CMS Revises ESRD Quality Reporting Requirements

Renal dialysis facilities will soon have new quality data reporting requirements for dialysis adequacy, infection and vascular access on all end stage renal disease (ESRD) claims. The Centers for Medicare & Medicaid Services (CMS) says the new requirements are necessary to implement an accurate quality incentive payment for dialysis providers in the near future.

MLN Matters article MM6782 informs renal dialysis facilities (RDFs) that Change Request (CR) 6782 requires new quality data reporting on all ESRD and ESRD hemodialysis claims with service dates on or after July 1.

In addition to the monthly measurement for hemoglobin or hematocrit as a measure of anemia management and urea reduction ratio (URR) as a measure of hemodialysis adequacy reported via ESRD claims, RDFs will be required to report the Kt/V (K-dialyzer clearance of urea; t-dialysis time; V-patient’s total body water) reading and date of reading, vascular access, and infection data.

Note: The National Quality Forum (NQF) granted time-limited endorsement of URR for hemodialysis patients. Providers should continue reporting the existing G1-G6 modifiers for URR at this time.

Claim level codes required on all ESRD claims with service dates on or after July 1:

  • Value code D5: Result of last Kt/V reading. For in-center hemodialysis patients, this is the last reading taken during the billing period. For peritoneal dialysis patients (and home hemodialysis patients), this may be before the current billing period but should be within four months of the claim service date.
  • Occurrence code 51: Date of last Kt/V reading. For in-center hemodialysis patients, this is the date of the last reading taken during the billing period. For peritoneal dialysis patients (and home hemodialysis patients), this date may be before the current billing period but should be within four months of the claim service date.

If a Kt/V test is not performed, the provider must state as such by reporting value code D5 with a 9.99 value and not reporting occurrence code 51. Note that Medicare will return 72x bill types with a service date on or after July 1 that do not contain occurance code 51, except where there is a D5 value of 9.99.

Report these line level codes on dialysis revenue code lines:

  • Modifier V8: Infection present
  • Modifier V9: No infection present

Revised CR 6782 clarifies that Medicare systems will return claims with service dates on or after July 1 when either of these two modifiers is not present on each dialysis revenue code line (0821, 0831, 0841, or 0851).

Report these line level codes on hemodialysis revenue code lines:

  • Vascular Access for ESRD Hemodialysis Patients: An indicator of the vascular access used at the last hemodialysis session of the month. The code is required to be reported on the latest line item service date billing for hemodialysis revenue code 0821. It may be reported on all revenue code 0821 lines at the discretion of the provider.
  • Modifier V5: Any vascular catheter (alone or with any other vascular access)
  • Modifier V6: Arteriovenous graft (or other vascular access not including a vascular catheter)
  • Modifier V7: Arteriovenous fistula only (in use with two needles)

Medicare systems will return claims with service dates on or after July 1 for hemodialysis when the latest line item service date billing for revenue code 0821 does not contain one of these HCPCS Level II modifiers. Note that modifiers V5-V7 are effective Jan. 1. Providers may voluntarily report these modifiers for claims with service dates Jan. 1 through July 1.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires CMS to implement an accurate quality incentive payment for dialysis providers by Jan. 1, 2012.

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