Diabetes Care Lipid Profile with LDL

(Source: NCQA) - Percentage of adult patients with diabetes aged 18-75 years receiving at least one lipid profile (or
ALL component tests)

Denominator Patients aged 18 75 years at the beginning of the measurement time period who had a
diagnosis of diabetes (type 1 or type 2).

Patients who had two face- to-face encounters with different dates of service in an outpatient
setting during the measurement year.

Codes to Identify Diabetes

Description ICD-9-CM Diagnosis
Diabetes 250, 357.2, 362.0, 366.41, 648.0

Codes to Identify Visit Type

Description CPT4
Outpatient 92002-92014, 99201-99205, 99211-99215,
99217-99220, 99241-99245, 99341-99345,
99347-99350, 99384-99387, 99394-99397,
99401-99404, 99411, 99412, 99420, 99429,
99455, 99456, 99499

Numerator A complete lipid profile performed during the measurement year, as identified by
claim/encounter or automated laboratory data. See associated code table.
Identify the most recent visit to the doctors office or clinic that occurred during the
measurement year in which a full lipid profile was documented.

The full profile test or each component of the profile (total cholesterol, HDL-C, triglycerides,
and LDL-C) must be noted with the date of the laboratory test and results.

Table: Codes to Identify Lipid Profile

Description CPT4* CPT* Category II LOINC**
Lipid panel 80061 3011F 24331-1
Total Cholesterol 2093-3, 14647-2
High density lipoprotein (HDL) 2085-9, 14646-4, 18263-4
Triglycerides 2571-8, 12951-0, 14927-8, 47210-0

Exclusion Exclude patients with a diagnosis of polycystic ovaries, gestational diabetes or steroid induced
diabetes.

Diagnosis of polycystic ovaries, gestational diabetes or steroid induced diabetes can occur at
any time in the patients history, but must have occurred during the measurement year.

Codes to Identify Exclusions

Description ICD-9-CM Diagnosis
Polycystic ovaries 256.4
Steroid induced 251.8, 962.0
Gestational diabetes 648.8