Comprehensive Diabetes Care
Helping you improve your scores, as you improve the health of your patients.
Healthcare Effectiveness Data and Information Set (HEDIS®) scores are not only important for you as a provider; they also help guide your patients to quality care. As your trusted partner with the mutual goal of helping people lead healthier lives, Cigna is happy to provide support in every way we can. Use this quick reference guide for tips and up-to-date procedure codes that will help you maintain and even improve your HEDIS scores.
What you need to know
Comprehensive diabetes care looks at patients 18-75 years of age with diabetes (type 1 and type 2) who had each of the following:
- HbA1c testing
- HbA1c (poor control) >9.0%
- HbA1c control (<8.0%)
- HbA1c control (<7.0%) for a selected population
- Eye exam (retinal)
- Medical attention for nephropathy
- Blood Pressure control (<140/90 mm Hg)
HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.
Tips for improving your scores
- Address diabetes standards of care during each patient office visit.
- Order lab work prior to patient appointments.
- For all patients with diabetes, encourage and provide yearly:
- HbA1c
- Cholesterol screenings
- Microalbumin measurements
- Dilated eye exams
- Monitor blood pressure at each office visit.
- Adjust therapy as needed to improve HbA1c and blood pressure control.
Common billing codes accepted by HEDIS® for comprehensive diabetes care
Identifying Diabetics:
| International Classificaiton of Diseases – 9th Edition (ICD-9) | International Classificaiton of Diseases – 10th Edition (ICD-10) |
|---|---|
| 250.00–250.93 | E10.10–E10.649 |
| 357.2 | E11.00–E11.9 |
| 362.01–362.07 | E13.00–E13.9 |
| 366.41 | O24.011–O24.83 |
| 648.00–648.04 |
Diabetic Retinal Exam (DRE)
| Current Procedural Terminology (CPT®) | Healthcare Common Procedure Coding System (HCPCS) |
|---|---|
| 67028 | S0620 |
| 67030 | S0621 |
| 67031 | S3000 |
| 67039 | |
| 67040 | |
| 67041 | |
| 67042 | |
| 67043 | |
| 67101 | |
| 67105 | |
| 67107 | |
| 67108 | |
| 67110 | |
| 67112 | |
| 67113 | |
| 67121 | |
| 67141 | |
| 67145 | |
| 67208 | |
| 67210 | |
| 67218 | |
| 67220 | |
| 67221 | |
| 67227 | |
| 67228 | |
| 92002 | |
| 92004 | |
| 92012 | |
| 92014 | |
| 92018 | |
| 92019 | |
| 92134 | |
| 92225 | |
| 92226 | |
| 92227 | |
| 92228 | |
| 92230 | |
| 92235 | |
| 92240 | |
| 92250 | |
| 92260 | |
| 99203 | |
| 99204 | |
| 99205 | |
| 99213 | |
| 99214 | |
| 99215 | |
| 99242 | |
| 99243 | |
| 99244 | |
| 99245 | |
| 3072F | |
| 2022F | |
| 2024F | |
| 2026F | |
| S0625 |
HbA1C Test
| CPT | Logical Observation Identifiers Names and Codes (LOINC) |
|---|---|
| 83036 | 17856-6 |
| 83037 | 4548-4 |
| 3044F | 4549-2 |
| 3045F | |
| 3046F |
Nephropathy Treatment
| CPT | ICD-10 | ICD-9 |
|---|---|---|
| 3066F | E08.21 | 250.4 |
| 4010F | E08.22 | 250.41 |
| E08.29 | 250.42 | |
| E09.21 | 250.43 | |
| E09.22 | 403 | |
| E09.29 | 403.01 | |
| E10.21 | 403.1 | |
| E10.22 | 403.11 | |
| E10.29 | 403.9 | |
| E11.21 | 403.91 | |
| E11.22 | 404 | |
| E11.29 | 404.01 | |
| E13.21 | 404.02 | |
| E13.22 | 404.03 | |
| E13.29 | 404.1 | |
| I12.0 | 404.11 | |
| I12.9 | 404.12 | |
| I13.0 | 404.13 | |
| I13.10 | 404.9 | |
| I13.11 | 404.91 | |
| I13.2 | 404.92 | |
| I15.0 | 404.93 | |
| I15.1 | 405.01 | |
| N00.0 | 405.11 | |
| N00.1 | 405.91 | |
| N00.2 | 580 | |
| N00.3 | 580.4 | |
| N00.4 | 580.81 | |
| N00.5 | 580.89 | |
| N00.6 | 580.9 | |
| N00.7 | 581 | |
| N00.8 | 581.1 | |
| N00.9 | 581.2 | |
| N01.0 | 581.3 | |
| N01.1 | 581.81 | |
| N01.2 | 581.89 | |
| N01.3 | 581.9 | |
| N01.4 | 582 | |
| N01.5 | 582.1 | |
| N01.6 | 582.2 | |
| N01.7 | 582.4 | |
| N01.8 | 582.81 | |
| N01.9 | 582.89 | |
| N02.0 | 582.9 | |
| N02.1 | 583 | |
| N02.2 | 583.1 | |
| N02.3 | 583.2 | |
| N02.4 | 583.4 | |
| N02.5 | 583.6 | |
| N02.6 | 583.7 | |
| N02.7 | 583.81 | |
| N02.8 | 583.89 | |
| N02.9 | 583.9 | |
| N03.0 | 584.5 | |
| N03.1 | 584.6 | |
| N03.2 | 584.7 | |
| N03.3 | 584.8 | |
| N03.4 | 584.9 | |
| N03.5 | 585.1 | |
| N03.6 | 585.2 | |
| N03.7 | 585.3 | |
| N03.8 | 585.9 | |
| N03.9 | 586 | |
| N04.0 | 587 | |
| N04.1 | 588 | |
| N04.2 | 588.1 | |
| N04.3 | 588.81 | |
| N04.4 | 588.89 | |
| N04.5 | 588.9 | |
| N04.6 | 753 | |
| N04.7 | 753.1 | |
| N04.8 | 753.11 | |
| N04.9 | 753.12 | |
| N05.0 | 753.13 | |
| N05.1 | 753.14 | |
| N05.2 | 753.15 | |
| N05.3 | 753.16 | |
| N05.4 | 753.17 | |
| N05.5 | 753.19 | |
| N05.6 | 791 | |
| N05.7 | ||
| N05.8 | ||
| N05.9 | ||
| N06.0 | ||
| N06.1 | ||
| N06.2 | ||
| N06.3 | ||
| N06.4 | ||
| N06.5 | ||
| N06.6 | ||
| N06.7 | ||
| N06.8 | ||
| N06.9 | ||
| N07.0 | ||
| N07.1 | ||
| N07.2 | ||
| N07.3 | ||
| N07.4 | ||
| N07.5 | ||
| N07.6 | ||
| N07.7 | ||
| N07.8 | ||
| N07.9 | ||
| N08 | ||
| N14.0 | ||
| N14.1 | ||
| N14.2 | ||
| N14.3 | ||
| N14.4 | ||
| N17.0 | ||
| N17.1 | ||
| N17.2 | ||
| N17.8 | ||
| N17.9 | ||
| N18.1 | ||
| N18.2 | ||
| N18.3 | ||
| N18.4 | ||
| N18.5 | ||
| N18.6 | ||
| N18.9 | ||
| N19 | ||
| N25.0 | ||
| N25.1 | ||
| N25.81 | ||
| N25.89 | ||
| N25.9 | ||
| N26.1 | ||
| N26.2 | ||
| N26.9 | ||
| Q60.0 | ||
| Q60.1 | ||
| Q60.2 | ||
| Q60.3 | ||
| Q60.4 | ||
| Q60.5 | ||
| Q60.6 | ||
| Q61.00 | ||
| Q61.01 | ||
| Q61.02 | ||
| Q61.11 | ||
| Q61.19 | ||
| Q61.2 | ||
| Q61.3 | ||
| Q61.4 | ||
| Q61.5 | ||
| Q61.8 | ||
| Q61.9 | ||
| R80.0 | ||
| R80.1 | ||
| R80.2 | ||
| R80.3 | ||
| R80.8 | ||
| R80.9 |
Billing and medical record documentation should always support the level of service provided at that visit.
®HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)
Reproduced with permission from HEDIS 2017, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). To purchase copies of this publication, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications.
Current Procedural Terminology (CPT) codes copyright 2016 American Medical Association. All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Uniform Bill Codes (“UB Codes”) are protected under federal copyright laws and are owned by the American Hospital Association (AHA). The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Software vendors and all others desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other use, must obtain a commercial use license directly from the AHA. To inquire about licensing, please contact ub04@healthforum.com.