Measure Description
Percentage of patients aged 18 years and older with a diagnosis of End Stage Renal Disease (ESRD) receiving maintenance hemodialysis for greater than or equal to 90 days whose mode of vascular access is a catheter
Instructions
This measure is to be submitted a minimum of once per performance period for patients with ESRD seen 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.
NOTE: Include only patients that have catheters at the time of initiation of hemodialysis through September 30 of the performance period. This will allow the evaluation of at least 90 days of catheter use for hemodialysis within the submission year.
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 receiving maintenance hemodialysis for greater than or equal to 90 days
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
All eligible instances of quality-data code G9240 (Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated as applied in the numerator for Measure #329 Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis)
AND NOT
DENOMINATOR EXCLUSIONS:
Patient is undergoing palliative dialysis with a catheter: G9749
OR
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant: G9750
Numerator
Patients whose mode of vascular access is a catheter
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 extended use of catheters for vascular access.
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 receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access (G9265)
OR
Denominator Exception: Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g. other medical reasons, patient declined AVF/AVG, other patient reasons) (G9264)
OR
Performance Not Met: Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access (G9266)