HEDIS® Tip Sheet

Eye Exam for Patients with Diabetes (EED)

Line of business: Commercial and Medicaid Expansion

Measure Description

Members 18–75 years of age with diabetes (types 1 or 2) who had a retinal eye exam.

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Notes

  • This measure applies to members ages 18-75 years as of December 31st of the measurement year.
  • Includes members identified as having diabetes in the measurement year or the year prior to the measurement year.
  • Blindness is not an exclusion for a diabetic eye exam. 

Measure Compliance (numerator):

  • A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist)
    • Negative retinal or dilated eye exam during the measurement year or the year before.
    • Positive retinal or dilated eye exam during the measurement year (must be done annually).
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Best Practices

  • Encourage patients to engage in Primary Care. Review diabetic services needed at each office visit.
  • Patients with retinopathy need an annual retinal eye exam, while patients without signs of retinopathy need a retinal eye exam every two years. These exams must be performed by an eye care professional.
  • Required documentation includes the date of service, eye exam results, and the eye care professional’s name and credentials.
  • Educate patients and their families or caregivers about the importance of routine screenings and medication compliance.
  • Utilize reminders in the patient’s EMR to alert staff of when patients’ screenings are due.
  • Promote utilization of patient portal if your facility provides it (i.e., MyChart).
  • Remind patients of upcoming appointments by making phone calls, sending text messages or utilizing patient portal messaging.
  • Review and follow up on lab test results, eye exam results, and any specialist referral.
  • Refer patients to an optometrist or ophthalmologist for a dilated or retinal eye exam and explain why this is different from a routine eye exam. 
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Exclusions

  • Bilateral absence of eyes at any time in the member’s history.
  • Bilateral eye enucleation at any time in the member's history.
  • Members who used palliative care or had a palliative care encounter during the measurement year.
  • Members in hospice during the measurement year.
  • Member who died during the measurement year.
  • Members ages 66+ as of December 31 of the measurement year with frailty and advanced illness. Must meet both criteria:
    • Frailty: at least two frailty indicators from different dates during the measurement year.
    • Advanced Illness: either two advanced illness diagnoses on different dates (current or prior year) -or- dispensed dementia medication.

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.

Questions  

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

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Updated 7/16/2025