Hospital Industry Data Institute ICD-10 Transitional Strategy

Transcription

1 Hospital Industry Data Institute ICD-1 Transitional Strategy DELAY IN ICD-1 SOFTWARE READINESS AFFECTING SELECT INDICATORS: ISSUES IDENTIFIED AND PRODUCT IMPACT ISSUES IDENTIFIED Q: What ICD-1 transition and readiness issues are being considered? A: Hospitals transitioned to using ICD-1 diagnosis and procedure codes for all administrative claims effective Oct. 1, 215. The Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services have not yet released ICD-1 compliant versions of software programs used to produce risk-adjusted measures of quality, safety and readmissions used in a number of reports produced by HIDI. Q: What HIDI reports and deliverables are impacted? A: All internal and external HIDI reporting and analytic deliverables involving risk-adjusted AHRQ indicators and 3-day readmissions for discharges dated Oct. 1, 215, forward, including reports available on HIDI Analytic Advantage and HIDI Analytic Advantage PLUS, as well as transparency initiative reporting displayed on the Focus on Hospitals website. Q: How will the delayed availability of ICD-1 ready software impact these products? A: In the absence of action, risk-adjusted reporting of impacted reports and deliverables for ICD- 1 coded discharges would be suspended until ICD-1 ready software versions are made available by AHRQ and CMS. PRODUCT IMPACT Q: What is the plan for affected products? A: To provide continued support and delivery for affected measures, HIDI will use the GEM ICD- 1 to ICD-9 crosswalk provided by CMS to backmap ICD-1 coded discharges to comparable ICD-9 codes to the extent necessary to enable use of available software to produce riskadjusted rates. For readmission measures, this means that selection criteria for conditionspecific cohorts will be based on submitted ICD-1 codes that are then backmapped to ICD-9 codes. Condition codes used for risk-adjustment purposes will be based on all submitted ICD- 1 codes backmapped to comparable ICD-9 codes. For AHRQ indicators, condition codes used to produce risk-adjusted calculations will be based on ICD-1 codes backmapped to comparable ICD-9 codes using the GEM crosswalk. AHRQ s risk-adjusted calculations will continue to be based on expected rates calculated from 212 nation data for the foreseeable future. Hospital Industry Data Institute 1 Revised July 216

2 Hospital Industry Data Institute ICD-1 Transitional Strategy Q: What is the overall timeline for the strategy with impacted products to take effect? A: Programming and preparation to operationalize the strategy with impacted reporting is complete, and scheduled to take effect with the April release of reports. HIDI plans to continue with this strategy until ICD-1 ready versions of affected programs are made available and fully evaluated. Q: Are there specific things that report users need to consider once reporting with the transitions to ICD-1 coded data? A: The transition to ICD-1 is a significant change that has numerous implications for measures and reporting based on administrative billing codes. Changes in measured performance corresponding with the Oct. 1, 215, transition to ICD-1 should be evaluated carefully and interpreted with caution. The HIDI team has processes and plans in place to monitor measures through this transition with the aim of identifying systematic trends resulting from the transition. As always, we encourage report users to contact a HIDI representative if you have questions or concerns about measured performance. CUSTOMER SUPPORT AND EDUCATION Q: Will there be supporting client documentation for this ICD-1 readiness change? A: AHRQ and readmission detail methodology will be provided upon request. Q: Will there be any special training for HIDI users around this to ICD-1 readiness? A: While no special training for HIDI users will be needed to support these changes, HIDI is planning a small number of webinars to discuss strategies with ICD-1 affected reports and provide a forum for questions and feedback. As always, we encourage all our stakeholders to contact a HIDI representative by phone or with questions or concerns. Q: Will HIDI provide a mapping between ICD-9 and ICD-1? A: The GEM ICD-1 to ICD-9 crosswalk, as well as other information regarding GEM coding, can be found on CMS website. Q: With the transition to ICD-1, how will HIDI reporting support trending analyses? A: The transition to ICD-1 is a significant change with numerous implications for measures and reporting based on administrative billing codes. Changes in measured performance corresponding with the Oct. 1, 215 transition to ICD-1 should be evaluated carefully and interpreted with caution. The HIDI team has processes and plans in place to monitor measures through this transition with the aim of identifying systematic trends resulting from the transition. As always, we encourage report users to contact a HIDI representative if you have questions or concerns about measured performance. Q: Who should I contact with questions? A: Contact a HIDI representative. Hospital Industry Data Institute 2 Revised July 216

3 Hospital Industry Data Institute ICD-1 Transitional Strategy TECHNICAL MANUAL ICD-1 TRANSITIONAL ACTIVITIES FOR READMISSION REPORTING Hospitals transitioned to using ICD-1 diagnosis and procedure codes for all administrative claims effective Oct. 1, 215. The Centers for Medicare & Medicaid Services has not yet released ICD-1 compliant versions of the software program used to produce risk-adjusted readmissions measures. However, CMS did provide a list of ICD-1 codes that they expect to be representative of the readmissions measures going forward. HIDI extracted records including appropriate ICD-1 codes, back-mapped those records using GEM coding to display ICD-9 codes, and used the ICD-9 compliant model to produce readmissions reports. HIDI plans to continue with this strategy until ICD-1 ready versions of affected programs are made available and fully evaluated. The transition to ICD-1 is a significant change that has numerous implications for measures and reporting based on administrative billing codes. Changes in measured performance corresponding with the Oct. 1, 215, transition to ICD-1 should be evaluated carefully and interpreted with caution. The HIDI team has processes and plans in place to monitor measures through this transition with the aim of identifying systematic trends resulting from the transition. GENERAL INFORMATION HIDI readmissions reports present hospital-specific readmission measures for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, stroke, hip/knee and pneumonia patients ages 18 and older residing in the state, with any payer. Hospital-wide readmissions also are included. Risk-adjusted metrics are considered unreliable for providers with fewer than 25 total readmissions during the 36-month period. The measures are developed by applying the methods used by the Centers for Medicare & Medicaid Services for public reporting and determining reimbursement penalties under the Hospital Readmission Reduction Program to the most recently-available 36 months of hospital discharge data. Data Steward: HIDI Custom Measure and the Centers for Medicare & Medicaid Services. Data Source: Discharge claims data Exclusions: Patient deaths, transfer patients, admissions with zero days to subsequent hospitalization, patients who leave against medical advice, obstetric and non-acute patients are excluded from the model cohorts, as are readmissions flagged by the CMS/Yale Planned Readmission Algorithm. Patient deaths are identified by discharge disposition codes of 2-Expired, 4-Expired at Home, 41-Expired in a Medical Facility, and 42-Expired in an Unknown Place. Transfer patients are identified by discharge disposition code 2-Short-Term General Hospital for Inpatient Care. Transfer Hospital Industry Data Institute 3 Revised July 216

4 Hospital Industry Data Institute ICD-1 Transitional Strategy patient records are removed from the transferring facility and assigned to the final receiving facility. Zero-day patients are identified if the admission date is equal to the previous discharge date. Selfdischarges AMA are identified by discharge disposition code 7-Left against medical advice or discontinued care. Non-acute patients are defined by inpatient place of services codes: 2-Psychiatric Unit, 3-Medical Rehabilitation Unit, 4-Alternate Level of Care, 5-Alcohol Rehabilitation Unit or 6-Drug Rehabilitation Unit. MDC 19 and MDC 2 also are omitted for psychiatric disorders and substance abuse. Obstetric patients are identified with MDC 14 pregnancy, childbirth and puerperium. Risk Adjustment: CMS/Yale Model Hierarchical generalized logistic regression adjusted for age group, sex and medical condition. For each hospital, the models produce a predicted readmission rate, an expected readmission rate, a risk-standardized readmission ratio and a risk-standardized readmission rate. The predicted rate controls for patient-level risk. The expected rate controls for provider-level risk. The SRR is the ratio of predicted-to-expected readmission rates for each hospital. The SRR is similar to an observed-toexpected ratio where a value below one indicates lower than expected readmissions and a value above one indicates higher than expected readmissions. The hospital RSRRs are standardized by multiplying the SRR for each hospital by the observed readmission rate for the entire state. Hospitalspecific estimates are shown along with estimates for all hospitals in the state. Observed Rate = Number of Readmissions/Number of Index Admissions RSR Ratio = Predicted /Expected Readmission RSR Rate = RSR Ratio *Statewide Observed Rate RSR Ranking = Providers with 25 or more index admissions are ranked according to the number of readmissions for each condition, with #1 indicating the lowest number of readmissions. Hospital Industry Data Institute 4 Revised July 216

5 Hospital Industry Data Institute ICD-1 Transitional Strategy ACUTE MYOCARDIAL INFARCTION Measure Name: AMI Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The AMI measure includes index admissions for qualifying diagnoses and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a primary diagnosis of AMI, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a primary diagnosis of AMI, and who do not meet any exclusion criteria listed below. Index admissions for AMI were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM DIAGNOSIS CODE Any 41.xx excluding 41.x2 DESCRIPTION ACUTE MYOCARDIAL INFARCTION ICD-1-CM DIAGNOSIS CODE I211 I212 I219 I2111 I2119 I2121 I2129 I213 I214 I22 I221 I222 I228 I229 DESCRIPTION STEMI INVOLVING LEFT MAIN CORONARY ARTERY STEMI INVOLVING LEFT ANTERIOR DESCENDING CORONARY ARTERY STEMI INVOLVING OTH CORONARY ARTERY OF ANTERIOR WALL STEMI INVOLVING RIGHT CORONARY ARTERY STEMI INVOLVING OTH CORONARY ARTERY OF INFERIOR WALL STEMI INVOLVING LEFT CIRCUMFLEX CORONARY ARTERY STEMI INVOLVING OTHER SITES ST ELEVATION (STEMI) MYOCARDIAL INFARCTION OF UNSP SITE NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION SUBSEQUENT STEMI OF ANTERIOR WALL SUBSEQUENT STEMI OF INFERIOR WALL SUBSEQUENT NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION SUBSEQUENT STEMI OF SITES SUBSEQUENT STEMI OF UNSP SITE Hospital Industry Data Institute 5 Revised July 216

6 Hospital Industry Data Institute ICD-1 Transitional Strategy CONGESTIVE HEART FAILURE Measure Name: HF Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The congestive heart failure measure includes index admissions for qualifying diagnoses and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a primary diagnosis of CHF, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a primary diagnosis of CHF, and who do not meet any exclusion criteria. Index admissions for CHF were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM DIAGNOSIS CODE DESCRIPTION 421 MAL HYPERT HRT DIS W HF 4211 BENIGN HYP HT DIS W HF 4291 HYP HT DIS NOS W HT FAIL 441 MAL HYP HT/KD I-IV W HF 443 MAL HYP HT/KD STG V W HF 4411 BEN HYP HT/KD I-IV W HF 4413 BEN HYP HT/KD STG V W HF 4491 HYP HT/KD NOS I-IV W HF 4493 HYP HT/KD NOS ST V W HF 428.xx CONGESTIVE HEART FAILURE ICD-1-CM DIAGNOSIS CODE I11 I13 I132 I51 I52 I521 DESCRIPTION HYPERTENSIVE HEART DISEASE WITH HEART FAILURE HYP HRT & CHR KDNY DIS W HRT FAILAND STG 1-4/UNSP CHR KDNY HYP HRT & CHR KDNY DIS W HRT FAILAND W STG 5 CHR KDNY/ESRD LEFT VENTRICULAR FAILURE UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE ACUTE SYSTOLIC (CONGESTIVE) HEART FAILURE Hospital Industry Data Institute 6 Revised July 216

7 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM DIAGNOSIS CODE I522 I523 I53 I531 I532 I533 I54 I541 I542 I543 I59 DESCRIPTION CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE UNSPECIFIED DIASTOLIC (CONGESTIVE) HEART FAILURE ACUTE DIASTOLIC (CONGESTIVE) HEART FAILURE CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE ACUTE ON CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE UNSP COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL ACUTE COMBINED SYSTOLIC AND DIASTOLIC (CONGESTIVE) HRT FAIL CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HRT FAIL HEART FAILURE, UNSPECIFIED Hospital Industry Data Institute 7 Revised July 216

8 Hospital Industry Data Institute ICD-1 Transitional Strategy PNEUMONIA Measure Name: PN Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The pneumonia measure includes index admissions for qualifying diagnoses and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a primary diagnosis of pneumonia, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a primary diagnosis of pneumonia, and who do not meet any exclusion criteria. Index admissions for pneumonia were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM DIAGNOSIS CODE DESCRIPTION 48 ADENOVIRAL PNEUMONIA 481 RESP SYNCYT VIRAL PNEUM 482 PARINFLUENZA VIRAL PNEUM 483 PNEUMONIA DUE TO SARS 488 VIRAL PNEUMONIA NEC 489 VIRAL PNEUMONIA NOS 481 PNEUMOCOCCAL PNEUMONIA 482 K. PNEUMONIAE PNEUMONIA 4821 PSEUDOMONAL PNEUMONIA 4822 H.INFLUENZAE PNEUMONIA 4823 STREPTOCOCCAL PNEUMN NOS PNEUMONIA STRPTOCOCCUS A PNEUMONIA STRPTOCOCCUS B PNEUMONIA OTH STREP 4824 STAPHYLOCOCCAL PNEU NOS METH SUS PNEUM D/T STAPH METH RES PNEU D/T STAPH 487 INFLUENZA WITH PNEUMONIA FLU DT 29 H1N1 W PNEU Hospital Industry Data Institute 8 Revised July 216

9 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-9-CM DIAGNOSIS CODE DESCRIPTION STAPH PNEUMONIA NEC PNEUMONIA ANAEROBES PNEUMONIA E COLI PNEUMO OTH GRM-NEG BACT LEGIONNAIRES DISEASE PNEUMONIA OTH SPCF BACT 4829 BACTERIAL PNEUMONIA NOS 483 PNEU MYCPLSM PNEUMONIAE 4831 PNEUMONIA D/T CHLAMYDIA 4838 PNEUMON OTH SPEC ORGNSM 485 BRONCHOPNEUMONIA ORG NOS 486 PNEUMONIA, ORGANISM UNSPECIFIED CONVERT ICD-1-CM DIAGNOSIS CODE A481 J11 J12 J121 J122 J1281 J1289 J129 J13 J14 J15 J151 J152 J15211 J15212 J1529 J153 J154 J155 DESCRIPTION LEGIONNAIRES DISEASE FLU DUE TO UNIDENTIFIED FLU VIRUS W UNSP TYPE OF PNEUMONIA ADENOVIRAL PNEUMONIA RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA PARAINFLUENZA VIRUS PNEUMONIA PNEUMONIA DUE TO SARS-ASSOCIATED CORONAVIRUS OTHER VIRAL PNEUMONIA VIRAL PNEUMONIA UNSPECIFIED PNEUMONIA DUE TO STREPTOCOCCUS PNEUMONIAE PNEUMONIA DUE TO HEMOPHILUS INFLUENZAE PNEUMONIA DUE TO KLEBSIELLA PNEUMONIAE PNEUMONIA DUE TO PSEUDOMOMAS PNEUMONIA DUE TO STAPHYLOCOCCUS, UNSPECIFIED PNEUMONIA DUE TO METHICILLIAN SUSCEP STAPH PNEUMONIA DUE TO METHICILLIN RESISTANT STAPHYLOCOCUS AUREUS PNEUMONIA DUE TO OTHER STAPHYLOCOCCUS PNEUMONIA DUE TO STREPTOCOCCUS, GROUP B PNEUMONIA DUE TO OTHER STREPTOCOCCI PNEUMONIA DUE TO ESCHERICHIA COLI Hospital Industry Data Institute 9 Revised July 216

10 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM DIAGNOSIS CODE J156 J157 J158 J159 J16 J168 J18 J181 J189 DESCRIPTION PNEUMONIA DUE TO OTHER AEROBIC GRAM-NEGATIVE BACTERIA PNEUMONIA DUE TO MYCOPLASMA PNEUMONIAE PNEUMONIA DUE TO OTHER SPECIFIED BACTERIA UNSPECFIFIED BACTERIAL PNEUMONIA CHYLAMIDIA PNEUMONIA PNEUMONIA DUE TO OTHER SPECIFIED INFECTIOUS ORGANISMS BRONCHOPNEUMONIA, UNSPECIFIED ORGANSIM LOBAR PNEUMONIA, UNSPECIFIED ORGANISM PNEUMONIA, UNSPECIFIED ORGANISM Hospital Industry Data Institute 1 Revised July 216

11 Hospital Industry Data Institute ICD-1 Transitional Strategy CHRONIC OBSTRUCTIVE PULMONARY DISEASE Measure Name: COPD Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The COPD measure includes index admissions for qualifying diagnoses and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a primary diagnosis of COPD, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a primary diagnosis of COPD, and who do not meet any exclusion criteria. Index admissions for COPD were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM DIAGNOSIS CODE DESCRIPTION OBS CHR BRONC W(AC) EXAC OBS CHR BRONC W AC BRONC 4918 CHRONIC BRONCHITIS NEC 4919 CHRONIC BRONCHITIS NOS 4928 EMPHYSEMA NEC 4932 CHRONIC OBST ASTHMA NOS CH OB ASTHMA W STAT ASTH CH OBST ASTH W (AC) EXAC 496 CHRONIC AIRWAY OBSTRUCTION, NOT ELSEWHERE CLASSIFIED (with 49121, 49122, or 49322) ACUTE RESPIRATRY FAILURE (with 49121, 49122, or 49322) (with 49121, 49122, or 49322) 7991 (with 49121, 49122, or 49322) OTHER PULMONARY INSUFF ACUTE AND CHRONIC RESP FAILURE RESPIRATORY ARREST Hospital Industry Data Institute 11 Revised July 216

12 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM DIAGNOSIS CODE J418 J42 J439 J44 J441 J449 J8 J96 J962 J969 R92 DESCRIPTION MIXED SIMPLE AND MUCOPURULENT CHRONIC BRONCHITIS UNSPECIFIED CHRONIC BRONCHITIS EMPHYSEMA, UNSPECIFIED CHRONIC OBSTRUCTIVE PULMON DISEASE W ACUTE LOWER RESP INFCT CHRONIC OBSTRUCTIVE PULMONARY DISEASE W (ACUTE) EXACERBATION CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED ACUTE RESPIRATORY DISTRESS SYNDROME ACUTE RESPIRATORY FAILURE, UNSP W HYPOXIA OR HYPERCAPNIA ACUTE AND CHR RESP FAILURE, UNSP W HYPOXIA OR HYPERCAPNIA RESPIRATORY FAILURE, UNSP, UNSP W HYPOXIA OR HYPERCAPNIA RESPIRATORY ARREST Hospital Industry Data Institute 12 Revised July 216

13 Hospital Industry Data Institute ICD-1 Transitional Strategy STROKE Measure Name: STROKE Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The ischemic stroke measure includes index admissions for qualifying diagnoses and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a diagnosis of ischemic stroke, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a diagnosis of ischemic stroke, and who do not meet any exclusion criteria. Index admissions for ischemic stroke were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM DIAGNOSIS CODE DESCRIPTION 4331 OCCLUSION AND STENOSIS OF BASILAR ARTERY WITH CEREBRAL INFRACTION OCCLUSION AND STENOSIS OF CAROTID ARTERY WITH CEREBRAL INFECTION OCCLUSION AND STENOSIS OF VERTEBRAL ARTERY WITH CEREBRAL INFARCTION OCCLUSION AND STENOSIS OF MULTIPLE AND BILATERAL PRECEREBRAL ARTERIES WITH CEREBRAL INFARCTION OCCLUSION AND STENOSIS OF OTHER SPECIFIED PRECEREBRAL ARTERY WITH CEREBRAL INFARCTION OCCLUSION AND STENOSIS OF UNSPECIFIED PRECEREBRAL ARTERY WITH CEREBRAL INFARCTION 4341 CEREBRAL THROMBOSIS WITH CEREBRAL INFARCTION CEREBRAL EMBOLISM WITH CEREBRAL INFARCTION CEREBRAL ARTERY OCCLUSION, UNSPECIFIED WITH CEREBRAL INFARCTION ICD-1-CM DIAGNOSIS CODE I63 I6311 I632 I6319 DESCRIPTION CEREBRAL INFARCTION DUE TO THROMBOS UNSP PRECEREBRAL ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF R VERTEB ART CEREBRAL INFARCTION DUE TO THROMBOSIS OF L VERTEB ART CEREBRAL INFARCTION DUE TO THROMBOS UNSP VERTEBRAL ARTERY Hospital Industry Data Institute 13 Revised July 216

14 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM DIAGNOSIS CODE I632 I6331 I6332 I6339 I639 I631 I63111 I63112 I63119 I6312 I63131 I63132 I63139 I6319 I632 I63211 I63212 I63219 I6322 I63231 I63232 I63239 I6329 I633 I63311 I63312 I63319 I63321 I63322 I63329 I63331 I63332 I63339 I63341 I63342 DESCRIPTION CEREBRAL INFARCTION DUE TO THROMBOSIS OF BASILAR ARTERY CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CAROTID ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CAROTID ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF UNSP CAROTID ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF PRECEREBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP PRECEREB ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF R VERTEB ART CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT VERTEBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP VERTEBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF BASILAR ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CAROTID ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CAROTID ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CAROTID ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF PRECEREBRAL ARTERY CERES INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP PRECERB ART CERES INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT VERTEB ART CERES INFRC DUE TO UNSP OCCLS OR STENOSIS OF LEFT VERTEB ART CERES INFRC DUE TO UNSP OCCLS OR STENOSIS OF UNSP VERTEB ART CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF BASILAR ART CERES INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CAROTID ART CERES INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CAROTID ART CERES INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CAROTID ART CEREBRAL INFRC DUE TO UNSP OCCLS OR STENOSIS OF PRECERB ART CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBRAL ARTERY CERES INFRC DUE TO THOMBOS OF RIGHT MIDDLE CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS OF LEFT MIDDLE CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS UNSP MIDDLE CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS OF RIGHT ANT CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS OF LEFT ANT CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS UNSP ANTERIOR CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS OF RIGHT POST CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS OF LEFT POST CEREBRAL ARTERY CEREBRAL INFRC DUE TO THOMBOS UNSP POSTERIOR CEREBRAL ARTERY CEREBRAL INFRC DUE TO THROMBOSIS OF RIGHT CEREBLR ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF LEFT CEREBLR ARTERY Hospital Industry Data Institute 14 Revised July 216

15 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM DIAGNOSIS CODE I63349 I6339 I634 I63411 I63412 I63419 I63421 I63422 I63429 I63431 I63432 I63439 I63441 I6339 I63442 I63449 I6349 I635 I63511 I63512 I63519 I63521 I63522 I63529 I63531 I63532 I63539 I63541 I63542 I63549 I6359 I636 I638 I639 DESCRIPTION CEREBRAL INFARCTION DUE TO THOMBOS UNSP CEREBELLAR ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF OTH CEREBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBRAL ARTERY CEREB INFRC DUE TO EMBOLISM OF RIGHT MIDDLE CEREBRAL ARTERY CEREB INFRC DUE TO EMBOLISM OF LEFT MIDDLE CEREBRAL ARTERY CEREB INFRC DUE TO EMBOLISM OF UNSP MIDDLE CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT ANT CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF LEFT ANT CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF UNSP ANT CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF RIGHT POST CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF LEFT POST CEREBRAL ARTERY CEREBRAL INFRC DUE TO EMBOLISM OF UNSP POST CEREBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT CEREBLR ARTERY CEREBRAL INFARCTION DUE TO THROMBOSIS OF OTH CEREBRAL ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF LEFT CEREBLR ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF UNSP CEREBLR ARTERY CEREBRAL INFARCTION DUE TO EMBOLISM OF OTHER CEREBRAL ARTERY CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREB ARTERY CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT MID CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT MID CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP MID CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT ANT CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT ANT CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP ANT CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF RIGHT POST CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF LEFT POST CEREB ART CEREB INFRC D/T UNSP OCCLS OR STENOS OF UNSP POST CEREB ART CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF RIGHT CEREBLR ART CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF LEFT CEREBLR ART CEREB INFRC DUE TO UNSP OCCLS OR STENOS OF UNSP CEREBLR ART CEREB INFRC DUE TO UNSP OCCLS OR STENOSIS OF CEREBRAL ARTERY CEREBRAL INFRC DUE TO CEREBRAL VENOUS THOMBOS, NONPYOGENIC OTHER CEREBRAL INFARCTION CEREBRAL INFARCTION, UNSPECIFIED Hospital Industry Data Institute 15 Revised July 216

16 Hospital Industry Data Institute ICD-1 Transitional Strategy TOTAL HIP/KNEE ARTHROPLASTY Measure Name: TKA/THA Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The hip and knee replacement measure includes index admissions for qualifying procedures and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a hip and/or knee replacement procedure, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a hip and/or knee replacement procedure, and who do not meet any exclusion criteria. Index admissions for hip and knee replacements were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM PROCEDURE CODE DESCRIPTION 8151 TOTAL HIP REPLACEMENT 8154 TOTAL KNEE REPLACEMENT ICD-1-CM PROCEDURE CODE OSR919 OSR91A OSR91Z OSR929 OSR92A OSR92Z OSR939 OSR93A OSR93Z OSR949 OSR94A OSR94Z OSR97Z OSR9J9 DESCRIPTION REPLACEMENT OF R HIP JT WITH METAL, CEMENT, OPEN APPROACH REPLACEMENT OF R HIP JT WITH METAL, UNCEMENT, OPEN APPROACH REPLACEMENT OF RIGHT HIP JOINT WITH METAL, OPEN APPROACH REPLACE R HIP JT W METAL ON POLY, CEMENT, OPEN REPLACE R HIP JT WITH METAL ON POLY, UNCEMENT, OPEN REPLACEMENT OF R HIP JT WITH METAL ON POLY, OPEN APPROACH REPLACEMENT OF R HIP JT WITH CERAMIC, CEMENT, OPEN APPROACH REPLACEMENT OF R HIP JT WITH CERAMIC, UNCEMENT, OPEN APPROACH REPLACEMENT OF RIGHT HIP JOINT WITH CERAMIC, OPEN APPROACH REPLACE R HIP JT W CERAMIC ON POLY, CEMENT, OPEN REPLACE R HIP JT W CERAMIC ON POLY, UNCEMENT, OPEN REPLACEMENT OF R HIP JT WITH CERAMIC ON POLY, OPEN APPROACH REPLACEMENT OF RIGHT HIP JOINT WITH AUTOL SUB, OPEN APPROACH REPLACE OF R HIP JT WITH SYNTH SUB, CEMENT, OPEN APPROACH Hospital Industry Data Institute 16 Revised July 216

17 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE OSR9JA OSR9JZ OSR9KZ OSRB19 OSRB1A OSRB1Z OSRB29 OSRB2A OSRB2Z OSRB39 OSRB3A OSRB3Z OSRB49 OSRB4A OSRB4Z OSRB7Z OSRBJ9 OSRBJA OSRBJZ OSRBKZ OSRC7Z OSRCJ9 OSRCJA OSRCJZ OSRCKZ OSRD7Z OSRDJ9 OSRDJA OSRDJZ OSRDKZ OSRT7Z OSRTJ9 OSRTJA OSRTJZ OSRTKZ DESCRIPTION REPLACE OF R HIP JT WITH SYNTH SUB, UNCEMENT, OPEN APPROACH REPLACE OF RIGHT HIP JOINT WITH SYNTH SUB, OPEN APPROACH REPLACEMENT OF R HIP JT WITH NONAUT SUB, OPEN APPROACH REPLACEMENT OF L HIP JT WITH METAL, CEMENT, OPEN APPROACH REPLACEMENT OF L HIP JT WITH METAL, UNCEMENT, OPEN APPROACH REPLACEMENT OF LEFT HIP JOINT WITH METAL, OPEN APPROACH REPLACE L HIP JT W METAL ON POLY, CEMENT, OPEN REPLACE L HIP JT W METAL ON POLY, UNCEMENT, OPEN REPLACEMENT OF L HIP JT WITH METAL ON POLY, OPEN APPROACH REPLACEMENT OF L HIP JT WITH CERAMIC, CEMENT, OPEN APPROACH REPLACE OF L HIP JT WITH CERAMIC, UNCEMENT, OPEN APPROACH REPLACEMENT OF LEFT HIP JOINT WITH CERAMIC, OPEN APPROACH REPLACE L HIP JT W CERAMIC ON POLY, CEMENT, OPEN REPLACE L HIP JT W CERAMIC ON POLY, UNCEMENT, OPEN REPLACEMENT OF HIP JT WITH CERAMIC ON POLY, OPEN APPROACH REPLACEMENT OF LEFT HIP JOINT WITH AUTOL SUB, OPEN APPROACH REPLACE OF L HIP JT WITH SYNTH SUB, CEMENT, OPEN APPROACH REPLACE OF L HIP JT WITH SYNTH SUB, UNCEMENT, OPEN APPROACH REPLACEMENT OF LEFT HIP JOINT WITH SYNTH SUB, OPEN APPROACH REPLACEMENT OF LEFT HIP JOINT WITH NONAUT SUB, OPEN APPROACH REPLACEMENT OF R KNEE JT WITH AUTOL SUB, OPEN APPROACH REPLACE OF R KNEE JT WITH SYNTH SUB, CEMENT, OPEN APPROACH REPLACE OF R KNEE JT WITH SYNTH SUB, UNCEMENT, OPEN APPROACH REPLACEMENT OF R KNEE JT WITH SYNTH SUB, OPEN APPROACH REPLACEMENT OF R KNEE JT WITH NONAUT SUB, OPEN APPROACH REPLACEMENT OF LEFT KNEE JOINT WITH AUTOL SUB, OPEN APPROACH REPLACE OF L KNEE JT WITH SYNTH SUB, CEMENT, OPEN APPROACH REPLACE OF L KNEE JT WITH SYNTH SUB, UNCEMENT, OPEN APPROACH REPLACEMENT OF LEFT KNEE JOINT WITH SYNTH SUB, OPEN APPROACH REPLACEMENT OF L KNEE JT WITH NONAUT SUB, OPEN APPROACH REPLACE OF R KNEE JT, FEMORAL WITH AUTOL SUB, OPEN APPROACH REPLACE R KNEE JT, FEMORAL W SYNTH SUB, CEMENT, OPEN REPLACE R KNEE JT, FEMORAL W SYNTH SUB, UNCEMENT, OPEN REPLACE OF R KNEE JT, FEMORAL WITH SYNTH SUB, OPEN APPROACH REPLACE OF R KNEE JT, FEMORAL WITH NONAUT SUB, OPEN APPROACH Hospital Industry Data Institute 17 Revised July 216

18 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE OSRU7Z OSRUJ9 OSRUJA OSRUJZ OSRUKZ OSRV7Z OSRVJ9 OSRVJA OSRVJZ OSRVKZ OSRW7Z OSRWJ9 OSRWJA OSRWJZ OSRWKZ DESCRIPTION REPLACE OF L KNEE JT, FEMORAL WITH AUTOL SUB, OPEN APPROACH REPLACE L KNEE JT, FEMORAL W SYNTH SUB, CEMENT, OPEN REPLACE L KNEE JT, FEMORAL W SYNTH SUB, UNCEMENT, OPEN REPLACE OF L KNEE JT, FEMORAL WITH SYNTH SUB, OPEN APPROACH REPLACE OF L KNEE JT, FEMORAL WITH NONAUT SUB, OPEN APPROACH REPLACE OF R KNEE JT, TIBIAL WITH AUTOL SUB, OPEN APPROACH REPLACE R KNEE JT, TIBIAL W SYNTH SUB, CEMENT, OPEN REPLACE R KNEE JT, TIBIAL W SYNTH SUB, UNCEMENT, OPEN REPLACE OF R KNEE JT, TIBIAL WITH SYNTH SUB, OPEN APPROACH REPLACE OF R KNEE JT, TIBIAL WITH NONAUT SUB, OPEN APPROACH REPLACE OF L KNEE JT, TIBIAL WITH AUTOL SUB, OPEN APPROACH REPLACE L KNEE JT, TIBIAL W SYNTH SUB,CEMENT, OPEN REPLACE KNEE JT, TIBIAL W SYNTH SUB, UNCEMENT, OPEN REPLACE OF L KNEE JT, TIBIAL WITH SYNTH SUB, OPEN APPROACH REPLACE OF L KNEE JT, TIBIAL WITH NONAUT SUB, OPEN APPROACH Hospital Industry Data Institute 18 Revised July 216

19 Hospital Industry Data Institute ICD-1 Transitional Strategy CORONARY ARTERY BYPASS GRAFTING Measure Name: CABG Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The CABG measure includes index admissions for qualifying procedures and readmissions for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital with a CABG procedure, and who do not meet any of the exclusion criteria. Measures were calculated using discharge records from participating hospitals. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital with a CABG procedure, and who do not meet any exclusion criteria listed below. Index admissions for CABG were identified by the ICD-9-CM and ICD-1-CM (for discharges on or after Oct. 1, 215) codes as follows. ICD-9-CM PROCEDURE CODE DESCRIPTION 36.1 AORTOCORONARY BYPASS FOR HEART REVASCULARIZATION, NOT OTHERWISE SPECIFIED (AORTO) CORONARY BYPASS OF ONE CORONARY ARTERY (AORTO) CORONARY BYPASS OF TWO CORONARY ARTERIES (AORTO) CORONARY BYPASS OF THREE CORONARY ARTERIES (AORTO) CORONARY BYPASS OF FOUR OR MORE CORONARY ARTERIES SINGLE INTERNAL MAMMARY-CORONARY ARTERY BYPASS DOUBLE INTERNAL MAMMARY-CORONARY ARTERY BYPASS ABDOMINAL-CORONARY ARTERY BYPASS OTHER BYPASS ANASTOMOSIS FOR HEART REVASCULARIZATION ICD-1-CM PROCEDURE CODE DESCRIPTION 2193 BYPASS 1 COR ART FROM COR ART WITH AUTOL VN, OPEN APPROACH 2198 BYPASS 1 COR ART FROM R INT MAMMARY W AUTOL VN, OPEN 2199 BYPASS 1 COR ART FROM L INT MAMMARY W AUTOL VN, OPEN 219C 219F BYPASS 1 COR ART FROM THOR ART WITH AUTOL VN, OPEN APPROACH BYPASS 1 COR ART FROM ABD ART WITH AUTOL VN, OPEN APPROACH Hospital Industry Data Institute 19 Revised July 216

20 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE 219W 21A3 21A8 21A9 21AC 21AF 21AW 21J3 21J8 21J9 21JC 21JF 21JW 21K3 21K8 21K9 21KC 21KF 21KW 21Z3 21Z8 21Z9 21ZC 21ZF DESCRIPTION BYPASS 1 COR ART FROM AORTA WITH AUTOL VN, OPEN APPROACH BYPASS 1 COR ART FROM COR ART WITH AUTOL ART, OPEN APPROACH BYPASS 1 COR ART FROM R INT MAMMARY W AUTOL ART, OPEN BYPASS 1 COR ART FROM L INT MAMMARY W AUTOL ART, OPEN BYPASS 1 COR ART FROM THOR ART WITH AUTOL ART, OPEN APPROACH BYPASS 1 COR ART FROM ABD ART WITH AUTOL ART, OPEN APPROACH BYPASS 1 COR ART FROM AORTA WITH AUTOL ART, OPEN APPROACH BYPASS 1 COR ART FROM COR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 1 COR ART FROM R INT MAMMARY W SYNTH SUB, OPEN BYPASS 1 COR ART FROM L INT MAMMARY W SYNTH SUB, OPEN BYPASS 1 COR ART FROM THOR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 1 COR ART FROM ABD ART WITH SYNTH SUB, OPEN APPROACH BYPASS 1 COR ART FROM AORTA WITH SYNTH SUB, OPEN APPROACH BYPASS 1 COR ART FROM COR ART WITH NONAUT SUB, OPEN APPROACH BYPASS 1 COR ART FROM R INT MAMMARY W NONAUT SUB, OPEN BYPASS 1 COR ART FROM L INT MAMMARY W NONAUT SUB, OPEN BYPASS 1 COR ART FROM THOR ART W NONAUT SUB, OPEN BYPASS 1 COR ART FROM ABD ART WITH NONAUT SUB, OPEN APPROACH BYPASS 1 COR ART FROM AORTA WITH NONAUT SUB, OPEN APPROACH BYPASS CORONARY ARTERY, ONE SITE FROM COR ART, OPEN APPROACH BYPASS 1 COR ART FROM R INT MAMMARY, OPEN APPROACH BYPASS 1 COR ART FROM L INT MAMMARY, OPEN APPROACH BYPASS 1 COR ART FROM THOR ART, OPEN APPROACH BYPASS CORONARY ARTERY, ONE SITE FROM ABD ART, OPEN APPROACH BYPASS 2 COR ART FROM COR ART WITH AUTOL VN, OPEN APPROACH BYPASS 2 COR ART FROM R INT MAMMARY W AUTOL VN, OPEN BYPASS 2 COR ART FROM L INT MAMMARY W AUTOL VN, OPEN 2119C 2119F 2119W 211A3 211A8 211A9 211AC 211AF BYPASS 2 COR ART FROM THOR ART WITH AUTOL VN, OPEN APPROACH BYPASS 2 COR ART FROM ABD ART WITH AUTOL VN, OPEN APPROACH BYPASS 2 COR ART FROM AORTA WITH AUTOL VN, OPEN APPROACH BYPASS 2 COR ART FROM COR ART WITH AUTOL ART, OPEN APPROACH BYPASS 2 COR ART FROM R INT MAMMARY W AUTOL ART, OPEN BYPASS 2 COR ART FROM L INT MAMMARY W AUTOL ART, OPEN BYPASS 2 COR ART FROM THOR ART WITH AUTOL ART, OPEN APPROACH BYPASS 2 COR ART FROM ABD ART WITH AUTOL ART, OPEN APPROACH Hospital Industry Data Institute 2 Revised July 216

21 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE 211AW 211J3 211J8 211J9 211JC 211JF 211JW 211K3 211K8 211K9 211KC 211KF 211KW 211Z3 211Z8 211Z9 211ZC 211ZF DESCRIPTION BYPASS 2 COR ART FROM AORTA WITH AUTOL ART, OPEN APPROACH BYPASS 2 COR ART FROM COR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 2 COR ART FROM R INT MAMMARY W SYNTH SUB, OPEN BYPASS 2 COR ART FROM L INT MAMMARY W SYNTH SUB, OPEN BYPASS 2 COR ART FROM THOR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 2 COR ART FROM ABD ART WITH SYNTH SUB, OPEN APPROACH BYPASS 2 COR ART FROM AORTA WITH SYNTH SUB, OPEN APPROACH BYPASS 2 COR ART FROM COR ART WITH NONAUT SUB, OPEN APPROACH BYPASS 2 COR ART FROM R INT MAMMARY W NONAUT SUB, OPEN BYPASS 2 COR ART FROM L INT MAMMARY W NONAUT SUB, OPEN BYPASS 2 COR ART FROM THOR ART W NONAUT SUB, OPEN BYPASS 2 COR ART FROM ABD ART WITH NONAUT SUB, OPEN APPROACH BYPASS 2 COR ART FROM AORTA WITH NONAUT SUB, OPEN APPROACH BYPASS 2 COR ART FROM COR ART, OPEN APPROACH BYPASS 2 COR ART FROM R INT MAMMARY, OPEN APPROACH BYPASS 2 COR ART FROM L INT MAMMARY, OPEN APPROACH BYPASS 2 COR ART FROM THOR ART, OPEN APPROACH BYPASS 2 COR ART FROM ABD ART, OPEN APPROACH BYPASS 3 COR ART FROM COR ART WITH AUTOL VN, OPEN APPROACH BYPASS 3 COR ART FROM R INT MAMMARY W AUTOL VN, OPEN BYPASS 3 COR ART FROM L INT MAMMARY W AUTOL VN, OPEN 2129C 2129F 2129W 212A3 212A8 212A9 212AC 212AF 212AW 212J3 212J8 212J9 212JC 212JF BYPASS 3 COR ART FROM THOR ART WITH AUTOL VN, OPEN APPROACH BYPASS 3 COR ART FROM ABD ART WITH AUTOL VN, OPEN APPROACH BYPASS 3 COR ART FROM AORTA WITH AUTOL VN, OPEN APPROACH BYPASS 3 COR ART FROM COR ART WITH AUTOL ART, OPEN APPROACH BYPASS 3 COR ART FROM R INT MAMMARY W AUTOL ART, OPEN BYPASS 3 COR ART FROM L INT MAMMARY W AUTOL ART, OPEN BYPASS 3 COR ART FROM THOR ART WITH AUTOL ART, OPEN APPROACH BYPASS 3 COR ART FROM ABD ART WITH AUTOL ART, OPEN APPROACH BYPASS 3 COR ART FROM AORTA WITH AUTOL ART, OPEN APPROACH BYPASS 3 COR ART FROM COR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 3 COR ART FROM R INT MAMMARY W SYNTH SUB, OPEN BYPASS 3 COR ART FROM L INT MAMMARY W SYNTH SUB, OPEN BYPASS 3 COR ART FROM THOR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 3 COR ART FROM ABD ART WITH SYNTH SUB, OPEN APPROACH Hospital Industry Data Institute 21 Revised July 216

22 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE 212JW 212K3 212K8 212K9 212KC 212KF 212KW 212Z3 212Z8 212Z9 212ZC 212ZF DESCRIPTION BYPASS 3 COR ART FROM AORTA WITH SYNTH SUB, OPEN APPROACH BYPASS 3 COR ART FROM COR ART WITH NONAUT SUB, OPEN APPROACH BYPASS 3 COR ART FROM R INT MAMMARY W NONAUT SUB, OPEN BYPASS 3 COR ART FROM L INT MAMMARY W NONAUT SUB, OPEN BYPASS 3 COR ART FROM THOR ART W NONAUT SUB, OPEN BYPASS 3 COR ART FROM ABD ART WITH NONAUT SUB, OPEN APPROACH BYPASS 3 COR ART FROM AORTA WITH NONAUT SUB, OPEN APPROACH BYPASS 3 COR ART FROM COR ART, OPEN APPROACH BYPASS 3 COR ART FROM R INT MAMMARY, OPEN APPROACH BYPASS 3 COR ART FROM L INT MAMMARY, OPEN APPROACH BYPASS 3 COR ART FROM THOR ART, OPEN APPROACH BYPASS 3 COR ART FROM ABD ART, OPEN APPROACH BYPASS 4+ COR ART FROM COR ART WITH AUTOL VN, OPEN APPROACH BYPASS 4+ COR ART FROM R INT MAMMARY W AUTOL VN, OPEN BYPASS 4+ COR ART FROM L INT MAMMARY W AUTOL VN, OPEN 2139C 2139F 2139W 213A3 213A8 213A9 213AC 213AF 213AW 213J3 213J8 213J9 213JC 213JF 213JW 213K3 213K8 213K9 213KC 213KF BYPASS 4+ COR ART FROM THOR ART WITH AUTOL VN, OPEN APPROACH BYPASS 4+ COR ART FROM ABD ART WITH AUTOL VN, OPEN APPROACH BYPASS 4+ COR ART FROM AORTA WITH AUTOL VN, OPEN APPROACH BYPASS 4+ COR ART FROM COR ART WITH AUTOL ART, OPEN APPROACH BYPASS 4+ COR ART FROM R INT MAMMARY W AUTOL ART, OPEN BYPASS 4+ COR ART FROM L INT MAMMARY W AUTOL ART, OPEN BYPASS 4+ COR ART FROM THOR ART W AUTOL ART, OPEN BYPASS 4+ COR ART FROM ABD ART WITH AUTOL ART, OPEN APPROACH BYPASS 4+ COR ART FROM AORTA WITH AUTOL ART, OPEN APPROACH BYPASS 4+ COR ART FROM COR ART WITH SYNTH SUB, OPEN APPROACH BYPASS 4+ COR ART FROM R INT MAMMARY W SYNTH SUB, OPEN BYPASS 4+ COR ART FROM L INT MAMMARY W SYNTH SUB, OPEN BYPASS 4+ COR ART FROM THOR ART W SYNTH SUB, OPEN BYPASS 4+ COR ART FROM ABD ART WITH SYNTH SUB, OPEN APPROACH BYPASS 4+ COR ART FROM AORTA WITH SYNTH SUB, OPEN APPROACH BYPASS 4+ COR ART FROM COR ART W NONAUT SUB, OPEN BYPASS 4+ COR ART FROM R INT MAMMARY W NONAUT SUB, OPEN BYPASS 4+ COR ART FROM L INT MAMMARY W NONAUT SUB, OPEN BYPASS 4+ COR ART FROM THOR ART W NONAUT SUB, OPEN BYPASS 4+ COR ART FROM ABD ART W NONAUT SUB, OPEN Hospital Industry Data Institute 22 Revised July 216

23 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1-CM PROCEDURE CODE 213KW 213Z3 213Z8 213Z9 213ZC 213ZF DESCRIPTION BYPASS 4+ COR ART FROM AORTA WITH NONAUT SUB, OPEN APPROACH BYPASS 4+ COR ART FROM COR ART, OPEN APPROACH BYPASS 4+ COR ART FROM R INT MAMMARY, OPEN APPROACH BYPASS 4+ COR ART FROM L INT MAMMARY, OPEN APPROACH BYPASS 4+ COR ART FROM THOR ART, OPEN APPROACH BYPASS 4+ COR ART FROM ABD ART, OPEN APPROACH Hospital Industry Data Institute 23 Revised July 216

24 Hospital Industry Data Institute ICD-1 Transitional Strategy HOSPITAL-WIDE READMISSIONS Measure Name: HWR Measure Description: 3-day risk-standardized readmission rates and ratios using CMS methodology with and without sociodemographic factors. The hospital-wide measure includes readmissions for any cause for any cause to an acute care hospital within 3 days of discharge from an acute care hospital. Numerator Statement: Patients, ages 18 and older, who were readmitted for any reason to an acute care hospital within 3 days of discharge from an acute care hospital, and who do not meet any exclusion criteria listed below. Measures were calculated using discharge records from participating hospitals. Index admissions for hospital-wide readmissions include almost all inpatient discharges. Denominator Statement: All patients, ages 18 and older, discharged from an acute care hospital, and who do not meet the exclusion criteria. Hospital Industry Data Institute 24 Revised July 216

25 Hospital Industry Data Institute ICD-1 Transitional Strategy ICD-1 TRANSITIONAL REPORTING WinQI and ICD-1 Hospitals transitioned to reporting ICD-1 diagnosis codes for all administrative claims effective Oct. 1, 215. The Agency for Healthcare Research and Quality has not yet released software that can use ICD-1 diagnosis codes to calculate AHRQ quality indicators. Therefore, HIDI will be translating ICD- 1 diagnosis codes to ICD-9 diagnosis codes to allow for processing through AHRQ s current WinQI software (version 5.). SUMMARY HIDI has begun to evaluate the differences observed across quarters in AHRQ measures based on discharge data before and after the ICD-1 change. HIDI gauged the level of incompleteness of the federal fiscal year 216 hospital discharge input file, as well as the associated numerator and denominator counts from the AHRQ WinQI output, pre- and post-icd-1. Measure-specific summary statistics were produced to determine the level of change observed between ICD-9 and ICD-1 time periods; graphic representations of these data appear in the HIDI AHRQ Measures Transition Appendix. In aggregate and at a measure-specific level, numerator and denominator magnitude of AHRQ quality indicators aligned with recent data points (see Charts 1a, 1b and 1c). The changes in numerator and denominator volume were not different in terms of direction or relativity versus data points observed throughout the last 12 quarters. Chart 1a Hospital Industry Data Institute 25 Revised July 216

26 Hospital Industry Data Institute ICD-1 Transitional Strategy Chart 1b Chart 1c Hospital Industry Data Institute 26 Revised July 216

27 Hospital Industry Data Institute ICD-1 Transitional Strategy The federal fiscal year 216 first quarter HIDI discharge file was observed to be possibly somewhat incomplete perhaps about 5 percent short of expected, but it reached similar lows in the third and fourth quarters of FFY 214 (see Chart 2). Other observed or unobserved trend divergences could be remnants of the built-in partial heterogeneity between ICD-9 and ICD-1. Additional intervening variables could be the lack of ICD-1 coding experience from MHA members coders, which may undergo correction throughout time, as well as the fact that the quarterly ICD-1 data point stands alone, compared to 12 prior quarters of ICD-9 trend produced under WinQI version 5.. Chart 2 Some measures were found to have an observed rate for Q1 FFY 216 that was either higher or lower than at any other point in the previous 12 quarters (IQI-171 [17A], IQI-18, IQI-21, IQI-22, NQI-3, PDI-1, PSI-11, PSI-13). However, every one of these instances appeared to follow an established trend and no QI FFY 216 measures violated the three standard deviation upper/lower limits. Comparatively, it s noteworthy to mention that three ICD-9-based measures (pre-ffy 216) produced data points that violated the three standard deviation upper/lower limit (PSI 17, PSI 18, PSI 19). No alarming observations have been uncovered that would suggest GEM-coded Q1 FFY 216 diagnoses are problematic in terms of AHRQ WinQI version 5. processing. However, the heterogeneity of the diagnostic sets suggests that there could be an observable difference in quality indicator rates when ICD-1-compliant risk-adjusted rate-producing software becomes available. Review will continue as future quarters of discharge data become available. Hospital Industry Data Institute 27 Revised July 216

28 HIDI AHRQ Measures Transition Appendix 4/28/216

29 IQI 8 Esophageal Resection Mortality Rate - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals IQI 8 Esophageal Resection Mortality Rate - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 18.% % 3 14.% 12.% 25 1.% 2 8.% 6.% 15 4.% 1 2.% 5.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 1

30 PSI 4E Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum E - Observed Rate, FFY213 - FFY216 (Q1) - HIDI- Reporting Hospitals PSI 4E Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum E - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 12.% 3 1.% 25 8.% 2 6.% 15 4.% 1 2.% 5.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 2

31 PSI 4D Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum D - Observed Rate, FFY213 - FFY216 (Q1) - HIDI- Reporting Hospitals PSI 4D Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum D - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 45.% 3 4.% % 3.% 2 25.% 2.% % 1.% 1 5.% 5.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 3

32 PSI 4C Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum C - Observed Rate, FFY213 - FFY216 (Q1) - HIDI- Reporting Hospitals PSI 4C Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum C - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 3.% 3 25.% 25 2.% 2 15.% 15 1.% 1 5.% 5.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 4

33 PSI 4B Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum B - Observed Rate, FFY213 - FFY216 (Q1) - HIDI- Reporting Hospitals PSI 4B Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum B - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 12.% % 7 8.% 6 6.% % 3 2.% 2.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 5

34 PSI 4A Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum A - Observed Rate, FFY213 - FFY216 (Q1) - HIDI- Reporting Hospitals PSI 4A Death Rate among Surgical Inpatients with Serious Treatable Complications Stratum A - Observed Rate, FFY213 - FFY216 (Q1) - HIDI-Reporting Hospitals 9.% 3 8.% 25 7.% 6.% 2 5.% 4.% 15 3.% 2.% 1 1.% 5.% Q1FFY213 Q2FFY213 Q3FFY213 Q4FFY213 Q1FFY214 Q2FFY214 Q3FFY214 Q4FFY214 Q1FFY215 Q2FFY215 Q3FFY215 Q4FFY215 Q1FFY ICD-9 (FY 13-15) ICD-1 (Q1FY 16) 6