Documentation of Diabetic Retinal Eye Exams

13.1% of Kentuckians have an active diagnosis of diabetes. African-Americans have a higher prevalence (14.4%) than do Caucasians (13.3%), which is consistent with national data. Diabetes is also more prevalent in Eastern Kentucky than in other areas of the state. Make sure your diabetic patients are getting dilated retinal eye exams as appropriate.

INTENT OF MEASURE: To recognize the signs of diabetic retinopathy as soon as possible in the population diagnosed with diabetes, Type l or Type ll, and prevent vision loss.

DOCUMENTATION REQUIREMENTS TO MEET THE MEASURE: It is best if the PCP has a copy of the retinal eye exam in the patient record. You can document the year and results of the eye exam in your notes based on patient information, however this will not be picked up electronically for reporting. For best practice, obtain a copy of the results from the eye doctors and attached to a reported order, which is easily picked up for reporting. KentuckyOne Health/CHI Medical Plan and Anthem Commercial EPHC only accept claims as proof of the actual retinal exam.

Retinal Eye Exam:
1. Is the patient Diabetic?
2. Did the patient have an eye exam? Yes/No
• CHI MEDICAL PLAN: Exam must be performed during measurement year.
• OTHER PAYERS: Exam during measurement year documented OR negative eye exam from previous year documented.

Eye exams can now be performed in the PCP office with use of specialized equipment, but must be interpreted by an ophthalmologist or optometrist.

For more information on HEDIS measures, contact:
Anna “Kitty” Grider, KentuckyOne Health Partners, 502.489.3042, AnnaGrider@KentuckyOneHealth.org