Glycemic Status Assessment for Patient with Diabetes (GSD)
Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)
Measure Description
Percentage of Members 18-75 years of age with diabetes (DM), types 1 and 2, whose hemoglobin A1C (HbA1c) fell into these levels during the current year:
- HbA1c controlled at <8.0%
- HbA1c poorly controlled at >9.0%
Compliance:
HbA1c Controlled
- Member has a HbA1c of <8.0% within the current year.
- Member is not compliant if the most recent HbA1c is ≥ 8.0%.
HbA1c Poorly Controlled
- Member has a HbA1c of >9.0% within the current year.
- The member is numerator compliant if their HbA1c is >9.0%.
Medical Records should include
- A note indicating the date when the HbA1c test was performed and the result.
- Ranges and thresholds do not meet criteria. There must be a numeric value.
Notes
- The most recent HbA1c test during the measurement year is used.
- The HbA1c Poor Control rate is part of the BlueAlliance and BlueAlliance Care+ Program.
- This measure requires a lab value. If a HbA1c result is missing or it was not completed during the measurement year, the member is numerator compliant for HbA1c Poor Control.
- A lower rate for HbA1c Poor Control indicates better performance.
Best Practices
- Inform patients of the North Dakota Diabetes Prevention and Control Program resource[TS1] .
- Ensure HbA1c and other labs are ordered prior to patient appointments.
- Consider referral to diabetic educator or nutritionist.
- Educate patients on the importance of their annual diabetic eye exam, completing lab work and screenings.
- Evaluate and document HbA1c every three to six months.
- Outreach to patients with sub-optimal HbA1c.
- Remind patients to bring logbooks or glucose monitors to their appointment.
- Care coordination with other providers caring for the patient.
- Ensure patient understands education materials with new onset diabetes.
- Set up a tracking mechanism within your healthcare system to identify gaps in care. Utilize EHR flags and reporting to assist in tracking patients in need of follow-up visits and those who cancel or do not show up for appointments so appropriate outreach can be made.
Exclusions
- Members who do not have diagnosis of diabetes and who had a diagnosis of polycystic ovarian syndrome, gestational diabetes, or steroid-induced diabetes.
- Members in hospice during the measurement year.
- Members who received palliative care during the measurement year.
- Members who died during the measurement year.
- Members 66+ years of age with frailty and advanced illness. Members must meet BOTH the frailty and advanced illness criteria to be excluded:
- At least two indicators of frailty with different dates of service during the measurement period.
- Any of the following during the measurement year or the year prior to the measurement year:
- At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
- At least one acute inpatient encounter with an advanced illness diagnosis.
- At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
- A dispensed dementia medication.
CPT® Code HbA1c Lab Test: 83036
HbA1c CPT® Category II Codes:
HbA1c ≥ 7.0 and < 8.0 | 3051F |
HbA1c <7.0: | 3044F |
HbA1c > 9.0 | 3046F |
HbA1c ≥ 8.0 and ≤ 9.0 | 3052F |
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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