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 (Claims)
Hybrid (HEDIS Chart Chase)
Supplemental Data Submission
- Standard – Electronic Clinical Data System (ECDS) Layout
- Non-Standard - Medical Record
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