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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
- 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
- Renal dysfunction
- Acute renal failure (ARF)
- Dialysis, hemodialysis or peritoneal dialysis
- Documentation of a renal transplant
- Documentation of a visit with a nephrologist
- Palliative Care
- 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
- Urine Protein Test Codes
- CPT: 81000-81005, 82042, 82043, 82044, 84156
- CPT II: 3060F, 3061F, 3062F, 3066F, 4010F