| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Registry | Process | Yes | Person and Caregiver-Centered Experience and Outcomes |
Measure Description
Percentage of patients aged 18 years and older with a diagnosis of ESRD who withdraw from hemodialysis or peritoneal dialysis who are referred to hospice care
Instruction
This measure is to be reported once per performance period for all patients being treated for end stage renal disease that have discontinued hemodialysis or peritoneal dialysis during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure for the primary management of patients with end stage renal disease based on the services provided and the measure-specific denominator coding.
Denominator
All patients aged 18 years and older with a diagnosis of ESRD who withdraw from hemodialysis or peritoneal dialysis
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for ESRD (ICD-10-CM): N18.6
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, 99304, 99305, 99306, 99307, 99308, 99309, 99310
WITHOUT
Telehealth Modifier: GQ, GT
AND
Patient discontinued from hemodialysis or peritoneal dialysis: G9523
Numerator
Patients who are referred to hospice care
Numerator Options:
Performance Met: Patient was referred to hospice care (G9524)
OR
Denominator Exception: Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) (G9525)
OR
Performance Not Met: Patient was not referred to hospice care, reason not given (G9526)