Description of Measure | Percentage of Medicare Advantage Clinformatics patients by age, race/ethnicity, gender, diabetes diagnosis and hypertension diagnosis |
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Data Source | Medicare Advantage Clinformatics from Optum Clinformatics data mart database (OptumInsight, Eden Prairie, MN) |
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Type of Data Source | Administrative |
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Data Set | Medicare Advantage Clinformatics enrollees aged 65 years or older |
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Health Care System Data | Yes |
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Regional or National | Regional |
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Demographic Group | Patients aged 65 years or older enrolled in Medicare Advantage Clinformatics insurance |
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Numerator | Patients in denominator by age, race/ethnicity, sex/gender, diabetes status and hypertension status |
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Denominator | Patients aged 65 years or older with a full year of enrollment in a given calendar year |
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Primary Data Source Indicator | Diagnosis code from inpatient and outpatient files |
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Primary Indicator Method of Measurement | Medical claim |
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Secondary (1) Variable | Age in years at the end of the current 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 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 |
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Secondary (5) Variable | Hypertension 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. |
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Period Currently Available | 2016 |
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Limitations of Indicator | The use of an ICD-9-CM or ICD-10-CM diagnosis code as a measure of prevalence, will underestimate the level of diabetes or hypertension in the general population |
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Analytical Considerations | In published literature, CKD is diagnosed by ICD-9-CM or ICD-10-CM codes in alternate ways (one outpatient, two or more outpatient or one inpatient claim). Care must be taken in comparisons. |
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ICD-9-CM Codes for CKD | 016.0, 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 |
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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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