Summary
BCBSRI has released updated guidance on HEDIS quality measures for ophthalmology practices, specifically focusing on the Comprehensive Diabetes Care measure that requires retinal eye exams. The policy clarifies specific CPT Category II codes that can be used to document diabetic eye exams and emphasizes the importance of proper claims submission to validate HEDIS measures.
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What to do
Action · 3 steps
01Billing team should ensure ophthalmology practices are using the correct CPT Category II codes (2022F, 2024F, 2026F, 3072F) when documenting diabetic retinal exams.
02Verify that claims include appropriate diabetes ICD-10 codes paired with eye exam codes (920xx) or E&M codes (992xx) to support HEDIS quality measure reporting.
03Contact Quality Concierge Team at QualityHEDIS@bcbsri.org or (401) 459-1005 for questions about gap closure reporting.
Codes mentioned
8303683037
Original notice
Hints for HEDIS® (and more)
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Policy updatesMediumEffective Oct 1, 2023 · Physician / FacilityHints for HEDIS® (and more)LowEffective Jan 1, 2019 · PhysicianHints for HEDIS® (and more)MediumEffective Feb 1, 2019 · PhysicianHints for HEDIS® (and more)MediumEffective Apr 1, 2019 · PhysicianBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list