#403: Adult Kidney Disease: Referral to Hospice

Quality ID

403

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Nephrology

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of ESRD who withdraw from hemodialysis or peritoneal dialysis who are referred to hospice care

 

Instructions

This measure is to be submitted once per performance period for all patients being treated for end stage renal disease that have discontinued hemodialysis or peritoneal dialysis during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure for the primary management of patients with end stage renal disease based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

All patients aged 18 years and older with a diagnosis of ESRD who withdraw from hemodialysis or peritoneal dialysis

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for ESRD (ICD-10-CM): N18.6

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, 99304, 99305, 99306, 99307, 99308, 99309, 99310

AND

Patient discontinued from hemodialysis or peritoneal dialysis: G9523

 

Numerator

Patients who are referred to hospice care

Numerator Options:

Performance Met: Patient was referred to hospice care (G9524)

OR

Denominator Exception: Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) (G9525)

OR

Performance Not Met: Patient was not referred to hospice care, Reason not given (G9526)

Register with MDinteractive