

HbA1c Level Greater Than or Equal To 8.0 and Less Than or Equal To 9.0

CPT-CAT-II

  • 3052F