Diabetic Retinopathy (DR) Treatment
Receipt of Services
VEHSS reports the percentage of people with diagnosed diabetic retinopathy (DR) who had a treatment claim in administrative claims databases and medical record information in the IRIS Registry of electronic health records. VEHSS reports the percent of diagnosed DR patients who received at least one included treatment during the year of observation. Therefore, all prevalence estimates are based on a denominator of DR patients who had a visit that included a DR diagnosis.
Anti-VEGF Injection
Anti-vascular endothelial growth factor (anti-VEGF) injections are identified based on the procedure, diagnosis, and National Drug Codes (NDC) listed below.
| Included Procedures | Procedure Codes |
|---|---|
| Injection, aflibercept | J0178, J9400 |
| Injection, ranibizumab | J2778 |
| Injection, bevacizumab, unclassified injectable, or compounded drug | J9035, J3490, J3590, J7999, C9257, C9142, Q5107, or Q9977 AND claim has primary diagnosis of DR or includes 67028 |
| Intravitreal injection of pharmacologic agent | 67028 with anti-VEGF NDC (61755-005-02, 61755-005-55, 50242-080-02, 50242-0080-02, 50242-080-03, 50242-0080-03, 50242-060-01, 50242-060-10 |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims. See data source documentation.
Laser Surgery or Photocoagulation
Laser/photocoagulation therapy procedures are identified among patients with diagnosed DR based on the procedure codes listed below.
| Included Procedures | Procedure Codes |
|---|---|
| Repair procedures on the retina or choroid | 67105 |
| Prophylaxis procedures on the retina or choroid | 67145 |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; cryotherapy, diathermy | 67208 |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; photocoagulation | 67210 |
| Destruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source) | 67218 |
| Destruction of localized lesion of choroid (e.g., choroidal neovascularization), photocoagulation, 1 or more sessions | 67220 |
| Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), cryotherapy, diathermy | 67227 |
| Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation | 67228 |
| Treatment of extensive or progressive retinopathy, 1 or more sessions, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (e.g., retinopathy of prematurity), photocoagulation or cryotherapy | 67229 |
| Unlisted procedures on the retina | 67299 |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims. See data source documentation.
Retinal detachment repair procedures are identified among patients with diagnosed DR based on the procedure listed below.
| Included Procedures | Procedure Codes |
|---|---|
| Repair of retinal detachment; with vitrectomy, any method | 67108 |
| Repair of complex retinal detachment (micropulse/retinex) | 67113 |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims. See data source documentation.
Vitrectomy procedures are identified among patients with diagnosed DR based on the procedure listed below.
| Included Procedures | Procedure Codes |
|---|---|
| Vitrectomy, mechanical, pars plana approach | 67036 |
| Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation | 67039 |
| Vitreous procedures on the posterior segment of the eye | 67040 |
| Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g., macular pucker) | 67041 |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims. See data source documentation.