Measure Description
Percentage of calendar months within a 12-month period during which patients aged 17 years and younger with a diagnosis of End Stage Renal Disease (ESRD) receiving hemodialysis or peritoneal dialysis have a hemoglobin level < 10 g/dL
Instructions
This measure is to be submitted each calendar month patients are seen with a diagnosis of ESRD (who are on hemodialysis or peritoneal dialysis) during the performance period. The most recent quality code submitted will be used for performance calculation. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians providing care for patients with ESRD will submit this measure.
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 calendar months during which patients aged 17 years and younger with a diagnosis of ESRD are receiving hemodialysis or peritoneal dialysis
Denominator Criteria (Eligible Cases):
Patients aged ≤ 17 years on date of encounter
AND
Diagnosis for ESRD (ICD-10-CM): N18.6
AND
Patient encounter during the performance period (CPT): 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90963, 90964, 90965, 90967, 90968, 90969
Numerator
Calendar months during which patients have a hemoglobin level < 10 g/dL
Numerator Instructions:
The hemoglobin values used for this measure should be a most recent (last) hemoglobin value recorded for each calendar month.
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
Numerator Options:
Performance Met: Most recent hemoglobin (Hgb) level < 10 g/dL (G8973)
OR
Denominator Exception: Hemoglobin level measurement not documented, Reason not given (G8974)
OR
Denominator Exception: Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dL (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons) (G8975)
OR
Performance Not Met: Most recent hemoglobin (Hgb) level ≥ 10 g/dL (G8976)