Don’t let missing exclusions impact your quality scores. By correctly billing exclusion diagnoses for the Statin Use in Persons with Diabetes (SUPD) measure, you can ensure accurate measure performance under the Quality Provider Program (QPP). Review your patients, code confidently, and close gaps.
The following conditions qualify for exclusion from the measure when reported with the appropriate ICD-10 code:
Accurate coding is essential to ensure appropriate exclusion of patients. When a patient has a diagnosis from the CMS-approved exclusion list (above), providers should:
- Submit the appropriate ICD-10 code that reflects the exclusion diagnosis.
- Include the diagnosis code on the same claim as an eligible office visit CPT code (e.g., 99213, 99214). You cannot submit the ICD-10 code alone.
Note: Documentation in the medical record alone is not sufficient to exclude a patient. Providers must ensure the qualifying ICD-10 code is included on the claim.
Virtual Visit Submission Option
When appropriate, providers may confirm and document exclusion diagnoses during a virtual visit. To report:
- Submit HCPCS code G9781 (non-reimbursable, $0.01)
- Include the applicable ICD-10 exclusion diagnosis code
This allows the claim to process and ensures accurate removal from the SUPD measure without requiring an in-person visit.