Ursa Health Chronic Kidney Disease Module Terms

Chronic Dialysis Episode

A period of time during which the patient can be considered to be receiving frequent, ongoing dialysis for a chronic condition. New episodes begin with an initial dialysis encounter with at least 60 days of prior negative history for dialysis and continue as long as the patient receives their next documented dialysis encounter within 60 days of the previous encounter. (The episode ends 60 days after the last dialysis encounter.) A dialysis episode qualifies as “chronic” if it contains at least one dialysis encounter performed in a dialysis facility or at home. The same dialysis episode can contain dialysis encounters in different settings, and with different dialysis modalities and vascular access types.

CKD Patient

Patients with chronic kidney disease (CKD). CKD patients are identified using the CMS Chronic Conditions Warehouse (CCW) definition, which is based on ICD-10-CM codes found in medical claim diagnoses, or by an administrative designation of the patient as an ESRD beneficiary in the CMS Monthly Membership Report. The patient’s CKD status can change over time, so a patient timeline data structure is appropriate.

Linked Terms: [URSA-CORE] Is CCW CKD

Linked Value Sets: CMS CCW CKD (URSA-CORE ICD10CM)

CKD Stage

The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate.

The following eGFR bands are used:

GFR >= 90: Stage 1;
60 <= GFR < 90: Stage 2;
30 <= GFR < 60: Stage 3;
15 <= GFR < 30: Stage 4;
GFR < 15: Stage 5.

The appropriate race-specific eGFR lab is used when the patient's race is known.

Linked Terms: Is Chronic Dialysis Patient, Kidney Transplantation Surgery Encounter

Linked Value Sets: CKD STAGE 1 (URSA-CORE ICD10CM), CKD STAGE 2 (URSA-CORE ICD10CM), CKD STAGE 3 (URSA-CORE ICD10CM), CKD STAGE 4 (URSA-CORE ICD10CM), CKD STAGE 5 (URSA-CORE ICD10CM), ESRD (URSA-CORE ICD10CM), GFR TESTS FOR BLACK PATIENTS (URSA-CKD LOINC), GFR TESTS FOR NON-BLACK PATIENTS (URSA-CKD LOINC), GFR TESTS WITHOUT PATIENT RACE SPECIFIED (URSA-CKD LOINC)

Clinician Office Visit with Nephrology Provider

A clinician office visit with a nephrologist or other clinician providing nephrology-related care. Identified by the presence of a nephrologist attending and/or service provider, or the presence of a nephrology group provider as the billing provider or provider group on the encounter.

Linked Terms: [URSA-CORE] Clinician Office Visit

Dialysis Encounter

Inpatient, outpatient, or home-based encounters during which dialysis was performed; identified via qualifying CPT/HCPCS or revenue center codes. The setting, dialysis modality, and vascular access type of the performed dialysis are identified, when possible, using CPT/HCPCS, place of service, revenue center, and type of bill codes. Instances of dialysis performed in the context of a hospital inpatient admission encounter, ED visit parent encounter, or observation stay parent encounter are also flagged.

ESRD Start Encounter

The encounter that marks the progression of a CKD patient from stage 5 or below to ESRD. There are two types of such encounters: (1) admissions with a kidney transplantation surgery performed; and (2) dialysis encounters; in all cases the patient must be found to meet the criteria for ESRD as of the encounter date, and only the first qualifying encounter in the patient’s life is included.

Is Chronic Dialysis Patient

Indicates that the patient has either (1) documentation in the last 12 months of a chronic dialysis status code; or (2) is currently undergoing regular episode as part of an episode that contains at least one non-inpatient dialysis encounter.

Linked Value Sets: CHRONIC DIALYSIS STATUS (URSA-CORE ICD10CM), DOCUMENTATION OF CHRONIC DIALYSIS STATUS (URSA-CORE HCPCS)

Is Chronic Dialysis Status Code

Indicates the presence of a code identifying the patient as currently undergoing chronic dialysis.

Linked Value Sets: CHRONIC DIALYSIS STATUS (URSA-CORE ICD10CM)

Is Document Dialysis Modality Hemodialysis

On documents for the performance of dialysis (i.e., Is Performed Dialysis Code = 1), indicates a dialysis modality of hemodialysis.

Linked Terms: Is Performed Dialysis Code

Linked Value Sets: HEMODIALYSIS MODALITY (URSA-CKD CMS_REVENUE_CENTER_CODE), HEMODIALYSIS MODALITY (URSA-CKD HCPCS)

Is Document Dialysis Setting Home

Indicates that the current document provides strong evidence that dialysis was performed at home; based on presence of either a qualifying Type of Bill Code or Place of Service code.

Is Document Dialysis Setting Inpatient

Indicates that the current document provides strong evidence that dialysis was performed in an inpatient setting; based on the presence of either a qualifying Type of Bill Code or Place of Service code. Note that hospital-based dialysis for ED or observation patients are not considered inpatient.

Is Document Dialysis Setting Outpatient Dialysis Facility

Indicates that the current document provides strong evidence that dialysis was performed in an outpatient dialysis facility; based on presence of either a qualifying Type of Bill Code or Place of Service code.

Linked Value Sets: OUTPATIENT DIALYSIS FACILITY ENCOUNTER (URSA-CORE CMS_TYPE_OF_BILL_CODE)

Is Document Dialysis Setting Outpatient Non-Dialysis Facility

Indicates that the current document suggests that dialysis was performed in an outpatient setting other than a (dedicated) dialysis facility; based on the absence of evidence for dialysis in other settings. Note that hospital-based dialysis for ED or observation patients is considered outpatient setting.

Is Performed Dialysis Code

Indicates the presence of a code for the actual performance of dialysis.

Kidney Transplantation Surgery Encounter

An encounter with a kidney transplantation surgery performed. The surgery is identified via MS-DRG, ICD-10-PCS, or CPT/HCPCS procedure code associated with a hospital inpatient admission encounter.

Linked Value Sets: KIDNEY TRANSPLANTATION (URSA-CORE HCPCS), KIDNEY TRANSPLANTATION (URSA-CORE ICD10PCS), KIDNEY TRANSPLANTATION (URSA-CORE MSDRG)

Nephrologist

A physician specializing in nephrology. Identified by the presence of a qualifying primary NUCC provider taxonomy code.

Linked Value Sets: NEPHROLOGY SPECIALTY (URSA-CKD NUCC_PROV_TAXONOMY_CODE)

Nephrology Group Provider

An organizational provider with affiliated nephrologists and/or non-nephrologist clinicians delivering nephrology-related care to patients. Identified by the presence of a qualifying primary NUCC provider taxonomy code or by an organization name containing certain key words.

Linked Value Sets: NEPHROLOGY SPECIALTY (URSA-CKD NUCC_PROV_TAXONOMY_CODE)

Patient Attribution to Nephrology Provider

A relationship between a patient and the nephrology provider (individual, group, or both) most responsible for that patient’s nephrology-related care. If the patient has received care from multiple qualifying nephrology providers or groups, the provider or group most responsible for care is determined empirically based on their history of office visits (the algorithm favors providers with the most clinician office visits in the last 2 years, up to a cap, with ties broken in favor of those with the most recent visit). The relationship can change over time, so a patient timeline data structure is used to capture those changes.
o Purpose: Used to assign performance – e.g., as reflected in a clinical quality or value measure – to the responsible nephrology provider.

Primary Care Clinician Office Visit for CKD

A primary care office visit during which CKD was addressed. Identified as primary care clinician office visits with at least one associated CKD diagnosis code.
o Purpose: Used to identify whether a patient’s CKD was managed by a primary care provider.

Linked Value Sets: CMS CCW CKD (URSA-CORE ICD10CM)

Race-Adjusted GFR Result Numeric

The GFR lab result value, expressed as a number, from the lab component appropriate for the patient's race, if known. (If the patients race is known, a result of NULL will be returned for non-race-appropriate lab components.)

Linked Value Sets: GFR TESTS FOR BLACK PATIENTS (URSA-CKD LOINC), GFR TESTS FOR NON-BLACK PATIENTS (URSA-CKD LOINC), GFR TESTS WITHOUT PATIENT RACE SPECIFIED (URSA-CKD LOINC)