2023 # 489 Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy

CMS Measure ID: #489

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: New

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of CKD (Stages 1-5, not receiving Renal Replacement Therapy (RRT)) and proteinuria 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: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

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

Description

Percentage of patients aged 18 years and older with a diagnosis of chronic kidney disease (CKD) (Stages 1-5, not receiving Renal Replacement Therapy (RRT)) and proteinuria who were prescribed ACE inhibitor or ARB therapy within a 12-month period.

Denominator

All patients aged 18 years and older with the diagnosis of CKD (Stages 1-5, not receiving RRT) and proteinuria

Definitions:

Proteinuria:

1. >300mg of albumin in the urine per 24 hours OR
2. Urine albumin-to-creatinine ratio (ACR) >300 mg/g OR
3. Urine protein-to-creatinine ratio (PCR) > 0.3 g/g

Renal Replacement Therapy (RRT) – For the purposes of this measure, RRT includes hemodialysis, peritoneal dialysis, and kidney transplantation.

Patients receiving RRT –

The following codes would be sufficient to define the Denominator Exclusion (M1199) of receiving RRT: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, I70.1, N18.6, Z49.31, Z49.32, Z99.2

Denominator Criteria (Eligible Cases):

All patients aged 18 years and older on the date of the encounter

AND

Diagnosis of CKD (Stages 1-5) (ICD-10-CM): E11.22, N18.1, N18.2, N18.30, N18.31, N18.32, N18.4, N18.5, N18.9

AND

Diagnosis of Proteinuria (ICD-10-CM): R80.1, R80.8, R80.9

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

AND NOT

DENOMINATOR EXCLUSION:

Patients receiving RRT: M1199

Numerator

Patients who were prescribed ACE inhibitor or ARB therapy within a 12-month period

Definition:

Prescribed – May include prescription given to the patient for ACE Inhibitor or ARB therapy OR patient already taking ACE Inhibitor or ARB therapy as documented in the current medication list.

Numerator Options:

Performance Met: ACE Inhibitor (ACE-I) or ARB therapy prescribed during the measurement period (M1200)

OR

Denominator Exception: Documentation of medical reason(s) for not prescribing ACE inhibitor (ACE-I) or ARB therapy during the measurement period (e.g., pregnancy, history of angioedema to ACE-I, other allergy to ACE-I and ARB, hyperkalemia or history of hyperkalemia while on ACE-I or ARB therapy, acute kidney injury due to ACE-I or ARB therapy, other medical reasons.) (M1201)

OR

Denominator Exception: Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy during the measurement period (e.g., patient declined, other patient reasons). (M1202)

OR

Performance Not Met:

ACE inhibitor or ARB therapy not prescribed during the measurement period, reason not given (M1203)