WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
MEASURE DESCRIPTION
The percentage of patients age 18 through 85 years of age with Stage I, II, or III Chronic Kidney Disease (CKD) or Chronic Kidney Disorder
who had the following during the 12-month measurement period:
1. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
Disclaimer: Measures reported by WCHQ healthcare organizations represent a specific aspect of care in relation to an evidence-based standard, but are
not clinical guidelines and do not establish standards of care.
All providers should have an individual care plan established with their patient.
GENERAL INFORMATION/RATIONALE
Chronic kidney disease (CKD) is a major public health problem. Improving outcomes for people with CKD requires a coordinated world-wide
approach to prevention of adverse outcomes. Interventions during the earlier stages of kidney disease includes evaluation and management
of co-morbid conditions, slowing progression of kidney disease, cardiovascular disease risk reduction, preventing and treating complications
of CKD.
High blood pressure can be either a cause or a consequence of CKD. The appropriate evaluation and management of high blood pressure
remains a major component of the care of patients with CKD. Cardiovascular disease is the leading cause of death in patients with chronic
kidney disease, regardless of the stage of kidney disease. All patients with chronic kidney disease should undergo assessment of
cardiovascular disease risk factors.
References:
National Kidney Foundation Clinical Practice Guidelines for the Treatment of Chronic Kidney Disease (2012). Retrieved March 2014 from:
http://www.kdigo.org/clinical_practice_guidelines/ckd.php
DEFINITIONS
12 Months: Measurement Period
24 Months: Measurement Period + Prior Year
Office Visit: Office visit in an outpatient, non-urgent care setting
PCP: For WCHQ measure purposes, a primary care provider is defined as any General Practice, Internal Medicine, Family Practice,
Pediatrics (MD, DO, PA, NP) and any other practitioners identified by the healthcare system as primary care practitioners. The rationale for
the additional practitioner(s) must be documented and must be applied consistently across all preventive care and chronic care measures by
the organization.
 Measure Specific Specialist: As part of the denominator population for this measure visits to a Cardiologist, Endocrinologist, or a
Nephrologist for all patients may be included as an office visit.
 Age Range 18-85: Patients born between 01/01/1930 and 01/01/1997.
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
1
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
DENOMINATOR DESCRIPTION
Adults, whose age at the beginning of the one year measurement period is at least 18 and whose age at the end of the one year
measurement period is less than 86 and who are alive as of the last day of the Measurement Period. Expired patients for whom a specific
date of expiration cannot be found are excluded from the denominator population.
The rationale for the denominator population is built from the following criteria:
[Question 1] – Is this a patient with the disease or condition?
[Question 2] – Is this a patient whose care is managed within the physician group?
[Question 3] – Is this a patient currently managed in our system?
ENCOUNTER DATA
Patients eligible for inclusion in the denominator include:
[Question 1] – Is this a patient with the disease, or condition?
Criteria 1: Identify patients with a diagnosis of Stage I or II or III CKD through ICD-9 Codes
a. Those who had a minimum of two CKD coded (including any diagnoses coded for the visit) – (Table CKD1-1) office visits (Table
CKD1-3), with any provider (MD, DO, PA, NP) in the Physician Group with different dates of service in an ambulatory setting
during the last 24 Months [Measurement Period + Prior Year]
OR
Criteria 2: Identify patients with a diagnosis of a Chronic Kidney Disorder (not CKD)
b. Those who had a minimum of two chronic kidney disorder coded (including any diagnoses coded for the visit) – (Table CKD1-2)
office visits (Table CKD1-3), with any provider (MD, DO, PA, NP) in the Physician Group with different dates of service in an
ambulatory setting during the last 24 Months [Measurement Period + Prior Year]
Denominator Exclusions:
a. The Physician Group should exclude from the eligible population all patients diagnosed with any of the following:
1. Patients with Stage IV or V CKD or ESRD identified by one of the following:
1. One Stage IV or V CKD or ESRD coded encounter (any type of visit to any service) (Table CKD1-4) during the last
24 months [measurement period + prior year]
2. One Stage IV or V CKD or ESRD diagnosis from an ICD-9 diagnosis-based problem list (Table CKD1-4)
3. Those with two diagnoses of 585.9 OR one diagnosis of 585.1, 585.2 or 585.3 and one diagnosis of 585.9 (when
585.9 is the most recent diagnosis). These patients must also have the two most recent consecutive eGFR’s with
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
2
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
results of less than 30 on different dates of service, a minimum of 90 days apart within the 12 month timeframe
[Measurement Period].
a. Organizations that have two eGFR results electronically for every patient (one with African American
component and one without) and have race available within a discreet field should use the race field to
determine which eGFR result to include in the CKD measure. When the race field is not populated the
non-African American eGFR should be included by default. Organizations who routinely have one eGFR
result electronically and provide manual eGFR calculation information for their providers to make the
determination based on race should always report the default (non-African American) eGFR.
b. If multiple ethnic groups are chosen within the discreet race field and “African American” is selected as one
of the ethnic groups, the African American value should be used.
c. If Multiracial is chosen within the discreet race field and “African American” is not specifically indicated
report the default (non-African American) eGFR.
[Question 2] – Is this a patient whose care is managed within the physician group?
Patients who had at least two office visits (Table CKD1-3), regardless of diagnosis code, on different dates of service, to a
PCP and/or Cardiologist, Endocrinologist, or Nephrologist in the past 24 months. If the Cardiologist, Endocrinologist or
Nephrologist is not considered a PCP, at least one of the two office visits must be to a PCP.
[Question 3] – Is this a patient currently managed in our system?
Those who had at least one office visit (Table CKD1-3), regardless of diagnosis code, with a PCP and/or Cardiologist,
Endocrinologist, or Nephrologist during the last 12 Months [Measurement Period].
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
3
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
NUMERATOR DESCRIPTIONS
Blood Pressure Control for all patients in the measure
The number of patients in the denominator whose most recent blood pressure (BP) is adequately
controlled during the Measurement Period. Adequate control is a representative systolic Blood
Pressure less than 140 mm Hg and a representative diastolic Blood Pressure <90 mm Hg (defined
by The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure).
IDENTIFYING A REPRESENTATIVE BLOOD PRESSURE
Blood Pressure Selection Criteria:
 Blood Pressure reading must have been obtained during the Measurement Period.
 Systolic and Diastolic numbers must be from the same BP reading.
 A controlled BP requires that both the systolic and diastolic readings must be less
than140/90.
 Exclusions: Inpatient Stays, Emergency Room Visits, Urgent Care Visits, and Patient SelfReported BP’s (Home and Health Fair Blood Pressures).
 Inclusions: Any office visit encounter, including Nurse Only BP Checks, not listed under
Exclusions above.
 Select the Blood Pressure from the most recent visit.
 In the event that multiple Blood Pressures are recorded in the same day of service, select
any reading that is controlled. If none are in control, select an uncontrolled reading.
 If no Blood Pressure is recorded during the Measurement Period, the patient is assumed to
be “not controlled”.
INTERNALLY DEVELOPED CODES – DATA TRANSLATION/MAPPING REQUIREMENTS
If a medical group utilizes internally generated codes to identify specific services or events required
for a given WCHQ performance measure, the group may translate or map the information to the
WCHQ performance measurement specifications. The medical group must assure that the
internally generated code matches the clinical specificity of the standard (ICD-9, CPT) codes
included in the WCHQ performance measurement specifications.
In order to use internally developed codes for WCHQ performance measure reporting, the medical
group needs to document the translation/mapping to the codes in the specifications. This
documentation should include the internally generated code, a description of the internally
developed code, any additional clinical information for the internally developed code, and the
equivalent standard code with description from the WCHQ performance measurement
specifications. Once the translation/ mapping documentation is established, the medical group’s
WCHQ performance measurement team must review the mapping on a yearly basis and document
that internally developed codes have not changed and are being used in the manner described in
the translation/ mapping document.
The medical group must have documented processes in place for adding codes to the medical
group’s administrative data system and procedures to implement the internally developed codes.
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
4
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
MEDICAL RECORD REVIEW FOR NUMERATOR INCLUSION/DENOMINATOR EXCLUSION
If appropriate, and/or when necessary, every organization may complement their electronic capture
of patient medical history with electronic or manual record review. The following criteria apply only
to data captured/reviewed during medical record review.
For WCHQ Chronic Condition Measures, proof of Numerator compliance requires:
 Date test was performed.
Denominator Exclusion
For all WCHQ Measures, proof of Denominator exclusion requires:
 Existence of exclusion criteria.
This data may be retrieved, in whole or in part, from any of the following:
 Notation in Progress Note
 Notation in Medical History or Surgical History
 Flag/Field in Electronic Medical Record
 Documentation in patient chart
REQUIRED DATA SUBMISSION FIELDS
Fields required for data submission for this measure depend upon the methodology used. The
fields are as follows:
TOTAL POPULATION METHODOLOGY:

Population Denominator (N) (Patients 18-85 years of age with Stage I, II, or III Chronic Kidney Disease

(CKD) or Chronic Kidney Disorder)
Numerators
1. Most recent Blood pressure controlled to a level of less than 140/90 mm Hg
Upon entry of these numbers, the rate is automatically calculated
FIELDS REQUIRED FOR MEASURE VALIDATION
Validation of this measure will require patient level data files for Administrative Data and/or for
Manual Review. The following indicates fields needed for validation, which may be helpful to
consider when querying the measure:
Denominator Data File fields:
1.
2.
3.
4.
5.
6.
Patient Identifier (can be medical record number or other ID)
Office Visit Dates
Provider Specialty
Patient Date of Birth
Chronic Kidney Disease or Chronic Kidney Disorder Codes
Stage IV, V, and ESRD Exclusion Codes
Numerator Data File fields:
1. Blood Pressure Control within the last 12 months
 Patient Identifier
 Blood Pressure Date(s) of Service
 Blood Pressure Result(s)
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
5
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
Appendix A
Primary Payer
In keeping with the changing atmosphere of quality measurement and reporting, WCHQ would like
for participating organizations to include the primary payer source with their data submissions for
the ambulatory care measures.
The primary payer source should be identified in the denominator upon answering the question, “Is
this patient current in our system?” Once it has been determined that a patient is current because
of a visit to their physician within the specified time period (12 months for chronic care measures
and 24 months for preventive care measures), the payer should be “pulled” into the query. The
primary payer should be the payer at the most recent office visit within the measurement period.
There will be four categories of primary payer that will need to be submitted to WCHQ via the data
submission tool: Medicare FFS, Medicaid (all types), Commercial (including Medicare HMO) and
Uninsured/Self-Pay. The raw numbers for the denominator and numerator should be included for
all three types of data submission, total population, hybrid, and sample.
Rationale
Opportunities exist for WCHQ to collect and report data on specific populations, like the Medicare
population, through grant applications to begin to understand the disparities in quality of care. The
purpose of this is to begin to understand the challenges of putting in additional data elements and
complexities of data display for public reporting. At this time, the primary payer information will not
be publicly reported.
Definitions:
Commercial: All plans not Medicaid or Medicare FFS (Includes VA, DoD, etc.)
FFS Medicare: FFS plans, not Medicare HMO (Medicare Railroad is FFS Medicare)
Medicaid: All Medicaid plans including those managed by commercial plans
Uninsured: Self-pay individuals
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
6
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
Appendix B
TABLE CKD1-1: Code to Identify CKD – Stages I, II, and III
ICD-9-CM
Diagnosis
Description
Codes
585.1
Chronic kidney disease, stage I
585.2
Chronic kidney disease, stage II
585.3
Chronic kidney disease, stage III (moderate)
585.9
Chronic kidney disease, unspecified
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
N18.1
N18.2
N18.3
N18.9
Description
Chronic kidney disease, stage 1
Chronic kidney disease, stage 2 (mild)
Chronic kidney disease, stage 3 (moderate)
Chronic kidney disease, unspecified
TABLE CKD1-2: Codes to Identify Other Types of Chronic Kidney Disorders
ICD-9-CM
Diagnosis
Description
Codes
581.81
Nephrotic syndrome in diseases classified elsewhere
582.9
Chronic glomerulonephritis with unspecified pathological lesion in kidney
583.81
With unspecified pathological lesion in kidney
588.xx
Disorders resulting from impaired renal function
588.0
Renal osteodystrophy
588.1
Nephrogenic diabetes insipidus
588.81
Secondary hyperparathyroidism (of renal origin)
588.89
Other specified disorders resulting from impaired renal function
588.9
Unspecified disorder resulting from impaired renal function
753.0
Renal agenesis and dysgenesis
753.1x
Congenital anomalies of urinary system
753.10
Cystic kidney disease unspecified
753.11
Congenital single renal cyst
753.12
Polycystic kidney unspecified type
753.13
Polycystic kidney autosomal dominant
753.14
Polycystic kidney autosomal recessive
753.15
Renal dysplasia
753.16
Medullary cystic kidney
753.17
Medullary sponge kidney
753.19
Other specified cystic kidney disease
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
7
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
N08
N03.9
N25.0
N25.1
N25.81
N25.89
N25.9
Q60.2
Q60.5
Q61.00
Q61.9
Q61.01
Q61.3
Q61.2
Q61.19
Q61.4
Q61.5
Q61.02
Q61.8
Description
Glomerular disorders in diseases classified elsewhere
Chronic nephritic syndrome with unspecified morphologic changes
Renal osteodystrophy
Nephrogenic diabetes insipidus
Secondary hyperparathyroidism of renal origin
Other disorders resulting from impaired renal tubular function
Disorder resulting from impaired renal tubular function, unspecified
Renal agenesis, unspecified
Renal hypoplasia, unspecified
Congenital renal cyst, unspecified
Cystic kidney disease, unspecified
Congenital single renal cyst
Polycystic kidney, unspecified
Polycystic kidney, adult type
Other polycystic kidney, infantile type
Renal dysplasia
Medullary cystic kidney
Congenital multiple renal cysts
Other cystic kidney diseases
TABLE CKD1-3: Office Visit Encounter Codes (Outpatient/non-acute inpatient)
CPT Codes
99201-99205
99212-99215
99241-99245
99347-99350
99384-99387
99394-99397
99401-99404
99411
99412
99420
99429
99488
(Deleted 01/01/15)
99495
99496
Description
a
b
Office or OP visit E&M , new patient
Office or OP visit E&M, established patient
Office or other OP consultations
Home visit for evaluation and management of an established patient
Initial preventive medicine E&Mb
Periodic preventive medicine E&Mb
Preventive medicine counseling
Preventive medicine counseling, group
Preventive medicine counseling, group
Risk assessment, admin and interpretation
Unlisted preventive medicine service
Complex chronic care coordination services; first hour of clinical staff time
directed by a physician or other qualified health care professional with one
face-to-face visit, per calendar month.
Transitional Care Management Services (Moderate Complexity)
Transitional Care Management Services (High Complexity)
HCPCS Code
Description
G0344
(deleted 12/31/08)
G0402
Initial preventive physical examination; face-to-face visit services limited to new
beneficiary during the first six months of Medicare enrollment
Initial preventive physical examination; face-to-face visit, services limited to
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
8
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
(Effective
01/01/09)
G0438
G0439
a
b
new beneficiary during the first 12 months of Medicare enrollment
Annual wellness visit; includes a personalized prevention plan of service, initial
visit
Annual wellness visit; includes a personalized prevention plan of service,
subsequent visit
outpatient
evaluation and management
TABLE CKD1-4: Code to Identify CKD – Stages IV, V and End-Stage
ICD-9-CM
Description
Diagnosis
Codes
585.4
Chronic kidney disease, stage IV
585.5
Chronic kidney disease, stage V
585.6
Chronic kidney disease, end-stage
403.01
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage
V or end stage renal disease
403.11
Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V
or end stage renal disease
403.91
Hypertensive chronic kidney disease, unspecified, with chronic kidney disease
stage V or end stage renal disease
404.03
Hypertensive heart and chronic kidney disease, malignant, with heart failure and
with chronic kidney disease stage V or end stage renal disease
404.12
Hypertensive heart and chronic kidney disease, benign, without heart failure and
with chronic kidney disease stage V or end stage renal disease
404.13
Hypertensive heart and chronic kidney disease, benign, with heart failure and
chronic kidney disease stage V or end stage renal disease
404.92
Hypertensive heart and chronic kidney disease, unspecified, without heart failure
and with chronic kidney disease stage V or end stage renal disease
404.93
Hypertensive heart and chronic kidney disease, unspecified, with heart failure and
chronic kidney disease stage V or end stage renal disease
V42.0
Kidney transplant
V45.1x
Renal dialysis status
V45.11
Renal dialysis status (post procedural)
V45.12
Noncompliance with renal dialysis
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
9
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
Effective 10/01/2015
ICD-10-CM
Diagnosis Codes
N18.4
N18.5
N18.6
I12.00
I12.0
I12.9
I13.10
I13.0
I13.11
I13.2
Z94.0
Z99.2
Z91.15
Description
Chronic kidney disease, stage 4 (severe)
Chronic kidney disease, stage 5
End stage renal disease
Hypertensive chronic kidney disease with stage 1 through stage 4 chronic
kidney disease, or unspecified chronic kidney disease
Hypertensive chronic kidney disease with stage 5 chronic kidney disease or
end stage renal disease
Hypertensive chronic kidney disease with stage 1 through stage 4 chronic
kidney disease, or unspecified chronic kidney disease
Hypertensive heart and chronic kidney disease without heart failure, with stage
1 through stage 4 chronic kidney disease, or unspecified chronic kidney
disease
Hypertensive heart and chronic kidney disease with heart failure and stage 1
through stage 4 chronic kidney disease, or unspecified chronic kidney disease
Hypertensive heart and chronic kidney disease without heart failure, with stage
5 chronic kidney disease, or end stage renal disease
Hypertensive heart and chronic kidney disease with heart failure and with
stage 5 chronic kidney disease, or end stage renal disease
Kidney transplant status
Dependence on renal dialysis
Patient's noncompliance with renal dialysis
CPT Codes
36145
36147
36800
36810
36815
36818
36819
36820
36821
36831
36832
36833
50300
50320
Description
Introduction of needle or intracatheter; arteriovenous shunt created for dialysis
(cannula, fistula, or graft)
Introduction of needle and/or catheter, arteriovenous shunt created for dialysis
(graft/fistula); initial access with complete radiological evaluation of dialysis access.
Insertion on cannula for hemodialysis, other purpose; vein to vein
Insertion of cannula – arteriovenous, external
Insertion of cannula – arteriovenous, external revision, or closure
Insertion of cannula – arteriovenous, external revision, or closure, upper arm
Arteriovenous anastomosis, open, by upper arm basilic vein transposition
Hemodialysis access, forearm vein transportation
Hemodialysis access direct, any site
Thrombectomy, open, arteriovenous fistula without revision, autogenous or
nonautogenous dialysis graft
Revision, open, arteriovenous fistula, without thrombectomy, autogenous or
nonautogenous dialysis graft
Revision, open, arteriovenous fistula with thrombectomy, autogenous or
nonautogenous dialysis graft
Donor nephrectomy, with preparation and maintenance of allograft, from cadaver
donor
Donor nephrectomy
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
10
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
50340
50360
50365
50370
50380
90935
90937
90940
90945
90947
90957
90958
90959
90960
90961
90962
90965
90966
90969
90970
90989
90993
90997
90999
99512
Recipient nephrectomy
Renal allotransplantation, implantation of graft
Renal allotransplantation, with recipient nephrectomy
Removal of transplanted renal allograft
Renal autotransplantation, reimplantation of kidney
Hemodialysis procedure with single physician evaluation
Hemodialysis procedure requiring repeat evaluations
Hemodialysis access flow study to determine blood flow in grafts and
arteriovenous fistulae by an indicator method (was previously reported as code
90939)
Dialysis procedure other than hemodialysis with single physician evaluation
Dialysis procedure other than hemodialysis requiring repeated physician
evaluations
ESRD Related Services monthly, for patients 12-19 years of age to include
monitoring for the adequacy of nutrition, assessment of growth and development,
and counseling of parents; with 4 or more face-to-face physician visits per month
ESRD Related Services monthly, for patients 12-19 years of age to include
monitoring for the adequacy of nutrition, assessment of growth and development,
and counseling of parents; with 2-3 face-to-face physician visits per month
ESRD Related Services monthly, for patients 12-19 years of age to include
monitoring for the adequacy of nutrition, assessment of growth and development,
and counseling of parents; with 1 face-to-face physician visit per month
ESRD Related Services monthly, for patients 20 years of age and older; with 4 or
more face-to-face physician visits per month
ESRD Related Services monthly, for patients 20 years of age and older; with 2-3
face-to-face physician visits per month
ESRD Related Services monthly, for patients 20 years of age and older; with 1
face-to-face physician visit per month
ESRD Related Services for home dialysis per full month, for patients 12-19 years
of age to include monitoring for the adequacy of nutrition, assessment of growth
and development, and counseling of parents
ESRD Related Services for home dialysis per full month, for patients 20 years of
age and older
ESRD related services for dialysis less than a full month of service, per day; for
patients 12-19 years of age
ESRD related services for dialysis less than a full month of service, per day; for
patients 20 years of age and older
Dialysis training, patient, completed course
Dialysis training, patient, course not completed
Hemoperfusion
Unlisted dialysis procedure, inpatient or outpatient
Home visit for hemodialysis
HCPCS
Codes
G0257
G0392
Description
ESRD Services
Transluminal balloon angioplasty, percutaneous: for maintenance of hemodialysis
access, arteriovenous fistula or graft; arterial
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
11
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
G0393
S9339
Transluminal balloon angioplasty, percutaneous: for maintenance of hemodialysis
access, arteriovenous fistula or graft; venous
Home Therapy, Peritoneal Dialysis
ICD-9-CM
Procedure
Codes
38.95
39.27
39.42
39.43
39.53
39.93
39.94
39.95
54.98
55.6x
55.61
55.69
Description
Venous catheterization for renal dialysis
Arteriovenostomy for renal dialysis
Revision of arteriovenous shunt for renal dialysis
Removal of shunt for renal dialysis
Repair of arteriovenous fistula
Insertion of vessel-to-vessel cannula
Replacement of vessel-to-vessel cannula
Hemodialysis
Peritoneal dialysis
Transplant of Kidney
Renal autotransplantation
Other kidney transplantation
Effective 10/01/2015
ICD-10-PCS
Description
Procedure Codes
5A1D00Z
Performance of Urinary Filtration, Single
5A1D60Z
Performance of Urinary Filtration, Multiple
3E1M39Z
Irrigation of Peritoneal Cavity using Dialysate, Percutaneous Approach
0TS00ZZ
Reposition Right Kidney, Open Approach
0TS10ZZ
Reposition Left Kidney, Open Approach
0TY00Z0
Transplantation of Right Kidney, Allogeneic, Open Approach
0TY00Z1
Transplantation of Right Kidney, Syngeneic, Open Approach
0TY00Z2
Transplantation of Right Kidney, Zooplastic, Open Approach
0TY10Z0
Transplantation of Left Kidney, Allogeneic, Open Approach
0TY10Z1
Transplantation of Left Kidney, Syngeneic, Open Approach
0TY10Z2
Transplantation of Left Kidney, Zooplastic, Open Approach
UB-92
Revenue
Codes
080x
0800
0801
0802
0803
0804
0809
082x
0820
Description
Inpatient Renal Dialysis
Sessions Inpatient Renal Dialysis - General
Sessions Inpatient Renal Dialysis – Inpatient Hemodialysis
Sessions Inpatient Renal Dialysis – Inpatient Peritoneal (non-CAPD)
Sessions Inpatient Renal Dialysis – Inpatient Continuous Ambulatory Peritoneal
Dialysis (CAPD)
Sessions Inpatient Renal Dialysis – Other Inpatient Dialysis
Sessions Inpatient Renal Dialysis – Other Inpatient Dialysis
Hemodialysis-Outpatient or Home
Sessions Hemodialysis – Outpatient or Home - General
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
12
WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
0821
0822
0823
0824
0825
0829
083x
0830
0831
0832
0833
0834
0835
0839
084x
0840
0841
0842
0843
0844
0845
0849
085x
0850
0851
0852
0853
0854
0855
0859
086X
087x
088x
0880
0881
0882
0889
Sessions Hemodialysis – Outpatient or Home – Hemodialysis / Composite or Other
Rate
Sessions Hemodialysis – Outpatient or Home – Home Supplies
Sessions Hemodialysis – Outpatient or Home – Home Equipment
Sessions Hemodialysis – Outpatient or Home – Maintenance / 100%
Sessions Hemodialysis – Outpatient or Home – Support Services
Sessions Hemodialysis – Outpatient or Home - Other Outpatient Hemodialysis
Peritoneal Dialysis-Outpatient or Home
Sessions Peritoneal Dialysis – Outpatient or Home - General
Sessions Peritoneal Dialysis – Outpatient or Home – Peritoneal / Composite or
Other Rate
Sessions Peritoneal Dialysis – Outpatient or Home - Home Supplies
Sessions Peritoneal Dialysis – Outpatient or Home – Home Equipment
Sessions Peritoneal Dialysis – Outpatient or Home – Maintenance / 100%
Sessions Peritoneal Dialysis – Outpatient or Home – Support Services
Sessions Peritoneal Dialysis – Outpatient or Home - Other Outpatient Peritoneal
Dialysis
CAPD-Outpatient or Home
CAPD - Outpatient or Home - General
CAPD - Outpatient or Home - CAPD / Composite or Other Rate
CAPD - Outpatient or Home - Home Supplies
CAPD - Outpatient or Home – Home Equipment
CAPD - Outpatient or Home - Maintenance / 100%
CAPD - Outpatient or Home – Support Services
CAPD - Outpatient or Home - Other Outpatient CAPD
CCPD-Outpatient or Home
CCPD - Outpatient or Home - General
CCPD - Outpatient or Home - CCPD / Composite or Other Rate
CCPD - Outpatient or Home - Home Supplies
CCPD - Outpatient or Home – Home Equipment
CCPD - Outpatient or Home - Maintenance / 100%
CCPD - Outpatient or Home – Support Services
CCPD - Outpatient or Home - Other Outpatient CCPD Dialysis
RESERVED FOR DIALYSIS (NATIONAL ASSIGNMENT)
RESERVED FOR DIALYSIS (NATIONAL ASSIGNMENT)
Miscellaneous Dialysis
Sessions Miscellaneous Dialysis – General
Sessions Miscellaneous Dialysis – Ultra filtration
Sessions Miscellaneous Dialysis – Home Dialysis Aid Visit
Sessions Miscellaneous Dialysis – Miscellaneous Dialysis Other
UB Type of
Bill Codes
721
722
723
Description
Clinic-Hospital Based or Independent Renal Dialysis Center (Admit through
Discharge Claim)
Clinic-Hospital Based or Independent Renal Dialysis Center (Interim-First Claim)
Clinic-Hospital Based or Independent Renal Dialysis Center (Interim-Continuing
Claim)
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
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WCHQ Ambulatory Measure Specification
WCHQ 29 – CKD Care in Stages I, II and III – Blood Pressure Control
Measurement Period: 01/01/2015 – 12/31/2015
Process Measure Type
NQS Domain: Clinical Process/Effectiveness
724
725
727
729
CMS DRG ‘s
317
MS DRG’s
685
Clinic-Hospital Based or Independent Renal Dialysis Center (Interim-Last Claim)
Clinic-Hospital Based or Independent Renal Dialysis Center (Late Charges Only
Claim)
Clinic-Hospital Based or Independent Renal Dialysis Center (Replacement of Prior
Claim)
Clinic-Hospital Based or Independent Renal Dialysis Center (Final Claim for a
Home Health PPS Episode)
Description (keep in specification through 2009 Reporting Period)
Renal dialysis
Description (effective October 1, 2007)
Admission for Renal Dialysis
CKD Care in Stages I, II, and III - Final 2014
This specification is updated annually; refer to previous versions for coding and other changes
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