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Indicator Details: Percentage of Patients with an ICD-9-CM or ICD-10-CM Code Indicating CKD
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The overall unadjusted percentage of patients with a CKD code (ICD-9-CM or ICD-10-CM diagnosis code, excluding ESRD) has slightly increased in the last decade, for patients age 65 or older enrolled in Clinformatics Medicare Advantage insurance.
Chart Explanation: These charts show the increasing prevalence of CKD diagnosed byICD-9-CM or ICD-10-CM codes in the CMS-Medicare data by age and year of observation, ICD-9-CM or ICD-10-CM code or CKD risk factor (gender, race, diabetes, or hypertension) status.
The Clinformatics™ Medicare Advantage dataset provides paid medical and prescription claims and enrollment information for participants in Medicare Advantage plans of a large U.S. managed care health insurance company.

CKD is defined using ICD-9-CM or ICD-10-CM diagnosis codes, and ESRD is based on International Classification of Diseases (ICD) diagnosis, Current Procedural Terminology (CPT) procedure, and Diagnosis Related Group (DRG) codes in the Clinformatics Medicare Advantage.
Description of MeasurePrevalence of clinically diagnosed CKD (by ICD-9-CM or ICD-10-CM codes) and ESRD stratified by age, race/ethnicity, gender, diabetes diagnosis and hypertension diagnosis.
Data SourceClinformatics Medicare Advantage from Optum Clinformatics™ Data Mart Database (OptumInsight, Eden Prairie, MN)
Type of Data SourceAdministrative
Data SetClinformatics Medicare Advantage enrollees age 65 or older.
Health Care System DataYes.
Regional or NationalRegional.
Demographic GroupPatients age 65 or older enrolled in Medicare Advantage insurance.
NumeratorPatients in denominator with diagnosed CKD from one inpatient or two outpatient claims by any of the ICD-9-CM or ICD-10-CM CKD codes listed below or identified as having ESRD.
DenominatorPatients age 65 or older with full year of enrollment in a given calendar year.
Primary Data Source IndicatorDiagnosis code from inpatient and outpatient files.
Primary Indicator Method of MeasurementMedical claim.
Secondary (1) VariableAge in years at the end of the current calendar year.
Secondary (2) VariableRace/ethnicity
Secondary (3) VariableSex/Gender
Secondary (4) VariableDiabetes status determined by the presence of an ICD-9-CM or ICD-10-CM code for diabetes or diabetic complications, on at least one inpatient, outpatient or medical services claim during a given calendar year.
Secondary (5) VariableHypertension status determined by the presence of an ICD-9-CM or ICD-10-CM code for hypertension on at least one inpatient, outpatient or medical services claim during a given calendar year.
Period Currently Available2016
Limitations of IndicatorThe use of ICD-9-CM or ICD-10-CM diagnosis code as measure of prevalence, will underestimate the level of chronic kidney disease in the general population.
Analytical ConsiderationsIn 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.
ICD-9-CM Codes for CKD016.0; 095.4; 189.0,189.9; 223.0; 236.91; 250.4; 271.4; 274.1; 283.11; 403; 404; 440.1; 442.1; 477.3; 572.4; 581-588; 591; 642.1; 646.2; 753.12-753.19; 753.2; 794.4
ICD-10-CM Codes for CKDA18.11, 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

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd