Case Definitions:?Diabetic Retinopathy (DR) Treatment

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.
eyeball showing treatment of diabetic retinopathy

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

Aflibercept (Eylea®)

Any of (J0177, J0178, C9161) or J9400 with primary diagnosis of DR or CPT 67028 on same claim

Brolucizumab

J0179

Bevacizumab (Mvasi®, Zirabev®, Alymsys®)

Any of (C9257, J9035, Q5107, Q5118, C9142, Q5126 ) with primary diagnosis of DR or CPT 67028 on same claim

Faricimab (Vabysmo®)

J2777

Pegaptanib sodium (Macugen®)

J2503

Ranibizumab (Lucentis®, Susvimo®, Byooviz®)

Any of (J2778, J2779, C9093, Q5124) or Q5128 with primary diagnosis of DR or CPT 67028 on same claim

Unclassified injectable or compounded drug

Any of (J3490, J3590, J7999, Q9977) with primary diagnosis of DR or CPT 67028 on same claim

Explore Data in the VEHSS Application

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims.

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

Laser surgery or photocoagulation

67210, 67220, 67228, 67229

Explore Data in the VEHSS Application

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims.

Retinal detachment repair

Retinal detachment repair procedures are identified among patients with diagnosed DR based on the procedure listed below.

Included Procedures

Procedure Codes

Retinal detachment repair

67101, 67105, 67107, 67108, 67110, 67113, 67141, 67145

Explore Data in the VEHSS Application

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, and MarketScan commercial insurance claims.

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

Explore Data in the VEHSS Application

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims.

Information on data sources

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion