I'm working with some USA medical claims data and was asked for a gaps in care report for members of the population with diabetes. The total population is around a million people, with tens of millions of claims. One of the gaps in care measures mentioned was "did the beneficiary have a foot exam in the past year?"
How do I identify diabetic foot exams/LOPS exams using claims data, CPT/ICD-10 codes, etc.? Is there a standard way of doing so in claims data? (I know it won't be perfect, but claims data never is)
Here's what I tried.
- In the HEDIS Comprehensive Diabetic Care guidelines, foot exams aren't listed.
- I found a reference that said to use the HCPCS/CPT codes G0245, G0246, and G0247. Unfortunately, none of the claims in my data have these codes, even though there are clearly diabetic beneficiaries in the data (they've filled relevant prescriptions, bought insulin pumps, had regular A1C screenings, etc.)
- I've found references to CPT II codes, like 2028F, but my claims data don't have those.
- There are MIPS guidelines that refer to G8404 and G2179, but barely any of those show up in the data either. Ditto for G9226.