CMS SOM App. H, Tag V504

The patient’s comprehensive assessment must

include, but is not limited to, the following: evaluation of the appropriateness of the…blood

pressure, and fluid management needs.

Interpretive Guidance §494.80(a)(2)

Note: this guidance is a continuation of the requirement at §494.80(a)(2)

Because of the adverse effects of ESRD, many patients experience spontaneous changes of blood

pressure and fluid management needs, the management of which may require reassessment of

medication needs, adjustments in target weight, and changes to the plan of care.

The comprehensive assessment should include evaluation of the patient’s pre/intra/post and

interdialytic blood pressures, interdialytic weight gains, target weight, and related intradialytic

symptoms (e.g., hypertension, hypotension, muscular cramping) along with an analysis for

potential root causes.

For pediatric patients weighing less than 35 kg., blood volume monitoring during hemodialysis

should be available in order to evaluate body weight changes for gains in muscle weight vs. fluid

overload.

Citation should not be based solely on the patient’s clinical results for blood pressure and fluid

management. Any deficiency in this area must be supported by the facility’s lack of

identification and assessment of the patient’s hemodynamic status and/or failure to develop or

implement an appropriate plan to help meet the patient’s needs.