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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
328 1667 Intermediate Outcome Yes Effective Clinical Care Registry

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 eligible clinicians providing care for patients with ESRD will submit this measure

NOTE: No data related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Numerator

Calendar months during which patients have a hemoglobin level < 10 g/dL

Definition

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 Quality-Data Coding Options

Performance Met:

Most recent hemoglobin (Hgb) level < 10 g/dL (G8973)

Denominator Exception:

Hemoglobin level measurement not documented, Reason not given (G8974)

OR

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  marrowdisease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream orperitoneal infection],other medical reasons) (G8975)

Performance Not Met:

Most recent hemoglobin (Hgb) level ≥ 10 g/dL (G8976)

NUMERATOR NOTE:  No notes

Denominator

All calendar months during which patients aged 17 years and younger with a diagnosis of ESRD are receiving hemodialysis or peritoneal dialysis

Option 1Physical Therapy 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

WITHOUT

Modifier:  GQ, GT, 95, POS 02

 

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