CMS SOM App. H, Tag V508

The patient’s comprehensive assessment must

include, but is not limited to, the following: (5) Evaluation of factors associated with renal

bone disease.

Interpretive Guidance §494.80(a)(5)

Disturbances in mineral and bone metabolism are common in patients with ESRD, often

resulting in hyperparathyroidism and Chronic Kidney Disease (CKD) mineral and bone disorder

if not managed effectively.

Evaluation should include the patient’s laboratory values for calcium, phosphorous, and

parathyroid hormone (PTH), along with a review of the patient’s current CKD mineral and bone

disorder medications (e.g. phosphate binders, vitamin D analogs, calcimimetic agents), over-the-counter medications, dietary factors, and medical conditions that may impact this issue.

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Pediatric patients present significant special needs in the areas of growth and development and

CKD mineral and bone disorder. A facility treating pediatric patients should follow current

professionally-accepted clinical practice standards for evaluating and monitoring the pediatric

patient population in this area.

Citation should not be based solely on the patient’s clinical laboratory results for disturbances

in mineral and bone metabolism, e.g. phosphorus and calcium levels. Any deficiency for mineral

and bone metabolism management must be supported by the facility’s lack of identification and

assessment of the patient’s metabolic status and/or failure to develop or implement an

appropriate plan to help meet the patient’s needs.

Requirements for the plan of care for CKD mineral and bone disorder management are at V546.