Provider Awareness of CKD
Percentage of patients with CKD with ICD-9-CM codes for CKD by diabetes diagnosis

National VA data were examined. Within each VISN (Veterans Integrated Service Network), a 5% random sample of patients was extracted from the national VA data repository each fiscal year (FY) from FY2005 to FY2009. Starting in FY2010 and continuing in future years, analyses were performed on the entire patient population (100% sample). "Patients with CKD" was defined by estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m² using the four-variable MDRD study formula, excluding dialysis and transplant patient, based on outpatient serum creatinine laboratory results (averaged if a patient had more than one test during the fiscal year). Inpatient serum creatinine data were not used as they would be influenced by presence of acute illnesses. Due to the infrequency of testing, albuminuria was not included in the definition of CKD. ICD-9-CM diagnosis codes used to define CKD are listed below. Dialysis patients were defined by clinic stop-codes (602-611), outpatient procedure codes for dialysis (CPT4: 90921 and 90925), outpatient diagnosis codes (ICD-9-CM: V56, V451 and E8791) and inpatient and outpatient diagnosis codes (ICD-9-CM: 5856) to indicate dialysis. Kidney transplant patients were identified by inpatient and outpatient ICD-9-CM diagnosis code V420 and inpatient procedure code 5569. These graphs/tables exclude ESRD patients (dialysis and transplant).

Overall, for VA patients with evidence of CKD stages 3-5 based on available outpatient serum creatinine values, the percent who also had an ICD-9-CM diagnosis code for CKD increased over time from 27% in 2005 to 39% in 2011.

This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.