Kidney Health Evaluation (2024)
| eCQMs / NQF #: | CMS951v2 / XXXX |
| Measure: | Percentage of patients aged 18-75 years with a diagnosis of diabetes who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the measurement period. |
| Numerator: | Patients who received a kidney health evaluation defined by an eGFR AND uACR within the measurement period. |
| Denominator: | All patients aged 18-75 years with a diagnosis of diabetes at the start of the measurement period with a visit during the measurement period. |
| Denominator Exclusion: | Exclude patients with a diagnosis of ESRD.
Exclude patients with a diagnosis of CKD Stage 5. Exclude patients who have an order for or are receiving hospice or palliative care. |
| Domain: | Effective Clinical Care |
In ChartMaker Clinical:
In order to qualify for this measure, the provider must have seen the patient of appropriate age (18 to 75) at least one time during the reporting period and have the appropriate information documented in the chart:
Required Data Elements for the Denominator:
This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the Diagnosis widget in a note.
| ICD-10: | |
| Code | Description |
| E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma |
| E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma |
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy |
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication |
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E10.3211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E10.3212 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E10.3213 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E10.3219 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E10.3291 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E10.3292 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E10.3293 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E10.3299 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E10.3311 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E10.3312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E10.3313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E10.3319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E10.3391 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E10.3392 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E10.3393 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E10.3399 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E10.3411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E10.3412 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E10.3413 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E10.3419 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E10.3491 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E10.3492 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E10.3493 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E10.3499 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E10.3511 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E10.3512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E10.3513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E10.3519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E10.3521 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E10.3522 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E10.3523 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E10.3529 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E10.3531 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E10.3532 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E10.3533 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E10.3539 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E10.3541 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E10.3542 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E10.3543 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E10.3549 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E10.3551 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E10.3552 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E10.3553 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E10.3559 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E10.3591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E10.3592 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E10.3593 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E10.3599 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E10.36 | Type 1 diabetes mellitus with diabetic cataract |
| E10.37X1 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E10.37X2 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E10.37X3 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E10.37X9 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication |
| E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified |
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E10.59 | Type 1 diabetes mellitus with other circulatory complications |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy |
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy |
| E10.620 | Type 1 diabetes mellitus with diabetic dermatitis |
| E10.621 | Type 1 diabetes mellitus with foot ulcer |
| E10.622 | Type 1 diabetes mellitus with other skin ulcer |
| E10.628 | Type 1 diabetes mellitus with other skin complications |
| E10.630 | Type 1 diabetes mellitus with periodontal disease |
| E10.638 | Type 1 diabetes mellitus with other oral complications |
| E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma |
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia |
| E10.69 | Type 1 diabetes mellitus with other specified complication |
| E10.8 | Type 1 diabetes mellitus with unspecified complications |
| E10.9 | Type 1 diabetes mellitus without complications |
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma |
| E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma |
| E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma |
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| SNOMED: | |
| Code | Description |
| 102781000119107 | Sensory neuropathy due to type 1 diabetes mellitus (disorder) |
| 104941000119109 | Ischemia of retina due to type 1 diabetes mellitus (disorder) |
| 104961000119108 | Ischemia of retina due to type 2 diabetes mellitus (disorder) |
| 109171000119104 | Retinal edema due to type 1 diabetes mellitus (disorder) |
| 110181000119105 | Peripheral sensory neuropathy due to type 2 diabetes mellitus (disorder) |
| 138881000119106 | Mild nonproliferative retinopathy due to type 1 diabetes mellitus (disorder) |
| 138891000119109 | Moderate nonproliferative retinopathy due to type 1 diabetes mellitus (disorder) |
| 138901000119108 | Severe nonproliferative retinopathy due to diabetes mellitus type 1 (disorder) |
| 138911000119106 | Mild nonproliferative retinopathy due to type 2 diabetes mellitus (disorder) |
| 138921000119104 | Moderate nonproliferative retinopathy due to type 2 diabetes mellitus (disorder) |
| 138941000119105 | Severe nonproliferative retinopathy due to diabetes mellitus type 2 (disorder) |
| 1481000119100 | Diabetes mellitus type 2 without retinopathy (disorder) |
| 1501000119109 | Proliferative retinopathy due to type 2 diabetes mellitus (disorder) |
| 1511000119107 | Peripheral neuropathy due to type 2 diabetes mellitus (disorder) |
| 1551000119108 | Nonproliferative retinopathy due to type 2 diabetes mellitus (disorder) |
| 190330002 | Hyperosmolar coma due to type 1 diabetes mellitus (disorder) |
| 190331003 | Hyperosmolar coma due to type 2 diabetes mellitus (disorder) |
| 190368000 | Type I diabetes mellitus with ulcer (disorder) |
| 190372001 | Type I diabetes mellitus maturity onset (disorder) |
| 190389009 | Type II diabetes mellitus with ulcer (disorder) |
| 199229001 | Pre-existing type 1 diabetes mellitus (disorder) |
| 199230006 | Pre-existing type 2 diabetes mellitus (disorder) |
| 23045005 | Insulin dependent diabetes mellitus type IA (disorder) |
| 237599002 | Insulin treated type 2 diabetes mellitus (disorder) |
| 237604008 | Maturity onset diabetes of the young, type 2 (disorder) |
| 28032008 | Insulin dependent diabetes mellitus type IB (disorder) |
| 28331000119107 | Retinal edema due to type 2 diabetes mellitus (disorder) |
| 31211000119101 | Peripheral angiopathy due to type 1 diabetes mellitus (disorder) |
| 31321000119102 | Diabetes mellitus type 1 without retinopathy (disorder) |
| 313435000 | Type I diabetes mellitus without complication (disorder) |
| 313436004 | Type II diabetes mellitus without complication (disorder) |
| 314893005 | Arthropathy due to type 1 diabetes mellitus (disorder) |
| 314902007 | Peripheral angiopathy due to type 2 diabetes mellitus (disorder) |
| 314903002 | Arthropathy due to type 2 diabetes mellitus (disorder) |
| 314904008 | Type II diabetes mellitus with neuropathic arthropathy (disorder) |
| 359642000 | Diabetes mellitus type 2 in nonobese (disorder) |
| 368101000119109 | Periodontal disease co-occurrent and due to diabetes mellitus type 2 (disorder) |
| 368521000119107 | Disorder of nerve co-occurrent and due to type 1 diabetes mellitus (disorder) |
| 368581000119106 | Neuropathy due to type 2 diabetes mellitus (disorder) |
| 41911000119107 | Glaucoma due to type 2 diabetes mellitus (disorder) |
| 420279001 | Renal disorder due to type 2 diabetes mellitus (disorder) |
| 420436000 | Mononeuropathy due to type 2 diabetes mellitus (disorder) |
| 420486006 | Exudative maculopathy due to type 1 diabetes mellitus (disorder) |
| 420789003 | Retinopathy due to type 1 diabetes mellitus (disorder) |
| 420918009 | Mononeuropathy due to type 1 diabetes mellitus (disorder) |
| 421075007 | Ketoacidotic coma due to type 1 diabetes mellitus (disorder) |
| 421326000 | Disorder of nervous system due to type 2 diabetes mellitus (disorder) |
| 421365002 | Peripheral circulatory disorder due to type 1 diabetes mellitus (disorder) |
| 421437000 | Hypoglycemic coma due to type 1 diabetes mellitus (disorder) |
| 421468001 | Disorder of nervous system due to type 1 diabetes mellitus (disorder) |
| 421779007 | Exudative maculopathy due to type 2 diabetes mellitus (disorder) |
| 421847006 | Ketoacidotic coma due to type 2 diabetes mellitus (disorder) |
| 421893009 | Renal disorder due to type 1 diabetes mellitus (disorder) |
| 422034002 | Retinopathy due to type 2 diabetes mellitus (disorder) |
| 422099009 | Disorder of eye due to type 2 diabetes mellitus (disorder) |
| 422166005 | Peripheral circulatory disorder due to type 2 diabetes mellitus (disorder) |
| 427027005 | Lumbosacral radiculoplexus neuropathy due to type 2 diabetes mellitus (disorder) |
| 427571000 | Lumbosacral radiculoplexus neuropathy due to type 1 diabetes mellitus (disorder) |
| 428007007 | Erectile dysfunction due to type 2 diabetes mellitus (disorder) |
| 44054006 | Diabetes mellitus type 2 (disorder) |
| 46635009 | Diabetes mellitus type 1 (disorder) |
| 60951000119105 | Blindness due to type 2 diabetes mellitus (disorder) |
| 609562003 | Maturity onset diabetes of the young, type 1 (disorder) |
| 609564002 | Pre-existing type 1 diabetes mellitus in pregnancy (disorder) |
| 609566000 | Pregnancy and type 1 diabetes mellitus (disorder) |
| 609567009 | Pre-existing type 2 diabetes mellitus in pregnancy (disorder) |
| 60961000119107 | Nonproliferative diabetic retinopathy due to type 1 diabetes mellitus (disorder) |
| 60971000119101 | Proliferative retinopathy due to type 1 diabetes mellitus (disorder) |
| 60991000119100 | Blindness due to type 1 diabetes mellitus (disorder) |
| 691000119103 | Erectile dysfunction due to type 1 diabetes mellitus (disorder) |
| 712882000 | Autonomic neuropathy due to type 1 diabetes mellitus (disorder) |
| 712883005 | Autonomic neuropathy due to type 2 diabetes mellitus (disorder) |
| 713702000 | Gastroparesis due to type 1 diabetes mellitus (disorder) |
| 713703005 | Gastroparesis due to type 2 diabetes mellitus (disorder) |
| 713705003 | Polyneuropathy due to type 1 diabetes mellitus (disorder) |
| 713706002 | Polyneuropathy due to type 2 diabetes mellitus (disorder) |
| 71441000119104 | Nephrotic syndrome due to type 2 diabetes mellitus (disorder) |
| 71721000119101 | Nephrotic syndrome due to type 1 diabetes mellitus (disorder) |
| 71791000119104 | Peripheral neuropathy due to type 1 diabetes mellitus (disorder) |
| 719216001 | Hypoglycemic coma due to type 2 diabetes mellitus (disorder) |
| 739681000 | Disorder of eye due to type 1 diabetes mellitus (disorder) |
| 770098001 | Cranial nerve palsy due to type 1 diabetes mellitus (disorder) |
| 81531005 | Diabetes mellitus type 2 in obese (disorder) |
| 82541000119100 | Traction detachment of retina due to type 2 diabetes mellitus (disorder) |
| 82551000119103 | Rubeosis iridis due to type 2 diabetes mellitus (disorder) |
| 82571000119107 | Traction detachment of retina due to type 1 diabetes mellitus (disorder) |
| 82581000119105 | Rubeosis iridis due to type 1 diabetes mellitus (disorder) |
| 87921000119104 | Cranial nerve palsy due to type 2 diabetes mellitus (disorder) |
| 97331000119101 | Macular edema and retinopathy due to type 2 diabetes mellitus (disorder) |
| 9859006 | Acanthosis nigricans due to type 2 diabetes mellitus (disorder) |
This is captured by adding a procedure with a valid CPT or SNOMED code using the Procedure widget in a note.
Office Visit
| CPT: | |
| Code | Description |
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. |
| SNOMED: | |
| Code | Description |
| 185463005 | Visit out of hours (procedure) |
| 185464004 | Out of hours visit – not night visit (procedure) |
| 185465003 | Weekend visit (procedure) |
| 30346009 | Evaluation and management of established outpatient in office or other outpatient facility (procedure) |
| 3391000175108 | Office visit for pediatric care and assessment (procedure) |
| 37894004 | Evaluation and management of new outpatient in office or other outpatient facility (procedure) |
| 439740005 | Postoperative follow-up visit (procedure) |
Annual Wellness Visit
| HCPCS: | |
| Code | Description |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| SNOMED: | |
| Code | Description |
| 444971000124105 | Annual wellness visit (procedure) |
| 456201000124103 | Medicare annual wellness visit (procedure) |
Preventive Care Services, 18 years old and Up
| CPT: | |
| Code | Description |
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years |
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years |
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years |
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older |
Home Healthcare Services
| CPT: | |
| Code | Description |
| 99341 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
| 99342 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 99343 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99344 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
| 99345 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. |
| 99347 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
| 99348 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 99349 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
| 99350 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
| SNOMED: | |
| Code | Description |
| 225929007 | Joint home visit (procedure) |
| 315205008 | Bank holiday home visit (procedure) |
| 439708006 | Home visit (procedure) |
| 698704008 | Home visit for rheumatology service (procedure) |
| 704126008 | Home visit for anticoagulant drug monitoring (procedure) |
Outpatient Consultation
| SNOMED: | |
| Code | Description |
| 281036007 | Follow-up consultation (procedure) |
| 77406008 | Confirmatory medical consultation (procedure) |
| CPT: | |
| Code | Description |
| 99241 | Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99242 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
| 99243 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 99244 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
| 99245 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. |
Telephone Visits
| CPT: | |
| Code | Description |
| 98966 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 98967 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 98968 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| SNOMED: | |
| Code | Description |
| 185317003 | Telephone encounter (procedure) |
| 314849005 | Telephone contact by consultant (procedure) |
| 386472008 | Telephone consultation (procedure) |
| 386473003 | Telephone follow-up (procedure) |
| 401267002 | Telephone triage encounter (procedure) |
Denominator Exclusions:
Denominator exclusions include patients with a diagnosis of ESRD that overlaps the measurement period; or patients with a diagnosis of CKD Stage 5 that overlaps the measurement period; or patients whose hospice care overlaps the measurement period; or patients receiving palliative care during the measurement period.
In order to meet the requirements for this exclusion, at least one of the aforementioned must be documented in the chart and start before or during the measurement period:
This is captured by adding a diagnosis with a valid SNOMED or ICD10 code using the diagnosis widget in a note.
| SNOMED: | |
| Code | Description |
| 236434000 | End stage renal failure untreated by renal replacement therapy (disorder) |
| 236435004 | End stage renal failure on dialysis (disorder) |
| 236436003 | End stage renal failure with renal transplant (disorder) |
| 46177005 | End-stage renal disease (disorder) |
| ICD-10: | |
| Code | Description |
| N18.6 | End stage renal disease |
Chronic Kidney Disease, Stage 5 Diagnosis (ICD-10 or SNOMED) Code overlapping the measurement period
This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the diagnosis widget in a note.
| ICD-10: | |
| Code | Description |
| N18.5 | Chronic kidney disease, stage 5 |
| SNOMED: | |
| Code | Description |
| 433146000 | Chronic kidney disease stage 5 (disorder) |
Hospice Services is captured by having an Inpatient Encounter with a Discharge for Hospice Care, or a Hospice Encounter, or Hospice Care Ambulatory Procedure Ordered or Performed, or a Hospice Diagnosis, or a Hospice Assessment with a result of Yes, during the measure period. In order to meet the requirements for the Hospice exclusion, at least one of the aforementioned must be documented in the chart and start before or during the measurement period:
Inpatient Encounter (SNOMED) during the measurement period that ends with Discharge for Hospice Care (SNOMED)
This is captured by adding a procedure with a valid SNOMED code using the Procedure widget in a note.
Encounter – Inpatient
| SNOMED: | |
| Code | Description |
| 183452005 | Emergency hospital admission (procedure) |
| 32485007 | Hospital admission (procedure) |
| 8715000 | Hospital admission, elective (procedure) |
and
Discharge Code
| SNOMED: | |
| Code | Description |
| 428361000124107 | Discharge to home for hospice care (procedure) |
| 428371000124100 | Discharge to healthcare facility for hospice care (procedure) |
Hospice Encounter (SNOMED or HCPCS) during or overlapping the measurement period
This is captured by adding a procedure with a valid SNOMED code using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 183919006 | Urgent admission to hospice (procedure) |
| 183920000 | Routine admission to hospice (procedure) |
| 183921001 | Admission to hospice for respite (procedure) |
| 305336008 | Admission to hospice (procedure) |
| 305911006 | Seen in hospice (finding) |
| 385765002 | Hospice care management (procedure) |
| HCPCS: | |
| Code | Description |
| G9473 | Services performed by chaplain in the hospice setting, each 15 minutes |
| G9474 | Services performed by dietary counselor in the hospice setting, each 15 minutes |
| G9475 | Services performed by other counselor in the hospice setting, each 15 minutes |
| G9476 | Services performed by volunteer in the hospice setting, each 15 minutes |
| G9477 | Services performed by care coordinator in the hospice setting, each 15 minutes |
| G9478 | Services performed by other qualified therapist in the hospice setting, each 15 minutes |
| G9479 | Services performed by qualified pharmacist in the hospice setting, each 15 minutes |
| Q5003 | Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) |
| Q5004 | Hospice care provided in skilled nursing facility (snf) |
| Q5005 | Hospice care provided in inpatient hospital |
| Q5006 | Hospice care provided in inpatient hospice facility |
| Q5007 | Hospice care provided in long term care facility |
| Q5008 | Hospice care provided in inpatient psychiatric facility |
| Q5010 | Hospice home care provided in a hospice facility |
| S9126 | Hospice care, in the home, per diem |
| T2042 | Hospice routine home care; per diem |
| T2043 | Hospice continuous home care; per hour |
| T2044 | Hospice inpatient respite care; per diem |
| T2045 | Hospice general inpatient care; per diem |
| T2046 | Hospice long term care, room and board only; per diem |
Hospice Care Ambulatory Procedure (SNOMED, CPT, or HCPCS) during or overlapping the measurement period
This is captured by adding a procedure with a valid SNOMED, CPT, or HCPCS code using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 385763009 | Hospice care (regime/therapy) |
| 385765002 | Hospice care management (procedure) |
| CPT: | |
| Code | Description |
| 99377 | Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes |
| 99378 | Supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more |
| HCPCS: | |
| Code | Description |
| G0182 | Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more |
Hospice Diagnosis (SNOMED) during or overlapping the measure period
This is captured by adding a diagnosis with a valid SNOMED code using the Diagnosis widget in a note.
| SNOMED: | |
| Code | Description |
| 170935008 | Full care by hospice (finding) |
| 170936009 | Shared care – hospice and general practitioner (finding) |
| 305911006 | Seen in hospice (finding) |
Hospice Assessment overlapping the measure period
To qualify for the Hospice Assessment denominator exclusion, the patient must have a Hospice Assessment with a LOINC code of 45755-6 with a result finding of Yes, with a SNOMED code 373066001, that overlaps the measurement period.
This can be achieved by configuring a checklist with a Hospice Care checklist item, and then selecting that checklist item for applicable patients.
First, create or modify a procedure/result condition via Edit > System Tables > All Conditions.
In the Conditions Properties dialog, be sure to select the Procedure option and attach the 45755-6 code in the corresponding LOINC Code field.
Check the Result option, the 45755-6 code should also appear in the corresponding LOINC Code field.
Next, in the Template Editor, access the template you want to create or modify a checklist to include the Hospice Care item.
In the checklist, right click and select Insert finding…
In the Finding dialog, configure an applicable Heading; then and create Normal finding, for example Receiving Hospice Care; and then click Tag and attach the procedure/result configured above.
Click the SNOMED button and then attach the 373066001 SNOMED code to the tagged item.
After the checklist has been configured with the Hospice Care, and configured for the note template, whenever a patient is receiving hospice care, simply select this option in the checklist for the patient.
Palliative Care is captured by having a Palliative Diagnosis, or a Palliative Encounter, or a Palliative Intervention, or a Palliative Care Assessment, during or overlapping the measure period. In order to meet the requirements for the Palliative Care exclusion, at least one of the aforementioned must be documented in the chart and start before or during the measurement period:
Palliative Diagnosis (ICD10 or SNOMED) overlapping the measure period
This is captured by adding a diagnosis with a valid SNOMED or ICD10 code using the Diagnosis widget in a note.
| SNOMED: | |
| Code | Description |
| 305686008 | Seen by palliative care physician (finding) |
| 305824005 | Seen by palliative care medicine service (finding) |
| 441874000 | Seen by palliative care service (finding) |
| ICD10: | |
| Code | Description |
| Z51.5 | Encounter for palliative care |
Palliative Encounter (SNOMED or HCPCS) overlapping the measure period
This is captured by adding a procedure with a valid SNOMED or HCPCS code using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 305284002 | Admission by palliative care physician (procedure) |
| 305381007 | Admission to palliative care department (procedure) |
| 4901000124101 | Palliative care education (procedure) |
| 713281006 | Consultation for palliative care (procedure) |
| HCPCS: | |
| Code | Description |
| G9054 | Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project) |
| M1017 | Patient admitted to palliative care services |
Palliative Intervention (SNOMED) overlapping the measure period
This is captured by adding a procedure with a valid SNOMED code using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 103735009 | Palliative care (regime/therapy) |
| 105402000 | Visit of patient by chaplain during palliative care (regime/therapy) |
| 1841000124106 | Palliative care medication review (procedure) |
| 395669003 | Specialist palliative care treatment (regime/therapy) |
| 395670002 | Specialist palliative care treatment – inpatient (regime/therapy) |
| 395694002 | Specialist palliative care treatment – daycare (regime/therapy) |
| 395695001 | Specialist palliative care treatment – outpatient (regime/therapy) |
| 433181000124107 | Documentation of palliative care medication action plan (procedure) |
| 443761007 | Anticipatory palliative care (regime/therapy) |
Palliative Care Assessment overlapping the measure period
To qualify for the Palliative Assessment denominator exclusion, the patient must have a Palliative Assessment with a LOINC code of 71007-9 that overlaps the measurement period.
This can be achieved by configuring a checklist with a Palliative Care checklist item, and then selecting that checklist item for applicable patients.
First, create or modify a procedure/result condition via Edit > System Tables > All Conditions.
In the Conditions Properties dialog, be sure to select the Procedure option and attach the 45755-6 code in the corresponding LOINC Code field.
Check the Result option, the 45755-6 code should also appear in the corresponding LOINC Code field.
Next, in the Template Editor, access the template you want to create or modify a checklist to include the Hospice Care item.
In the checklist, right click and select Insert finding…
In the Finding dialog, configure an applicable Heading; then and create Normal finding, for example Receiving Palliative Care; and then click Tag and attach the procedure/result configured above.
After the checklist has been configured with the Palliative Care option, and configured for the note template, whenever a patient is receiving palliative care, simply select this option in the checklist for the patient.
Required Data Elements for the Numerator:
This is captured by:
- An electronic lab result with a valid LOINC code,
- Adding a finding with a valid LOINC code using the Checklist widget in a note,
- Adding a numeric result with a valid LOINC code using a Numeric control in a note, or
- Adding a procedure with a valid LOINC code using the procedure widget in a note.
| LOINC: | |
| Code | Description |
| 48642-3 | Glomerular filtration rate/1.73 sq M.predicted among non-blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD) |
| 48643-1 | Glomerular filtration rate/1.73 sq M.predicted among blacks [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD) |
| 50044-7 | Glomerular filtration rate/1.73 sq M.predicted among females [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD) |
| 50210-4 | Glomerular filtration rate/1.73 sq M.predicted [Volume Rate/Area] in Serum, Plasma or Blood by Cystatin C-based formula |
| 62238-1 | Glomerular filtration rate/1.73 sq M.predicted [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI) |
| 69405-9 | Glomerular filtration rate/1.73 sq M.predicted [Volume Rate/Area] in Serum, Plasma or Blood |
| 70969-1 | Glomerular filtration rate/1.73 sq M.predicted among males [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD) |
| 77147-7 | Glomerular filtration rate/1.73 sq M.predicted [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (MDRD) |
| 98979-8 | Glomerular filtration rate/1.73 sq M.predicted [Volume Rate/Area] in Serum, Plasma or Blood by Creatinine-based formula (CKD-EPI 2021) |
This is captured by:
- An electronic lab result with a valid LOINC code,
- Adding a finding with a valid LOINC code using the Checklist widget in a note,
- Adding a numeric result with a valid LOINC code using a Numeric control in a note, or
- Adding a procedure with a valid LOINC code using the procedure widget in a note.
| LOINC: | |
| Code | Description |
| 13705-9 | Albumin/Creatinine [Mass Ratio] in 24 hour Urine |
| 14585-4 | Albumin/Creatinine [Molar ratio] in Urine |
| 14958-3 | Microalbumin/Creatinine [Mass Ratio] in 24 hour Urine |
| 14959-1 | Microalbumin/Creatinine [Mass Ratio] in Urine |
| 30000-4 | Microalbumin/Creatinine [Ratio] in Urine |
| 30001-2 | Microalbumin/Creatinine [Ratio] in Urine by Test strip |
| 32294-1 | Albumin/Creatinine [Ratio] in Urine |
| 44292-1 | Microalbumin/Creatinine [Mass Ratio] in 12 hour Urine |
| 59159-4 | Microalbumin/Creatinine [Ratio] in 24 hour Urine |
| 76401-9 | Albumin/Creatinine [Ratio] in 24 hour Urine |
| 77253-3 | Microalbumin/Creatinine [Ratio] in Urine by Detection limit <= 1.0 mg/L |
| 77254-1 | Microalbumin/Creatinine [Ratio] in 24 hour Urine by Detection limit <= 1.0 mg/L |
| 9318-7 | Albumin/Creatinine [Mass Ratio] in Urine |