CMS 134v9: Diabetes: Medical Attention for Nephropathy

Measure: Percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period
Numerator Patients with a screening for nephropathy or evidence of nephropathy during the measurement period
Denominator Exceptions None
Denominator Exclusions
  • Patients whose hospice care overlaps the measurement period
  • Patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period
  • Patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured

A lab interface can be used to meet this eCQM but is not required. Customers interested in a lab interface should contact Sevocity Support to begin the process of a new interface setup. Interface setup requirements and fees vary per request.

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 18 years and < 75 years at the beginning of the Measurement Period

    AND

  • Have an active diagnosis of Type 1 or Type 2 diabetes during the Measurement Period

    AND

  • Have at least one eligible encounter during the Measurement Period finalized by the EC/EP

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

HCPCS: G0438, G0439

The patient must have an active diagnosis of Type 1 or Type 2 diabetes during Measurement Period. Patients with a diagnosis of secondary diabetes due to another condition are not counted.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for diabetes can be located here.

A patient will be excluded from this measure if they meet any of the following conditions:

  • Is in hospice care during the Measurement Period
  • Age is ≥ 65 at the start of the Measurement Period and has spent more than 90 consecutive days during the Measurement Period living in long term care
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of advanced illness
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of frailty

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Pending or Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

To document a stay in long term care:

  1. Go to Chart > Admissions and click Add
  2. Select a Place of Service
  3. Optional: select a Facility
  4. Populate the Admit Date
  5. Optional: populate the Discharge Date
  6. Click OK

If the admissions event does not have a Discharge Date when the eCQM report is generated, the length of stay will be calculated with a discharge date of the Reporting Period end date or the Measurement Period end date, whichever occurs first.

A patient has evidence of advanced illness if they meet any of the following criteria:

  • Had an inpatient encounter with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
  • Had 2 or more outpatient encounters with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
    • Diagnosis must be active during all eligible encounters
  • Was prescribed medication for dementia during the Measurement Period or in the year prior

"Advanced illness" refers to a wide range of conditions and includes diseases such as Alzheimer's disease, cancer, and heart failure.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for advanced illness can be located here.

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439, G0463, T1015

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible dementia medications can be located here.

A patient has evidence of frailty if they meet any of the following criteria:

  • Has an active diagnosis of Frailty during the Measurement Period
  • Has an active diagnosis of Frailty Symptom during the Measurement Period
  • Is using a frailty device during the Measurement Period
  • Has a frailty encounter during the Measurement Period

"Frailty" refers to a range of conditions that includes falls and problems affecting mobility.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for frailty can be located here.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for frailty symptoms are:

ICD-10: R26.0, R26.1, R26.2, R26.89, R26.9, R41.81, R53.1, R53.81, R53.83, R54, R62.7, R63.4, R63.6, R64

The use of a frailty device can be documented in the patient's Medical or Social History.

To document the patient's use of oxygen:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Oxygen use node

    1. Optional: select continuously or when ambulating

To document the patient's use of a respiratory assistive device:

  1. Go to Encounter > Past History > Structured > Medical History

  2. Select the hardcoded Respiratory assistive device node

    1. Optional: select BIPAP, CPAP, Home ventilator, or Ventilator

To document a patient's bedridden status:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Mobilizing/Moving subnode

  4. Select Bedridden

  5. Click OK to save

To document a patient's use of mobility aids:

  1. Go to Encounter > Past History > Social History

  2. Select the hardcoded Activities of Daily Living node

  3. Select the Use of Mobility Aids subnode

  4. Select Dependent on cane, Dependent on walker, or Dependent on wheelchair

  5. Click OK to save

CPT: 99504, 99509

HCPCS: G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031

A patient will be counted in the numerator if they received a screening for nephropathy during the Measurement Period or have evidence of nephropathy during the Measurement Period. Evidence of nephropathy qualifies as one or more of the following:

  • Active diagnosis of Hypertensive Chronic Kidney Disease, Kidney Failure, Glomerulonephritis and Nephrotic Syndrome, Diabetic Nephropathy, or Proteinuria
  • Active prescription for an ACE inhibitor or angiotensin-receptor blocker (ARB)
  • Procedure for kidney transplant, vascular access for dialysis, dialysis services, or end-stage renal disease (ESRD) monthly outpatient services performed
  • Dialysis education or Other services related to dialysis performed
  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Diabetes Care flowsheet and click Add
  4. Click Add Column
  5. Populate a Date and a Value for Urine test for protein
  6. Click OK to save

  1. From the Clinic Inbox, select the lab result to be stored and click View
  2. Click Select to search for and select a patient
  3. Verify patient displayed matches the lab result and select the I have verified the following lab results belong to the above patient checkbox
  4. Click Sign/Route
  5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for hypertensive chronic kidney disease, kidney failure, glomerulonephritis and nephrotic syndrome, diabetic nephropathy, and proteinuria can be located here.

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible ACE inhibitor and ARB medications can be located here.

To document a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete.

Kidney Transplant

CPT: 50300, 50320, 50340, 50360, 50365, 50370, 50380

HCPCS: S2065

Vascular Access for Dialysis

CPT: 36800, 36810, 36815, 36818, 36819, 36820, 36821, 36831, 36832, 36833

Dialysis Services

CPT: 90935, 90937, 90940, 90945, 90947, 90957, 90958, 90959

HCPCS: G0257

ESRD Monthly Outpatient Services

CPT: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 90997, 90999, 99512

To document the performance of these services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete.

Dialysis Education

SNOMED CT: 28812006, 385972005, 59596005, 66402002

Other Services Related to Dialysis

SNOMED CT: 233591003, 251000124108, 311000124103, 3257008, 385970002, 385971003, 385973000, 406168002, 717738008, 718019005, 718308002, 718330001, 718331002, 73257006

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab

https://ecqi.healthit.gov/ecqm/ep/2021/cms134v9

 

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