Optimal Diabetes Care Specifications 2013 (01/01/2012 to 12/31/2012 Dates of Service) Revised 09/19/2012

Transcription

1 Summary of Changes Date of birth clarification Added language to clarify date of birth range. Please note the changes in the denominator section. Addition of Ischemic Vascular Disease ICD-9 Diagnosis Codes Added ICD-9 Diagnosis codes 440.0, and to the list of ICD-9 diagnosis codes used to identify patients who have a co-morbidity of Ischemic Vascular Disease. Description Methodology Rationale Measurement Period Denominator Composite ( optimal care) measure of the percentage of adult patients who have type 1 or type 2 diabetes with optimally managed modifiable risk factors. Population identification is accomplished via a query of a practice management system or electronic medical record (EMR) to identify the population of eligible patients (denominator). Data elements are either extracted from an EMR system or abstracted through medical record review. Clinics that had an EMR in place by 01/01/2011 are required to submit data on their full population. According to the Minnesota Department of Health, diabetes is a high impact clinical condition in Minnesota. More than one in three adults and one in six youth in Minnesota have diabetes or are at high risk of developing it. Each year more than 20,000 Minnesotans are newly diagnosed with diabetes. Diabetes is the sixth leading cause of death in Minnesota and is a significant risk factor in developing cardiovascular disease and stroke, non-traumatic lower extremity amputations, blindness, and end-stage renal disease. Diabetes costs Minnesota almost $2.7 billion annually, including medical care, lost productivity and premature mortality. According to the American Diabetes Association, an estimated 23.6 million American children and adults have diabetes. Most people with diabetes have other risk factors, such as high blood pressure and cholesterol that increase the risk for heart disease and stroke. In fact, more than 65% of people with diabetes die from these complications. Measurement period will be a fixed twelve month period: 01/01/2012 to 12/31/2012. Established patient who meets each of the following criteria is included in the population: Patient was age 18 to 75 at the start of the measurement period (date of birth was on or between 01/01/1937 to 01/01/1994). Patient was seen by an eligible provider in an eligible specialty face-to-face at least two times during the last two years (01/01/2011 to 12/31/2012) with visits coded with a diabetes mellitus ICD-9 diagnosis code (in any position, not only primary). Use this date of service range when querying the practice management or EMR system to allow a count of the visits within this time frame. Patient was seen by an eligible provider in an eligible specialty face-to-face at least one time during the last twelve months (01/01/2012 to 12/31/2012) for any reason. This may or may not include one of the face-to-face diabetes visits. Diagnosis of Diabetes mellitus; ICD-9 diagnosis codes include: Eligible specialties: Family Medicine (includes General Practice), Internal Medicine, Geriatric Medicine, Endocrinology. Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Nurse Practitioner (NP). Page 1

2 Allowable Exclusions Numerator Patient was a permanent nursing home resident during the measurement period. Patient was in hospice at any time during the measurement period. Patient died prior to the end of the measurement period. Documentation that diagnosis was coded in error. Patient was pregnant during measurement period (ICD-9 diagnosis codes: ). The number of diabetes patients who met ALL of the following targets: The most recent HbA1c in the measurement period has a value <8.0. The most recent LDL test in the measurement period has a value <100. The most recent Blood Pressure in the measurement period has a systolic value of <140 and a diastolic value of <90 (BOTH values must be less than). There is documentation in the chart that the patient is currently a non-tobacco user. If the patient has a co-morbidity of Ischemic Vascular Disease, there is documentation in the measurement period that the patient is on daily aspirin OR there is documentation of an accepted contraindication (any date). Page 2

3 Coding Conventions Used in MN Community Measurement Documentation MNCM uses the standard HEDIS coding conventions from HEDIS 2013, Comprehensive Diabetes Care. Unless otherwise noted, codes are stated to the minimum specificity required. For example, if a code is presented to the third digit, any valid fourth or fifth digits may be used. When necessary, a code may be specified with an x, which represents a required digit; for example, ICD-9-CM diagnosis code 640.0x indicates a fifth digit is required, but the fifth digit could be any number allowed by the coding manual. This coding convention is used to describe ranges of codes, please refer to the tables included for the complete list of codes. Diabetes Mellitus Codes Table 1: ICD-9 Diagnosis Codes for Identifying Diabetes Mellitus ICD-9 Diagnosis Code DMII WO CMP NT ST UNCNTR DMI WO CMP NT ST UNCNTRL DMII WO CMP UNCNTRLD DMI WO CMP UNCNTRLD DMII KETO NT ST UNCNTRLD DMI KETO NT ST UNCNTRLD DMII KETOACD UNCONTROLD DMI KETOACD UNCONTROLD DMII HPRSM NT ST UNCNTRL DMI HPRSM NT ST UNCNTRLD DMII HPROSMLR UNCONTROLD DMI HPROSMLR UNCONTROLD DMII O CM NT ST UNCNTRLD DMI O CM NT ST UNCNTRLD DMII OTH COMA UNCONTROLD DMI OTH COMA UNCONTROLD DMII RENL NT ST UNCNTRLD DMI RENL NT ST UNCNTRLD DMII RENAL UNCNTRLD DMI RENAL UNCNTRLD DMII OPHTH NT ST UNCNTRL DMI OPHTH NT ST UNCNTRLD DMII OPHTH UNCNTRLD DMI OPHTH UNCNTRLD DMII NEURO NT ST UNCNTRL Page 3

4 ICD-9 Diagnosis Code Optimal Diabetes Care Specifications DMI NEURO NT ST UNCNTRLD DMII NEURO UNCNTRLD DMI NEURO UNCNTRLD DMII CIRC NT ST UNCNTRLD DMI CIRC NT ST UNCNTRLD DMII CIRC UNCNTRLD DMI CIRC UNCNTRLD DMII OTH NT ST UNCNTRLD DMI OTH NT ST UNCNTRLD DMII OTH UNCNTRLD DMI OTH UNCNTRLD DMII UNSPF NT ST UNCNTRL DMI UNSPF NT ST UNCNTRLD DMII UNSPF UNCNTRLD DMI UNSPF UNCNTRLD Ischemic Vascular Disease Codes used to identify co-morbidity Table 2: ICD-9 Diagnosis Codes for Identifying Ischemic Vascular Disease ICD-9 Diagnosis Code AMI ANTEROLATERAL,UNSPEC AMI ANTEROLATERAL, INITIAL AMI ANTEROLATERAL,SUBSEQ AMI ANTERIOR WALL,UNSPEC AMI ANTERIOR WALL, INITIAL AMI ANTERIOR WALL,SUBSEQ AMI INFEROLATERAL,UNSPEC AMI INFEROLATERAL, INITIAL AMI INFEROLATERAL,SUBSEQ AMI INFEROPOST, UNSPEC AMI INFEROPOST, INITIAL AMI INFEROPOST, SUBSEQ AMI INFERIOR WALL,UNSPEC AMI INFERIOR WALL, INITIAL Page 4

5 ICD-9 Diagnosis Code Optimal Diabetes Care Specifications AMI INFERIOR WALL,SUBSEQ AMI LATERAL NEC, UNSPEC AMI LATERAL NEC, INITIAL AMI LATERAL NEC, SUBSEQ TRUE POST INFARCT,UNSPEC TRUE POST INFARCT, INITIAL TRUE POST INFARCT,SUBSEQ SUBENDO INFARCT, UNSPEC SUBENDO INFARCT, INITIAL SUBENDO INFARCT, SUBSEQ AMI NEC, UNSPECIFIED AMI NEC, INITIAL AMI NEC, SUBSEQUENT AMI NOS, UNSPECIFIED AMI NOS, INITIAL AMI NOS, SUBSEQUENT POST MI SYNDROME INTERMED CORONARY SYND ACUTE COR OCCLSN W/O MI AC ISCHEMIC HRT DIS NEC 412 OLD MYOCARDIAL INFARCT ANGINA DECUBITUS PRINZMETAL ANGINA ANGINA PECTORIS NEC/NOS COR ATH UNSP VSL NTV/GFT CRNRY ATHRSCL NATVE VSSL CRN ATH ATLG VN BPS GRFT CRN ATH NONATLG BLG GRFT COR ATH ARTRY BYPAS GRFT COR ATH BYPASS GRAFT NOS COR ATH NATV ART TP HRT COR ATH BPS GRAFT TP HRT CHR TOT OCCLUS COR ARTRY Page 5

6 ICD-9 Diagnosis Code Optimal Diabetes Care Specifications COR ATH DUE TO LIPID RICH PLAQUE CHR ISCHEMIC HRT DIS NEC CHR ISCHEMIC HRT DIS NOS ASCVD OCL BSLR ART WO INFRCT OCL BSLR ART W INFRCT OCL CRTD ART WO INFRCT OCL CRTD ART W INFRCT OCL VRTB ART WO INFRCT OCL VRTB ART W INFRCT OCL MLT BI ART WO INFRCT OCL MLT BI ART W INFRCT OCL SPCF ART WO INFRCT OCL SPCF ART W INFRCT OCL ART NOS WO INFRCT OCL ART NOS W INFRCT CRBL THRMBS WO INFRCT CRBL THRMBS W INFRCT CRBL EMBLSM WO INFRCT CRBL EMBLSM W INFRCT CRBL ART OC NOS WO INFRC CRBL ART OCL NOS W INFRC ATHERSCLEROSIS OF AORTA RENAL ARTERY ATHEROSCLER ATHSCL EXTRM NTV ART NOS ATH EXT NTV AT W CLAUDCT ATH EXT NTV AT W RST PN ATH EXT NTV ART ULCRTION ATH EXT NTV ART GNGRENE ATHRSC EXTRM NTV ART OTH CHR TOT OCCL ART EXTREM ABD AORTIC EMBOLISM SADDLE EMBOLUS OF ABDOMINAL AORTA Page 6

7 ICD-9 Diagnosis Code OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA THORACIC AORTIC EMBOLISM UPPER EXTREMITY EMBOLISM LOWER EXTREMITY EMBOLISM ILIAC ARTERY EMBOLISM ARTERIAL EMBOLISM NEC ARTERIAL EMBOLISM NOS ATHEROEMBOLISM,UPPER EXT ATHEROEMBOLISM,LOWER EXT ATHEROEMBOLISM, KIDNEY ATHEROEMBOLISM, SITE NEC Codes used to identify patients who meet exclusion criteria Table 3: ICD-9 Diagnosis Codes for Identifying Pregnancy for Patients with Diabetes Mellitus ICD-9 Diagnosis Code DM of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable DM of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition DM of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication DM of mother, complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication DM of mother, complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication Page 7