Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
Description
Composite (“optimal” care) measure of the percentage of adult patients who
have type 1 or type 2 diabetes with optimally managed modifiable risk factors.
Methodology
Population identification is accomplished via a query of a practice management
system or electronic medical record (EMR) to identify the population of eligible
patients (denominator). Data elements are either extracted from an EMR system
or abstracted through medical record review. Clinics that had an EMR in place
by 01/01/2012 are required to submit data on their full population.
Rationale
According to the Minnesota Department of Health, diabetes is a high impact
clinical condition in Minnesota. More than one in three adults and one in six
youth in Minnesota have diabetes or are at high risk of developing it. Each year
more than 20,000 Minnesotans are newly diagnosed with diabetes. Diabetes is
the sixth leading cause of death in Minnesota and is a significant risk factor in
developing cardiovascular disease and stroke, non-traumatic lower extremity
amputations, blindness, and end-stage renal disease. Diabetes costs Minnesota
almost $2.7 billion annually, including medical care, lost productivity and
premature mortality. According to the American Diabetes Association, an
estimated 23.6 million American children and adults have diabetes. Most people
with diabetes have other risk factors, such as high blood pressure and
cholesterol that increase the risk for heart disease and stroke. In fact, more than
65% of people with diabetes die from these complications.
Measurement
Period
Measurement period will be a fixed 12-month period: 01/01/2013 to 12/31/2013.
Denominator
Established patient who meets each of the following criteria is included in the
population:
 Patient was age 18 to 75 at the start of the measurement period (date of
birth was on or between 01/01/1938 to 01/01/1995).
 Patient was seen by an eligible provider in an eligible specialty face-toface at least two times during the last two measurement periods
(01/01/2012 to 12/31/2013) with visits coded with a diabetes mellitus
ICD-9 diagnosis code (in any position, not only primary). Use this date of
service range when querying the practice management or EMR system to
allow a count of the visits within the measurement period.
 Patient was seen by an eligible provider in an eligible specialty face-toface at least one time during the measurement period (01/01/2013 to
12/31/2013) for any reason. This may or may not include one of the faceto-face diabetes visits.
 Diagnosis of Diabetes mellitus; ICD-9 diagnosis codes include: 250.00250.93. See Table 1.
Eligible specialties: Family Medicine, General Practice, Internal Medicine,
Geriatric Medicine, Endocrinology
Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician
Assistant (PA), Nurse Practitioner (NP)
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)

Allowable
Exclusions




Numerator
Patient was a permanent nursing home resident during the measurement
period.
Patient was in hospice at any time during the measurement period.
Patient died prior to the end of the measurement period.
Patient was pregnant during measurement period (ICD-9 diagnosis
codes: 648.00-648.04). See Table 3.
Documentation that diagnosis was coded in error.
The number of diabetes patients who met ALL of the following targets:
 The most recent HbA1c in the measurement period has a value <8.0.
 The most recent LDL test in the measurement period has a value <100.
 The most recent Blood Pressure in the measurement period has a
systolic value of <140 and a diastolic value of <90 (both values must be
less than).
 There is documentation in the chart that the patient is currently a nontobacco user.
 If the patient has a co-morbidity of Ischemic Vascular Disease, there is
documentation in the measurement period that the patient is on daily
aspirin OR there is documentation of an accepted contraindication (any
date). Diagnosis of Ischemic Vascular Disease; ICD-9 diagnosis codes
include: 410.00-410.92, 411.0-411.89, 412, 413.0-413.9, 414.00-414.07,
414.2, 414.3, 414.8, 414.9, 429.2, 433.00-433.91, 434.00-434.91, 440.1,
440.20- 440.29, 440.4, 444.01-444.9, 445.01-445.89. See Table 2.
Diabetes Mellitus Codes
Table 1: ICD-9 Diagnosis Codes for Identifying Diabetes Mellitus
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
250.00
DMII WO CMP NT ST UNCNTR
250.01
DMI WO CMP NT ST UNCNTRL
250.02
DMII WO CMP UNCNTRLD
250.03
DMI WO CMP UNCNTRLD
250.10
DMII KETO NT ST UNCNTRLD
250.11
DMI KETO NT ST UNCNTRLD
250.12
DMII KETOACD UNCONTROLD
250.13
DMI KETOACD UNCONTROLD
250.20
DMII HPRSM NT ST UNCNTRL
250.21
DMI HPRSM NT ST UNCNTRLD
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
250.22
DMII HPROSMLR UNCONTROLD
250.23
DMI HPROSMLR UNCONTROLD
250.30
DMII O CM NT ST UNCNTRLD
250.31
DMI O CM NT ST UNCNTRLD
250.32
DMII OTH COMA UNCONTROLD
250.33
DMI OTH COMA UNCONTROLD
250.40
DMII RENL NT ST UNCNTRLD
250.41
DMI RENL NT ST UNCNTRLD
250.42
DMII RENAL UNCNTRLD
250.43
DMI RENAL UNCNTRLD
250.50
DMII OPHTH NT ST UNCNTRL
250.51
DMI OPHTH NT ST UNCNTRLD
250.52
DMII OPHTH UNCNTRLD
250.53
DMI OPHTH UNCNTRLD
250.60
DMII NEURO NT ST UNCNTRL
250.61
DMI NEURO NT ST UNCNTRLD
250.62
DMII NEURO UNCNTRLD
250.63
DMI NEURO UNCNTRLD
250.70
DMII CIRC NT ST UNCNTRLD
250.71
DMI CIRC NT ST UNCNTRLD
250.72
DMII CIRC UNCNTRLD
250.73
DMI CIRC UNCNTRLD
250.80
DMII OTH NT ST UNCNTRLD
250.81
DMI OTH NT ST UNCNTRLD
250.82
DMII OTH UNCNTRLD
250.83
DMI OTH UNCNTRLD
250.90
DMII UNSPF NT ST UNCNTRL
250.91
DMI UNSPF NT ST UNCNTRLD
250.92
DMII UNSPF UNCNTRLD
250.93
DMI UNSPF UNCNTRLD
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
Ischemic Vascular Disease Codes
Table 2: ICD-9 Diagnosis Codes for Identifying Ischemic Vascular Disease
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
410.00
AMI ANTEROLATERAL,UNSPEC
410.01
AMI ANTEROLATERAL, INITIAL
410.02
AMI ANTEROLATERAL,SUBSEQ
410.10
AMI ANTERIOR WALL,UNSPEC
410.11
AMI ANTERIOR WALL, INITIAL
410.12
AMI ANTERIOR WALL,SUBSEQ
410.20
AMI INFEROLATERAL,UNSPEC
410.21
AMI INFEROLATERAL, INITIAL
410.22
AMI INFEROLATERAL,SUBSEQ
410.30
AMI INFEROPOST, UNSPEC
410.31
AMI INFEROPOST, INITIAL
410.32
AMI INFEROPOST, SUBSEQ
410.40
AMI INFERIOR WALL,UNSPEC
410.41
AMI INFERIOR WALL, INITIAL
410.42
AMI INFERIOR WALL,SUBSEQ
410.50
AMI LATERAL NEC, UNSPEC
410.51
AMI LATERAL NEC, INITIAL
410.52
AMI LATERAL NEC, SUBSEQ
410.60
TRUE POST INFARCT,UNSPEC
410.61
TRUE POST INFARCT, INITIAL
410.62
TRUE POST INFARCT,SUBSEQ
410.70
SUBENDO INFARCT, UNSPEC
410.71
SUBENDO INFARCT, INITIAL
410.72
SUBENDO INFARCT, SUBSEQ
410.80
AMI NEC, UNSPECIFIED
410.81
AMI NEC, INITIAL
410.82
AMI NEC, SUBSEQUENT
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
410.90
AMI NOS, UNSPECIFIED
410.91
AMI NOS, INITIAL
410.92
AMI NOS, SUBSEQUENT
411.0
POST MI SYNDROME
411.1
INTERMED CORONARY SYND
411.81
ACUTE COR OCCLSN W/O MI
411.89
AC ISCHEMIC HRT DIS NEC
412
OLD MYOCARDIAL INFARCT
413.0
ANGINA DECUBITUS
413.1
PRINZMETAL ANGINA
413.9
ANGINA PECTORIS NEC/NOS
414.00
COR ATH UNSP VSL NTV/GFT
414.01
CRNRY ATHRSCL NATVE VSSL
414.02
CRN ATH ATLG VN BPS GRFT
414.03
CRN ATH NONATLG BLG GRFT
414.04
COR ATH ARTRY BYPAS GRFT
414.05
COR ATH BYPASS GRAFT NOS
414.06
COR ATH NATV ART TP HRT
414.07
COR ATH BPS GRAFT TP HRT
414.2
CHR TOT OCCLUS COR ARTRY
414.3
COR ATH DUE TO LIPID RICH PLAQUE
414.8
CHR ISCHEMIC HRT DIS NEC
414.9
CHR ISCHEMIC HRT DIS NOS
429.2
ASCVD
433.00
OCL BSLR ART WO INFRCT
433.01
OCL BSLR ART W INFRCT
433.10
OCL CRTD ART WO INFRCT
433.11
OCL CRTD ART W INFRCT
433.20
OCL VRTB ART WO INFRCT
433.21
OCL VRTB ART W INFRCT
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
433.30
OCL MLT BI ART WO INFRCT
433.31
OCL MLT BI ART W INFRCT
433.80
OCL SPCF ART WO INFRCT
433.81
OCL SPCF ART W INFRCT
433.90
OCL ART NOS WO INFRCT
433.91
OCL ART NOS W INFRCT
434.00
CRBL THRMBS WO INFRCT
434.01
CRBL THRMBS W INFRCT
434.10
CRBL EMBLSM WO INFRCT
434.11
CRBL EMBLSM W INFRCT
434.90
CRBL ART OC NOS WO INFRC
434.91
CRBL ART OCL NOS W INFRC
440.1
RENAL ARTERY ATHEROSCLER
440.20
ATHSCL EXTRM NTV ART NOS
440.21
ATH EXT NTV AT W CLAUDCT
440.22
ATH EXT NTV AT W RST PN
440.23
ATH EXT NTV ART ULCRTION
440.24
ATH EXT NTV ART GNGRENE
440.29
ATHRSC EXTRM NTV ART OTH
440.4
CHR TOT OCCL ART EXTREM
444.01
SADDLE EMBOLUS OF ABD AORTA
444.09
OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABD AORTA
444.1
THORACIC AORTIC EMBOLISM
444.21
UPPER EXTREMITY EMBOLISM
444.22
LOWER EXTREMITY EMBOLISM
444.81
ILIAC ARTERY EMBOLISM
444.89
ARTERIAL EMBOLISM NEC
444.9
ARTERIAL EMBOLISM NOS
445.01
ATHEROEMBOLISM,UPPER EXT
445.02
ATHEROEMBOLISM,LOWER EXT
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Optimal Diabetes Care Specifications
2014 (01/01/2013 to 12/31/2013 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
445.81
ATHEROEMBOLISM, KIDNEY
445.89
ATHEROEMBOLISM, SITE NEC
Codes Used to Identify Patients who Meet Exclusion Criteria
Table 3: ICD-9 Diagnosis Codes for Identifying Pregnancy for Patients with Diabetes Mellitus
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
648.00
DM of mother, complicating pregnancy, childbirth, or the puerperium,
unspecified as to episode of care or not applicable
648.01
DM of mother, complicating pregnancy, childbirth, or the puerperium, delivered,
with or without mention of antepartum condition
648.02
DM of mother, complicating pregnancy, childbirth, or the puerperium, delivered,
with mention of postpartum complication
648.03
DM of mother, complicating pregnancy, childbirth, or the puerperium,
antepartum condition or complication
648.04
DM of mother, complicating pregnancy, childbirth, or the puerperium,
postpartum condition or complication
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