Measure focus: Eye exam for patients with diabetes

The percentage of members ages 18-75 with diabetes (type 1 and type 2) who had a retinal

eye exam.

How does a member fall into the denominator?

Members are identified as diabetic by both claims/encounter data as well as pharmacy data. Any code for an acute inpatient encounter for diabetes, or two outpatient encounters for diabetes, will pull the member into this measure. Pharmacy claims for insulin/antihyperglycemics will also place the member into this measure.

What closes the gap:

CPT Category II codes to identify diabetic retinal screening with an eye care professional:

• 2022F – Dilated retinal eye exam with interpretation by an ophthalmologist or

optometrist documented and reviewed; with evidence of retinopathy

• 2023F – Dilated retinal eye exam with interpretation by an ophthalmologist or

optometrist documented and reviewed; without evidence of retinopathy

• 2024F – Seven standard field stereoscopic retinal photos with interpretation by an

ophthalmologist or optometrist documented and reviewed; with evidence of

retinopathy

• 2025F – Seven standard field stereoscopic retinal photos with interpretation by an

ophthalmologist or optometrist documented and reviewed; without evidence of

retinopathy

• 2026F – Eye imaging validated to match diagnosis from seven standard field

stereoscopic retinal photos; results documented and reviewed; with evidence of

retinopathy

• 2033F – Eye imaging validated to match diagnosis from seven standard field

stereoscopic retinal photos; results documented and reviewed; without evidence of

retinopathy

Note: CPT Category II codes for retinal eye exam results must be submitted with the

date of service of the eye exam.

CPT Category II codes to identify diabetic retinal screenings negative for retinopathy:

• 3072F – Low risk for retinopathy (no evidence of retinopathy in the prior year)

Note: 3072F should be used for a date of service in 2023 for an eye exam result that

occurred in 2022.

Tips for discussing this test with members:

• Remind members that a comprehensive retinal eye exam should be a routine part of their eye care.
• Remind members to mention to their eye care professional that they are diabetic.

For more information on PQIP 2023, or to connect with a BCBSRI Quality Concierge Nurse to enhance your practice’s quality processes, please reach out to QualityHEDIS@bcbsri.org. 

Please refer to your 2023 PQIP Booklet for additional information. Please do not hesitate to reach out to your Quality Representative with any questions at QualityHEDIS@bcbsri.org.