PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS. HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate
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1 PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate Measure Title Description Measure Type Data Source Level of Analysis Numerator HRS-3: Implantable Cardioverter-Defibrillator (ICD) Complications Rate Physician-specific risk-standardized rates of procedural complications following the implantation of an ICD. Outcome Electronic administrative data/claims, registry data, Medicare enrollment data Physician Number of patients from the denominator with one or more of the following complications or mortality within 30 or 90 days (depending on the complication) following ICD implantation. Complications measured for 30 days: 1. Death 2. Pneumothorax or hemothorax plus a chest tube 3. Hematoma plus a blood transfusion or evacuation 4. Cardiac tamponade or pericardiocentesis Denominator Statement Exclusions Risk Adjustment Complications measured for 90 days: 5. Mechanical complications requiring a system revision 6. Device related infection 7. Additional ICD implantation All inpatient and outpatient ICD implants for Medicare Fee-For-Service (FFS) beneficiaries at least 65 years of age at the time of implantation who have matching information in the National Cardiovascular Disease Registry (NCDR) ICD Registry. 1. Non-Medicare FFS patients. 2. Claims that are not the first in the same claim bundle. 3. Patient stays that lack 90 days of Medicare FFS enrollment post-discharge. 4. Patients with prior ICD implantation. 5. Patient with prior pacemaker implantation Hierarchical logistic regression. Risk adjustment variables: 1. Age (10-year increments) 2. Gender 3. Reason admitted for this procedure (cardiac vs. non-cardiac) 4. New York Heart Association (NYHA) Class Current Status NYHA I
2 Reporting NYHA II NYHA III NYHA IV 5. Previous Coronary Artery Bypass Graft (CABG) 6. Chronic Lung Disease 7. Hypertension 8. Renal Failure, Dialysis 9. Atrioventricular Conduction (AVC) Normal Abnormal 1 st Degree Heart Block Only Abnormal 2 nd /3 rd Degree Heart Block Paced (any) 10. BUN >30mg/dl 11. Sodium <135mg/dl 135 to 145mg/dl >145mg/dl 12. Systolic Blood Pressure <100mmHG 13. ICD Type Single Chamber Dual Chamber Biventricular The reporting time window can be specified from one to three years. 2
3 CODE KEY Diagnosis/Procedure ICD-9 Codes CPT Codes DENOMITOR Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (crt-p) 0.5 Implantation of cardiac resynchronization defibrillator, total system (crt-d) 0.51 Implantation of replacement of transvenous lead (electrode) into left ventricular coronary venous system 0.52 Implantation or replacement of cardiac resynchronization pacemaker pulse generator only (crt-p) 0.53 Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only (crt-d) 0.54 Implantation or replacement of automatic cardioverter/defibrillator, total system (aicd) Insertion, single chamber transverse electrode ICD Insertion, dual chamber transverse electrode ICD Repair, single chamber transverse electrode ICD Repair, dual chamber transverse electrode ICD Pocket revision ICD Initial pulse generator insertion only with existing dual leads Initial pulse generator insertion only Insertion of single or dual chamber ICD pulse generator Removal of single or dual chamber ICD pulse generator Insertion or repositioning of electrode lead(s) for single or dual chamber pacing ICD and insertion of pulse generator Removal pulse generator with replacement pulse generator only single lead system (transvenous) Removal pulse generator with replacement pulse generator only dual lead system (transvenous) Removal pulse generator with replacement pulse generator only multiple lead system (transvenous)
4 NUMERATOR Complications Measured for 30 Days (1) Death Medicare enrollment data (2) Pneumothorax (requires code for chest tube [2a] for inclusion in numerator) 512, (2) Hemothorax (requires code for chest tube [2a] for inclusion in numerator) (2a) Chest tube (requires code[s] for pneumothorax and/or hemothorax for inclusion in numerator) (3) Hematoma complicating a procedure (requires code for blood transfusion [3a] and/or hematoma evacuation [3b] for inclusion in numerator) (3a) Blood transfusion (requires code for hematoma complicating a procedure for inclusion in numerator) 34.04, 34.05, 34.06, (procedure codes) 998.1, , 287.4, V59.01, V58.2 (diagnosis codes) or 99.00, 99.03, (procedure codes) (3b) Hematoma evacuation (requires code for hematoma complicating a procedure for inclusion in numerator) 34.04, (4a) Cardiac tamponade OR (4b) Pericardiocentesis Complications Measured for 90 Days (5) Mechanical complications requiring a system revision (6) Device-related infection (7a) Additional ICD implantation (inpatient or outpatient) A. Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system (crt-p) 420, 423.0, 423.3, , (procedure codes) 996.0, (diagnosis AND any of the following procedure codes: 37.75, 37.77, 37.79, 37.94, 37.97, 37.99, 39.94, (diagnosis (procedure 4
5 B. Implantation of cardiac resynchronization defibrillator, total system (crt-d) C. Implantation or replacement of transvenous lead (electrode) into left ventricular coronary venous system D. Implantation or replacement of cardiac resynchronization pacemaker pulse generator only (crt-p) E. Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only (crt-d) F. Implantation or replacement of automatic cardioverter/defibrillator, total system (aic) (7b) Additional ICD implantation (outpatient) (procedure (procedure (procedure (procedure (procedure A. Insertion, single chamber transverse electrode ICD B. Insertion, dual chamber transverse electrode ICD C. Repair, single chamber transverse electrode ICD D. Repair, dual chamber transverse electrode ICD E. Pocket revision ICD F. Initial pulse generator insertion only with existing dual leads G. Initial pulse generator insertion only H. Insertion of single or dual chamber ICD pulse generator I. Removal of single or dual chamber ICD pulse generator H. Insertion or repositioning of electrode lead(s) for single or dual chamber pacing ICD and insertion of pulse generator J. Removal pulse generator with replacement pulse generator only single lead system (transvenous) K. Removal pulse generator with replacement pulse generator only dual lead system (transvenous) L. Removal pulse generator with replacement pulse generator only multiple lead system (transvenous) Paroxysmal tachycardia, unspecified Atrial flutter Wolf-Parkinson-White syndrome Nonparoxysmal atrioventricular nodal tachycardia Atrioventricular nodal reentrant tachycardia
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