Ensure that patients with diabetes have regular screenings for eye and kidney disease

Patients with diabetes require consistent medical care and monitoring to reduce the risk of complications and improve outcomes. Clinical interventions go far beyond glycemic control.

That’s why we were surprised to see the results of a recent analysis of clinical data on Blue Cross Blue Shield of Michigan members with diabetes:

• Thirty percent of diabetic Medicare Advantage PPO members didn’t receive an eye exam in 2015.
• Fifteen percent diabetic Medicare Advantage PPO members didn’t have nephropathy screening in 2015.

As you know, annual screening for eye disease can prevent or delay blindness. And urine microalbumin screens for early renal failure in patients with diabetes and hypertension can identify renal disease several years before it becomes significant enough to cause symptoms and affect management decisions.

What do providers need to do?
Providers should ensure that all diabetic patients have annual screenings for eye and kidney diseases to prevent or delay blindness and end-stage renal disease.

Retinal eye exam
Encourage diabetic patients to get annual eye exams. Ensure that they are referred to an eye care professional (optometrist or ophthalmologist) and let them know you need to receive a copy of the eye exam report. Follow up with the patient at every visit until you receive it.

Nephropathy screening and treatment
The National Kidney Foundation recommends annual microalbumin screening for diabetic patients. When you order an A1c test or other lab tests for your patients, make sure you include a urine microalbumin test.

A visit with a nephrologist or a prescription for an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy counts as treatment for nephropathy.

Use correct procedure codes when billing
Not all Blue Cross Medicare Advantage PPO members have Blue Cross pharmacy coverage so evidence of treatment with ACE or ARB medications isn’t always available to us. If your diabetic patient is taking an ACE inhibitor or ARB, be sure to include procedure code *4010F on their office visit claims.

If your patient is being treated for renal disease or has been treated by a nephrologist, include procedure code *3066F on their office visit claims. See chart below.

Did you know?... Individuals with diabetes have a two times higher risk of depression than those without diabetes. According to Richard L. Kravitz, M.D., professor of research at the University of California, Davis, “Diabetic patients with depression have more diabetic complications, more adverse long-term outcomes, and don’t engage as actively in self care.”