#122: Adult Kidney Disease: Blood Pressure Management

Measure description

Percentage of patient visits for those patients aged 18 years and older with a diagnosis of chronic kidney disease (CKD) (stage 3, 4, or 5, not receiving Renal Replacement Therapy [RRT]) with a blood pressure < 140/90 mmHg OR ≥ 140/90 mmHg with a documented plan of care

Instructions

This measure is to be submitted at each denominator eligible visit indicated within the denominator, for patients with a diagnosis of chronic kidney disease (CKD) (stage 3, 4, or 5, not receiving RRT) seen during the performance period. It is anticipated that eligible clinicians providing care for patients with CKD will submit this measure.

This measure will be calculated with 3 performance rates:

1. Percentage of patient visits with blood pressure results < 140/90 mmHg
2. Percentage of patient visits with blood pressure results ≥ 140/90 mmHg and plan of care
3. Overall percentage of patient visits with blood pressure results < 140/90 mmHg and ≥ 140/90 mmHg with a documented plan of care

Eligible clinicians should continue to submit the measure as specified, with no additional steps needed to account for multiple performance rates.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Denominator

All patient visits for those patients aged 18 years and older with a diagnosis of CKD (stage 3, 4, or 5, not receiving RRT)

Definition:

RRT (Renal Replacement Therapy) – For the purposes of this measure, RRT includes hemodialysis, peritoneal dialysis, and kidney transplantation.

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for stage 3, 4, or 5 CKD (ICD-10-CM): N18.3, N18.4, N18.5

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Numerator

Patient visits with blood pressure < 140/90 mmHg OR ≥ 140/90 mmHg with a documented plan of care

Numerator Instructions: If multiple blood pressure measurements are taken at a single visit, use the most recent measurement taken at that visit.

Definition:

Plan of Care – A documented plan of care should include one or more of the following: recheck blood pressure within 90 days; initiate or alter pharmacologic therapy for blood pressure control; initiate or alter non-pharmacologic therapy (lifestyle changes) for blood pressure control; documented review of patient’s home blood pressure log which indicates that patient’s blood pressure is or is not well controlled.

Numerator Options:

Performance Met: Most recent blood pressure has a systolic measurement of < 140 mmHg and a diastolic measurement of < 90 mmHg (G8476)

OR

Performance Met: Most recent blood pressure has a systolic measurement of ≥ 140 mmHg and/or a diastolic measurement of ≥ 90 mmHg (G8477)

AND

Elevated blood pressure plan of care documented (0513F)

OR

Performance Not Met: Blood pressure measurement not performed or documented, reason not given (G8478)

OR

Performance Not Met: No documentation of elevated blood pressure plan of care, reason not otherwise specified (0513F with 8P)

AND

Most recent blood pressure has a systolic measurement of ≥140 mmHg and/or a diastolic measurement of ≥ 90 mmHg (G8477)