Description of Measure | CKD Status (No CKD/ESRD, CKD not ESRD, and ESRD) diagnosed by ICD-9-CM or ICD-10-CM codes, stratified by age, race/ethnicity, gender, diabetes diagnosis and hypertension diagnosis |
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Data Source | Centers for Medicare and Medicaid Services |
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Type of Data Source | Administrative |
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Data Set | Medicare National 5% Sample |
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Health Care System Data | Yes |
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Regional or National? | National |
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Demographic Group | Patients aged 65 years or older using fee-for-service Medicare |
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Numerator | Patients in denominator by CKD Status (No CKD/ESRD, CKD not ESRD, and ESRD) determined by a diagnosis from an outpatient, inpatient or carrier claim by any of the ICD-9-CM or ICD-10-CM CKD codes listed in the FIeld/DATA tab or identified as having ESRD. |
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Denominator | Patients aged 65 years or older with full-year Part A and B enrollment and at least one outpatient visit in the calendar year, within the specified stratification category |
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Primary Data Source Indicator | Diagnosis code from inpatient, outpatient or carrier visit |
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Primary Indicator Method of Measurement | Medical claim |
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Secondary (1) Variable | Age at the end of the previous calendar year |
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Secondary (2) Variable | Race/ethnicity |
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Secondary (3) Variable | Sex/gender |
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Secondary (4) Variable | Diabetes status determined by the presence of an ICD-9-CM code (250.x, 357.2, 362.01, 362.02 or 366.41) or ICD-10-CM code (E08.3xx, E08.4xx, E09.3xx, E09.4xx, E10.xxx, E11.xxx, E13.0x, E13.1x, E13.2x, E13.3xx, E13.4x, E13.5x, E13.6xx, E13.8, E13.9) for diabetes or diabetic complications on at least one inpatient, outpatient or carrier claim during the given calendar year. |
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Secondary (5) Variable | Hypertension status determined by the presence of an ICD-9-CM code (401.x through 405.x) or ICD-10 code (H35.03x, I10.xx, I11.xx, I12.xx, I13.xx, I15.xxx, I67.4, N26.2) for hypertension on at least one inpatient, outpatient or carrier claim during the given calendar year. |
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Period Currently Available | 2018 |
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Limitations of Indicator | As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate the level of chronic kidney disease in the general population. |
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Analytical Considerations | In published literature, disease is diagnosed by ICD-9-CM or ICD-10-CM codes in alternate ways (one outpatient; two or more outpatient or one inpatient). Care must be taken in comparisons. |
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ICD-10-CM Codes for CKD | A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 |
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ICD-9-CM Codes for CKD | Description of code |
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16 | Tuberculosis of kidney of kidney |
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95.4 | Syphilis of kidney |
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189 | Malignant neoplasm of kidney except pelvis |
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189.1 | Malignant neoplasm of renal pelvis |
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189.9 | Malignant neoplasm of urinary organ site unspecified |
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236.91 | Neoplasm of uncertain behavior of kidney and ureter |
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250.4 | Diabetes mellitus with renal manifestations type II or unspecified type not stated as uncontrolled |
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250.41 | Diabetes mellitus with renal manifestations type I not stated as uncontrolled |
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250.42 | Diabetes mellitus with renal manifestations type II or unspecified type uncontrolled |
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250.43 | Diabetes mellitus with renal manifestations type I uncontrolled |
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271.4 | Renal glycosuria |
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274.1 | Gouty nephropathy |
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283.11 | Hemolytic-uremic syndrome |
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403 | Malignant hypertensive renal disease without renal failure |
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403.01 | Malignant hypertensive renal disease with renal failure |
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403.1 | Benign hypertensive renal disease without renal failure |
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403.11 | Benign hypertensive renal disease with renal failure |
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403.9 | Unspecified hypertensive renal disease without renal failure |
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403.91 | Unspecified hypertensive renal disease with renal failure |
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404 | Malignant hypertensive heart and renal disease without heart failure or renal failure |
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404.01 | Malignant hypertensive heart and renal disease with heart failure |
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404.02 | Malignant hypertensive heart and renal disease with renal failure |
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404.03 | Malignant hypertensive heart and renal disease with heart failure and renal failure |
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404.1 | Benign hypertensive heart and renal disease without heart failure or renal failure |
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404.11 | Benign hypertensive heart and renal disease with heart failure |
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404.12 | Benign hypertensive heart and renal disease with renal failure |
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404.13 | Benign hypertensive heart and renal disease with heart failure and renal failure |
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404.9 | Unspecified hypertensive heart and renal disease without heart failure or renal failure |
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404.91 | Unspecified hypertensive heart and renal disease with heart failure |
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404.92 | Unspecified hypertensive heart and renal disease with renal failure |
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404.93 | Unspecified hypertensive heart and renal disease with heart failure and renal failure |
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405.01 | Malignant renovascular hypertension |
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440.1 | Atherosclerosis of renal artery |
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442.1 | Aneurysm of renal artery |
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447.3 | Hyperplasia of renal artery |
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453.3 | Embolism and thrombosis of renal vein |
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572.4 | Hepatorenal syndrome |
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580 | Acute glomerulonephritis with lesion of proliferative glomerulonephritis |
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580.4 | Acute glomerulonephritis with lesion of rapidly progressive; glomerulonephritis |
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580.81 | Acute glomerulonephritis in diseases classified elsewhere |
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580.89 | Acute glomerulonephritis with other specified pathologicallesion in kidney |
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580.9 | Acute glomerulonephritis with unspecified pathological lesion in kidney |
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581 | Nephrotic syndrome with lesion of proliferative glomerulonephritis |
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581.1 | Nephrotic syndrome with lesion of membranous glomerulonephritis |
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581.2 | Nephrotic syndrome with lesion of membranoproliferative glomerulonephritis |
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581.3 | Nephrotic syndrome with lesion of minimal change glomerulonephritis |
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581.81 | Nephrotic syndrome in diseases classified elsewhere |
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581.89 | Other nephrotic syndrome with specified pathological lesion in kidney |
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581.9 | Nephrotic syndrome with unspecified pathological lesion in kidney |
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582 | Chronic glomerulonephritis with lesion of proliferative glomerulonephritis |
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582.1 | Chronic glomerulonephritis with lesion of membranous glomerulonephritis |
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582.2 | Chronic glomerulonephritis with lesion of membranoproliferative glomerulonephritis |
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582.4 | Chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis |
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582.81 | Chronic glomerulonephritis in diseases classified elsewhere |
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582.89 | Other chronic glomerulonephritis with specified pathological lesion in kidney |
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582.9 | Chronic glomerulonephritis with unspecified pathological lesion in kidney |
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583 | Nephritis and nephropathy not specified as acute or chronic with lesion of proliferative glomerulonephritis |
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583.1 | Nephritis and nephropathy not specified as acute or chronic with lesion of membranous glomerulonephritis |
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583.2 | Nephritis and nephropathy not specified as acute or chronic with lesion of membranoproliferative glomerulonephritis |
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583.4 | Nephritis and nephropathy not specified as acute or chronic with lesion of rapidly progressive glomerulonephritis |
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583.6 | Nephritis and nephropathy not specified as acute or chronic with lesion of renal cortical necrosis |
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583.7 | Nephritis and nephropathy not specified as acute or chronic with lesion of renal medullary necrosis |
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583.81 | Nephritis and nephropathy not specified as acute or chronic in diseases classified elsewhere |
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583.89 | Other nephritis and nephropathy not specified as acute or chronic with specified pathological lesion in kidney |
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583.9 | Nephritis and nephropathy not specified as acute or chronic with unspecified pathological lesion in kidney |
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584.5 | Acute renal failure with lesion of tubular necrosis |
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584.6 | Acute renal failure with lesion of renal cortical necrosis |
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584.7 | Acute renal failure with lesion of renal medullary (papillary) necrosis |
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584.8 | Acute renal failure with other specified pathological lesion in kidney |
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584.9 | Acute renal failure unspecified |
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585.x | Chronic Kidney Disease (CKD)
585.1 Stage 1 585.2 Stage 2 585.3 Stage 3 585.4 Stage 4
585.5 Stage 5 (excluding dialysis) 585.6 End Stage Renal Disease
585.9 Chronic kidney disease, unspecified |
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586 | Renal failure unspecified |
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587 | Renal sclerosis unspecified |
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588 | Renal osteodystrophy |
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588.1 | Nephrogenic diabetes insipidus |
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588.81 | Secondary hyperparathyroidism (of renal origin) |
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588.89 | Other specified disorders resulting from impaired renal function |
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588.9 | Unspecified disorder resulting from impaired renal function |
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589 | Small kidney of unknown cause |
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590 | Chronic pyelonephritis |
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590.8 | Other pyelonephritis or pyonephrosis not specified as acute or chronic |
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591 | Hydronephrosis |
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593.1 | Hypertrophy of kidney |
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593.3 | Stricture or kinking of ureter |
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593.4 | Other ureteric obstruction |
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593.5 | Hydroureter |
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593.6 | Postural proteinuria |
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593.7 | Vesicoureteral reflux |
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593.81 | Pyelitis or pyelonephritis in diseases classified elsewhere |
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593.89 | Other specified disorders of kidney and ureter |
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593.9 | Unspecified disorder of kidney and ureter |
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642.1 | Hypertension secondary to renal disease complicating pregnancy childbirth and the puerperium |
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646.2 | Unspecified renal disease in pregnancy without mention of hypertension |
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753 | Renal agenesis and dysgenesis |
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753.1 | Cystic kidney disease unspecified |
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753.11 | Congenital single renal cyst |
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753.12 | Polycystic kidney unspecified type |
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753.13 | Polycystic kidney autosomal dominant |
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753.14 | Polycystic kidney autosomal recessive |
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753.15 | Renal dysplasia |
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753.16 | Medullary cystic kidney |
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753.17, | Medullary sponge kidney |
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753.19 | Other specified cystic kidney disease |
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753.2 | Unspecified obstructive defect of renal pelvis and ureter |
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753.21 | Congenital obstruction of ureteropelvic junction |
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753.22 | Congenital obstruction of ureterovesical junction |
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753.23 | Congenital ureterocele |
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753.29 | Other obstructive defect of renal pelvis and ureter |
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753.3 | Other specified anomalies of kidney |
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794.4 | Nonspecific abnormal results of function study of kidney |
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