Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Eligible Population:
Members 18 and 85 years of age as of December 31 of the measurement year.

Definition:
Percentage of members 18–85 years of age with diabetes (type 1 and type 2) as of December 31 of the measurement year  who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year.

Reports three age stratifications and a total rate:

• 18-64
• 65-75
• 76-85
• Total. The total is the sum of the age stratifications.

New for Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• The measurement year.

Best Practice and Measure Tips

• Requires both an eGFR and a uACR during the measurement year on the same or different dates of service:
  • Routinely refer members with a diagnosis of diabetes for both eGFR and uACR.  A quantitative urine albumin test and a urine creatinine test require service dates four or less days apart.
• Follow up with patients to discuss and educate on lab results
• Educate on how diabetes can affect the kidneys and offer tips to your patients on preventing damage to their kidneys
• Controlling their blood pressure, blood sugars, cholesterol, and lipid levels
• Take medications as prescribed that can protect kidney function (ACE inhibitors or ARBs)
• Offer education on medications that could be harmful to the kidneys (NSAIDs such as naproxen or ibuprofen)
• Limit protein intake and salt in diet
• Coordinate care with specialists such as an endocrinologist or nephrologist as needed.

Measure Exclusions

Required Exclusions:

• ESRD 
• Dialysis
• Palliative Care
• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Frailty
• Frailty and Advanced Illness
• Living in Long Term Care     

Measure Codes

There is a large list of approved NCQA codes used to identify the services included in the KED measure. The following are just a few of the approved codes.

• Estimated Glomerular Filtration Rate Lab Test
  • CPT: 80047, 80048, 80050, 80053, 80069, 82565
• Quantitative Urine Albumin Lab Test
  • CPT: 82043
  • LOINC: 100158-5, 14957-5, 1754-1, 21059-1, 30003-8, 43605-5, 53530-2, 53531-0, 57369-1, 89999-7
• Urine Albumin Creatinine Ratio (uACR) Lab Test
  • LOINC: 13705-9, 14958-3, 14959-1, 30000-4, 44292-1, 59159-4, 76401-9, 77253-3, 77254-1, 89998-9, 9318-7
• Urine Creatinine Lab Test
  • CPT: 82570
  • LOINC: 20624-3, 2161-8, 35674-1, 39982-4, 57344-4, 57346-9, 58951-5

Medication List: Diabetes Medications