Measure Description
Percentage of patients aged 18 years and older with a diagnosis of End Stage Renal Disease (ESRD) who initiate maintenance hemodialysis during the measurement period, whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
Instructions
This measure is to be submitted a minimum of once per performance period for patients with ESRD who initiated maintenance hemodialysis 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 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 initiate maintenance hemodialysis during the measurement period
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for ESRD (ICD-10-CM): N18.6, Z49.31
AND
Patient encounter during performance period (CPT): 90957, 90958, 90959, 90960, 90961, 90962, 90966, 90970
AND
Initiation of maintenance hemodialysis during the submission/maintenance period
AND NOT
DENOMINATOR EXCLUSIONS:
Patient is undergoing palliative dialysis with a catheter: G9747
OR
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant: G9748
Numerator
Patients whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
Numerator Instructions:
Of note, the performance tags indicating ‘Performance Met’ and ‘Performance Not Met’ are included to highlight what is being measured and submitted and not to encourage catheter use.
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: Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated (G9240)
OR
Denominator Exception: Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing AVF/AVG, time-limited trial of hemodialysis, other medical reasons, patient declined AVF/AVG, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons) (G9239)
OR
Performance Not Met: Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated (G9241)