HEDIS® Tip Sheet

Kidney Health Evaluation for Patients With Diabetes (KED)

Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)

Measure Description

Percentage of members 18–85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.

Compliance

Members who received both an eGFR and a uACR during the measurement year.  These tests can be performed on the same or different dates of service.

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Notes

  • A uACR can be identified by either of the following:
    • Both a quantitative urine albumin test and a urine creatinine test with services dates no more than four days apart.
    • A uACR lab test.
  • Members with diabetes are identified by claims/encounter data and by pharmacy data.
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Best Practices

  • Use each office visit as a time to review services needed.
  • Prepare for office visits by ordering labs ahead of time.
  • Provide patient education about the importance of regular kidney health screenings.
  • Inform patients of the North Dakota Diabetes Prevention and Control Program resource.
  • Consider referral to diabetic educator or nutritionist. 
  • Care coordination with other providers caring for the patient.
  • 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.
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Exclusions

  • Members diagnosed with End-Stage Renal Disease (ESRD) any time in the member’s history.
  • Members who have had dialysis anytime in the member’s history.
  • Members in hospice during the measurement year.
  • Members receiving palliative care or who had an encounter for palliative care during the measurement year.
  • Members who die any time during the measurement period.
  • Members 66-80 years of age as of December 31st of the measurement year with frailty and advanced illness.
  • Note: Members must meet BOTH the frailty and advanced illness criteria to be excluded:
    • 1. Frailty: At least two indicators of frailty with different dates of service during the measurement year.
    • 2. Advanced Illness: Either of the following during the measurement year or the year prior to the measurement year:
      • Diagnosis of advanced illness on at least two different dates of service. 
      • A dispensed dementia medication including Cholinesterase inhibitors (Donepezil, Galantamine, Rivastigmine), memantine, and Donepezil-memantine.
  • Members 81+ years of age as of December 31st of the measurement year with at least two indications of frailty on different dates of service during the measurement year. 

Estimated Glomerular Filtration Rate Lab Test Codes: 



Quantitative Urine Albumin Lab Test Codes:



Urine Creatinine Lab Test Codes:



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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