Summary & Overview
HCPCS Level II M1190: Documentation Missing for Kidney Health Evaluation
HCPCS Level II code M1190 flags instances where documentation for a kidney health evaluation was not completed or did not include both an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR). Nationally, this code identifies gaps in documentation of two core laboratory measures used to assess kidney function and kidney damage. Tracking use of M1190 can inform quality improvement efforts and administrative reviews across payers.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report provides a concise overview of payer coverage approaches, common modifiers used with the code, and alignment with clinical expectations for kidney health monitoring.
Readers will learn what M1190 represents, where it is typically reported (ambulatory outpatient and primary care settings), and what documentation elements are implied by the code description. The publication also summarizes benchmarking and policy considerations relevant to national payer programs and highlights clinical context around the importance of eGFR and uACR for kidney disease identification and monitoring.
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Billing Code Overview
HCPCS Level II code M1190 indicates that documentation of a kidney health evaluation was not performed or not defined by an estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR). The service type implied is a kidney health evaluation documentation assessment, focusing on whether key laboratory measures—eGFR and uACR—were completed and recorded. The typical site of service for evaluations and related documentation is ambulatory outpatient settings or primary care clinics, where chronic kidney disease screening and monitoring commonly occur.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with long-standing type 2 diabetes mellitus and hypertension presents for an annual chronic disease follow-up in a primary care clinic. The clinician documents that a kidney health evaluation was not performed because no recent laboratory results are available and the chart lacks documentation of an estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR). The workflow: during the visit the provider reviews the problem list and notes prior microalbuminuria screening was not completed; attempts to order serum creatinine for automatic eGFR calculation and a spot urine albumin-creatinine ratio are made. The provider documents the reason testing was not performed (patient refusal, specimen not obtained, or logistical barriers). The visit is coded with the HCPCS Level II code M1190 to indicate that a kidney health evaluation was not performed or defined by eGFR and uACR documentation. Follow-up orders and patient instructions for completing labs are generated, and the clinic schedules a return or outreach for lab completion and result review.
Coding Specifications
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