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Comprehensive Diabetes Care - Medical Attention for Nephropathy

Advantage MD. Members 18-75 years of age.

Percentage of Medicare Advantage members 18-75 years of age with diabetes (type 1 and type 2) who had the following:

  • Medical Attention for Nephropathy

Best Practice and Measure Tips

Acceptable Documentation:

  • Nephropathy screening or monitoring test (urine test for albumin or protein), with date and results. At a minimum, documentation must include a note indicating the date a urine test was performed, and the result or finding. Any of the following meet the criteria:
    • 24-hour, spot or timed urine for albumin or protein
    • Urine or random urine for albumin/creatinine ratio
    • 24-hour urine for total protein
  • Evidence of ACE/ARB therapy. Documentation in the medical record can be one of these:
    • Documentation that a prescription for ACE inhibitor or ARB was written or filled during the measurement year.
    • Documentation that the patient took an ACE inhibitor or ARB during the measurement year.
    • At least one ACE inhibitor or ARB dispensing event
  • Documentation of medical attention for any of the following:
    • Diabetic nephropathy
    • End-stage renal disease (ESRD)
    • Chronic renal failure (CRF)
    • Chronic kidney disease (CKD)
    • Renal insufficiency
    • Proteinuria
    • Albuminuria
    • Renal dysfunction
    • Acute renal failure (ARF)
    • Dialysis, hemodialysis or peritoneal dialysis
  • Documentation of a renal transplant
  • Documentation of a visit with a nephrologist

Measure Exclusions

Required Exclusions:

  • Palliative Care
  • Hospice
  • Fraility
  • Fraility and Advanced Illness
  • Living in Long Term Care

Optional Exclusion:  Members without a diagnosis of diabetes in any setting and a diagnosis of polycystic ovarian syndrome, gestational diabetes or steroid-induced diabetes during the measurement year or the year prior

Measure Codes

  • Urine Protein Test Codes
    • CPT: 81000-81005, 82042, 82043, 82044, 84156
    • CPT II: 3060F, 3061F, 3062F, 3066F, 4010F