Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Eligible Population:
Members 18 and 85 years of age as of December 31 of the measurement year. This includes HealthChoice Performance Measure reporting for Priority Partners.

Definition:
Percentage of members 18–85 years of age with diabetes (type 1 and type 2) as of December 31 of the measurement year  who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.

Reports three age stratifications and a total rate:

• 18-64
• 65-75
• 76-85
• Total. The total is the sum of the age stratifications.

New for Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• The measurement year.

Best Practice and Measure Tips

• Requires both an eGFR and a uACR during the measurement year on the same or different dates of service:
  • Routinely refer members with a diagnosis of diabetes for both eGFR and uACR.  A quantitative urine albumin test and a urine creatinine test require service dates four or less days apart.
• Follow up with patients to discuss and educate on lab results.
• Educate on how diabetes can affect the kidneys and offer tips to your patients on preventing damage to their kidneys
  • National Kidney Foundation educational flyer
• Controlling their blood pressure, blood sugars, cholesterol, and lipid levels
• Take medications as prescribed that can protect kidney function (ACE inhibitors or ARBs)
• Offer education on medications that could be harmful to the kidneys (NSAIDs such as naproxen or ibuprofen)
• Limit protein intake and salt in diet
• Coordinate care with specialists such as an endocrinologist or nephrologist as needed.
• To close measure gap, make sure that both urine test, quantitative urine albumin lab test and urine creatinine lab test, are ordered, reported and both codes are being billed (82043, 82570).

Measure Exclusions

Required Exclusions:

• ESRD 
• Dialysis
• Palliative Care
• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Frailty: Members age 81 and older with frailty during the measurement year.
• Members 67–80 years of age as of December 31 of the measurement year (all product lines) with frailty and advanced illness.
•  Medicare members 66 years of age and older by the end of the measurement period who meet either of the following:
  • Enrolled in an Institutional SNP (I-SNP).
  • Living in Long Term Care.

Measure Codes

To ensure gap closure, verify the practitioner orders and lab facilities include all three CPT codes, eGFR and both urine test, quantitative urine albumin lab test and urine creatinine lab test, in the claim.

Note: Measure can only be closed through claims or EMR supplemental data feed.

• Estimated Glomerular Filtration Rate Lab Test
  • CPT: 80047, 80048, 80050, 80053, 80069, 82565
  • LOINC: 102097-3, 50044-7, 50210-4, 50384-7, 62238-1, 69405-9, 70969-1, 77147-7, 94677-2, 98979-8, 98980-6
• Quantitative Urine Albumin Lab Test
  • CPT: 82043
  • LOINC: 100158-5, 14957-5, 1754-1, 21059-1, 30003-8, 43605-5, 53530-2, 53531-0, 57369-1, 89999-7
• Urine Albumin Creatinine Ratio (uACR) Lab Test
  • LOINC: 13705-9, 14958-3, 14959-1, 30000-4, 44292-1, 59159-4, 76401-9, 77253-3, 77254-1, 89998-9, 9318-7
• Urine Creatinine Lab Test
  • CPT: 82570
  • LOINC: 20624-3, 2161-8, 35674-1, 39982-4, 57344-4, 57346-9, 58951-5

Medication List: Diabetes Medications