25 medical records of patients with diabetes should be reviewed. Refer the seriously uncontrolled to a specialist or diabetes nurse …
Instructions for the Diabetes Physician Audit Tool
Step 1:Choose and pull the records
25 medical records of patients with diabetes should be reviewed The records will be chosen from a random sampling of all patients with a diagnosis of diabetes ICD9 code 250, 3572, 3620, 36641, 6480 between the ages of 18-75 To obtain this sample, use a claim computer system query that includes all patients with the above age and diagnostic codes Then, take the entire number, divide by 25 and take that interval for the sample frequency to pull the records Do not use patients with late-stage renal disease Example: If 100 patients show up on the computer report as having any of the above ICD9s, divide 100 by 25 4 Take every fourth name for the audit
Step 2: HbA1c — two components
For any time in the past six months, find if HbA1c also known as A1c was done If it was done, put a check in the yes column column 2 Then record the actual results in column 4 if 70 or less and column 5 if more than 70 If it the HbA1c was not done, put checks in both the no column column 3 and More than 70 column under HbA1c result column 5 You may find the value under any of the following names: look for the HgA1c,
HgbA1c, glycated hemoglobin, glycosylated hemoglobin, A1c, glycohemoglobin A1c, or hemoglobin A1c The CPT code for this test is 83036 Typically you will see a note that the HbA1c is certified as traceable to the DCCT standard
Step 3: Eye Exam by an Eye Professional
Look in the chart for a consult note or a physician note that states that an ophthalmologist or optometrist did an eye exam within the past 24 months If an eye exam was done, place a check in the yes column column 6 If no evidence of an eye exam by an ophthalmologist or optometrist is noted, place a check in the no column column 7 Note: This does not follow HEDIS exactly, but closely parallels the recommendations
Step 4: LDL-C
For any time in the past 24 months, find the result of the LDL-Cholesterol in the medical record Record the LDL-C result in either column 8 if less than 100 mg/dL or in column 9 if 100 mg/dL or more If no result is available place a check in column 9
Step 5: Monitoring for Diabetic Nephropathy
For any time in the past 24 months, determine if a urine test for microalbuminemia was performed The CPT codes for these tests are: 82042, 82043, 82044 These include the 24 hour test, timed test, and spot
urine for microalbuminemia If done, place a check in the yes column column 10 If not done, place a check in the no column column 11 You may find the elements noted above in the following areas: medical record: problem lists, office note, SOAP note, encounter form, telephone call record, diagnostic report, hospital discharge summary
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Diabetes Physician Audit Tool Worksheet
Date of audit: ____________ Name of Person Performing Audit: _____________________
Patient ID do not include names
Was a HbA1c A1c done?
Yes No
Column 3
HbA1c A1c result
70 or less
Column 4 More than 70 or not done Column 5
Was an eye exam done in last 24 months?
Yes
Column 6
LDL-C result
100 or Less
Column 8 More than 100 or not done Column 9
Tested for
microalbuminemia
Yes
Column 10
No
Column 7
No
Column 11
Column 1
Column 2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Total Checked Total checked Total checked Total Checked Total checked
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Column 7
Column 8
Column 9
Column 10
Column 11
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Your Diabetes Management results are calculated using the following formulas: HEDIS measure
HbA1c tested rate result
from column 2 X 100 25
100 Your Result Goal 100
HbA1c controlled rate result from column 4 X 100 25
100
Eye exam rate result from column 6 X 100 25
100
LDL-C controlled rate result from column 8 X 100 25
100
Microalbuminemia screening rate result from column 10 X 100 25
I certify that I followed the instructions on the attached pages and that the results are accurate:
Signature: _____________________________ Date: ______________
If you did not do as well as you wished, consider some of the following interventions: Verify the diagnosis Start a call-back program to get the members not controlled into the office Changing the drugs of patients not controlled Sending out educational material to members Improved tracking ie computerized of patients with diabetes Asking every patient with diabetes to view a video Developing a nurse diabetes management program Pill counts, or prescription verification of patients not controlled Refer the seriously uncontrolled to a specialist or diabetes nurse
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Source:namcp.com
