Is your patient with diabetes on a statin

January 28, 2022

Some diabetes patients are unable to take statin medications.

We all know that every patient with diabetes would benefit from a statin. However, some of our patients are unable to take a statin medication for one reason or another. If we simply do not prescribe a statin, that patient counts against our quality of care. If we dictate in our office note why the patient isn’t taking a statin, that patient still counts against our quality of care.

However, by documenting this exclusion with an appropriate ICD-10 diagnosis code, we can prevent a patient with diabetes who is not on a statin from counting against our quality of care.

How to document statin exclusions for patients with diabetes

If a patient with diabetes isn’t taking a statin medication and has one of the following conditions, using the correct ICD-10 code will exclude the patient from the statin requirement:

  • Pregnancy
  • In vitro fertilization
  • End-stage renal disease
  • Cirrhosis
  • Hospice
  • Palliative care
  • Myalgia
  • Myositis
  • Myopathy
  • Rhabdomyolysis

Some important things to note are:

  • The ICD-10 code for the appropriate condition needs to be documented at one visit during the year.
  • This diagnosis/ICD-10 code must be included in an office visit each year moving forward if the diagnosis still applies to the patient.
  • Using an ICD-10/diagnosis code of “adverse reaction to statin” will not exclude the patient. Only the diagnosis codes listed above will successfully remove the diabetic patient from the statin requirement.
  • Other areas of focus within diabetic care are kidney disease monitoring, blood sugar control, frequency of HbA1c testing, medication adherence, and annual eye exam.

In future articles, I hope to draw attention to additional areas in which we can document better to increase our quality scores. I will also share updates to guidelines as they occur.

As healthcare continues to transition to quality-based pay, we find ourselves in a hybrid environment that also includes fee-for-service pay. Navigating the data that drives quality-based incentive pay is critical to our success and will ultimately result in better outcomes for our patients.