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

Bilateral Modifier

Diabetic Retinal Screening

Diabetic Retinal Screening Negative In Prior Year

Eye Exam With Evidence of Retinopathy

Eye Exam Without Evidence of Retinopathy

Unilateral Eye Enucleation

Unilateral Eye Enucleation Left

Unilateral Eye Enucleation Right