What to know
- 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
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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
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Retinal detachment repair
Retinal detachment repair procedures are identified among patients with diagnosed DR based on the procedure listed below.
- Included Procedures - Repair of retinal detachment; with vitrectomy, any method
- Procedure Codes - 67108
- Included Procedures - Repair of complex retinal detachment (micropulse/retinex)
- Procedure Codes - 67113
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Vitrectomy
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