AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Review of Proposed Changes with ICD–10–CM/PCS Conversion of AHRQ Quality Indicators™ (QI)

The Agency for Healthcare Research and Quality (AHRQ) seeks comments on the proposed conversion of the AHRQ Quality Indicators™ to the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM and ICD-10-PCS) codes. These changes would be applicable to hospital discharges occurring on or after October 1, 2014.

CODES FOR REVIEW: There are four modules of the AHRQ Quality Indicators (QI): the Prevention Quality Indicators (PQI), Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI) and Pediatric Quality Indicators (PDI). Together the modules include 101 AHRQ QI. All of the AHRQ QI are proposed to undergo conversion to ICD-10-CM/PCS.

The proposed changes for each of the AHRQ QI have been formatted as a series of spreadsheets containing the current International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes and the corresponding ICD-10-CM/PCS codes. There is one spreadsheet for each AHRQ Quality Indicator and one spreadsheet for each appendix of a module. The list of AHRQ QI and appendices can be found in the Table of Contents.

Each AHRQ QI spreadsheet has four tabs:

  • Numerator
  • Numerator Exclusions
  • Denominator
  • Denominator Exclusions

Each AHRQ QI composite spreadsheet has three tabs:

  • Description
  • Numerator and Exclusion
  • Denominator and Exclusion

Each AHRQ QI appendix has a tab for each appendix (A-M), if applicable.

Each spreadsheet follows the clinical concepts in the order as shown in the technical specifications for the AHRQ Quality Indicators or Appendix, version 4.5. Each clinical concept represents a group of diagnosis codes or a group of procedure codes, depending on the intent of the measure. If there is no clinical concept representing a diagnosis group or a procedure group, there will be a statement “Not Applicable” in the tab. This indicates there is no proposed mapping of the ICD-10-CM/PCS codes.

BACKGROUND: The goal of the proposed changes was to take advantage of the more specific code set to form a new version of the measure, but care was taken to be fully consistent with the original intent. For review of each quality indicator, it is important to remember that the clinical concept in ICD-10-CM/PCS may not overlap completely with the clinical concept in ICD-9-CM, which may cause the ICD-10-CM/PCS specification to describe patients who are not captured by the current ICD-9-CM specification. We invite feedback on the relevancy and applicability of the ICD-10-CM/PCS codes listed.

A structured approach was adopted for converting the existing AHRQ QI specifications from ICD–9–CM to ICD–10–CM/PCS, incorporating coding expertise, clinical expertise, and health services research/quality measurement expertise. This process is summarized in the AHRQ ICD-10-CM/PCS Conversion Project Report. Additional background information about the process adopted for converting the existing AHRQ QI specifications from ICD-9-CM to ICD-10 CM/PCS is available here.

DEADLINE FOR COMMENT SUBMISSION: Comments must be received no later than 5 pm EDT on December 26, 2013.

COMMENT SUBMISSION PROCESS: AHRQ is seeking comments on the use of the proposed ICD-10-CM/PCS codes. Comments can be provided via email or paper.

AHRQ is interested in the following information on the individual indicators (if applicable):

  • Indicator type, number, and name (e.g., PDI 02, Pressure Ulcer Rate)
  • Comment(s) related to the numerator of this QI
  • Comment(s) related to the numerator exclusions of this QI
  • Comment(s) related to the denominator of this QI
  • Comment(s) related to the denominator exclusions of this QI
  • Other comment(s) related to this QI

AHRQ is interested in the following information on the appendices (if applicable):

  • Indicator type, appendix letter, and the name of the appendix (e.g., IQI Appendix B, Breech Procedure Codes)
  • Comment(s) about the relevant diagnosis group
  • Comment(s) about the relevant procedure group
  • Additional code(s) that should be included in the appendix
  • Other comment(s) related to the appendix

Postal mail addressed to AHRQ is subject to delay due to security screening. As a result, AHRQ encourages submission of comments via email. Please submit email comments to: QIComment@AHRQ.hhs.gov with “AHRQ QI ICD-10 Conversion” as the subject line.

If comments are provided via paper, write “AHRQ QI ICD-10 Conversion” on such comments and on the envelope, and mail them to the following address:

Pamela Owens, PhD
Scientific Lead, AHRQ Quality Indicator™ Program
Center for Delivery, Organization and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850

AHRQ will remove all identifying information from the comments and will not provide individual responses. AHRQ will provide a summary of comments and actions taken as a result of those comments. The summary document will be posted on the AHRQ QI website no later than the end of January 2014.


TABLE OF CONTENTS

The file containing ICD-9-CM codes mapped to the corresponding ICD-10-CM/PCS codes can be accessed by clicking on the name/number of each indicator.

Prevention Quality Indicators (PQI)

PQI 01 Diabetes Short-term Complications Admission Rate
PQI 02 Perforated Appendix Admission Rate
PQI 03 Diabetes Long-term Complications Admission Rate
PQI 05 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate
PQI 07 Hypertension Admission Rate
PQI 08 Heart Failure Admission Rate
PQI 09 Low Birth Weight Rate
PQI 10 Dehydration Admission Rate
PQI 11 Bacterial Pneumonia Admission Rate
PQI 12 Urinary Tract Infection Admission Rate
PQI 13 Angina Without Procedure Admission Rate
PQI 14 Uncontrolled Diabetes Admission Rate
PQI 15 Asthma in Younger Adults Admission Rate
PQI 16 Lower-Extremity Amputation among Patients with Diabetes Rate
PQI 90 Prevention Quality Overall Composite
PQI 91 Prevention Quality Acute Composite
PQI 92 Prevention Quality Chronic Composite


PQI Appendices

PQI A Admission Codes for Transfers*
PQI B Cardiac Procedure Codes
PQI C Immunocompromised State Diagnosis and Procedure Codes
PQI D Definitions of Neonate, Newborn, Normal Newborn, and Outborn

* This will not have a proposed mapping of ICD-10-CM or ICD-10-PCS codes.


Inpatient Quality Indicators (IQI)

IQI 01 Esophageal Resection Volume
IQI 02 Pancreatic Resection Volume
IQI 04 Abdominal Aortic Aneurysm (AAA) Repair Volume
IQI 05 Coronary Artery Bypass Graft (CABG) Volume
IQI 06 Percutaneous Coronary Intervention (PCI) Volume
IQI 07 Carotid Endarterectomy Volume
IQI 08 Esophageal Resection Mortality Rate
IQI 09 Pancreatic Resection Mortality Rate
IQI 11 Abdominal Aortic Aneurysm (AAA) Repair Mortality Rate
IQI 12 Coronary Artery Bypass Graft (CABG) Mortality Rate
IQI 13 Craniotomy Mortality Rate
IQI 14 Hip Replacement Mortality Rate
IQI 15 Acute Myocardial Infarction (AMI) Mortality Rate
IQI 16 Heart Failure Mortality Rate
IQI 17 Acute Stroke Mortality Rate
IQI 18 Gastrointestinal Hemorrhage Mortality Rate
IQI 19 Hip Fracture Mortality Rate
IQI 20 Pneumonia Mortality Rate
IQI 21 Cesarean Delivery Rate, Uncomplicated
IQI 22 Vaginal Birth After Cesarean (VBAC) Delivery Rate, Uncomplicated
IQI 23 Laparoscopic Cholecystectomy Rate
IQI 24 Incidental Appendectomy in the Elderly Rate
IQI 25 Bilateral Cardiac Catheterization Rate
IQI 26 Coronary Artery Bypass Graft (CABG) Rate
IQI 27 Percutaneous Coronary Intervention (PCI) Rate
IQI 28 Hysterectomy Rate
IQI 29 Laminectomy or Spinal Fusion Rate
IQI 30 Percutaneous Coronary Intervention (PCI) Mortality Rate
IQI 31 Carotid Endarterectomy Mortality Rate
IQI 32 Acute Myocardial Infarction (AMI) Mortality Rate, Without Transfer Cases
IQI 33 Primary Cesarean Delivery Rate, Uncomplicated
IQI 34 Vaginal Birth After Cesarean (VBAC) Rate, All
IQI 90 Mortality for Selected Procedures
IQI 91 Mortality for Selected Conditions


IQI Appendices

IQI A Abnormal Presentation, Preterm, Fetal Death and Multiple Gestation Diagnosis Codes
IQI B Breech Procedure Codes


Patient Safety Indicators (PSI)

EXP 01 Rate of Complications of Anesthesia*
EXP 02 Obstetric Trauma Rate – Cesarean Delivery*
PSI 02 Death Rate in Low-Mortality Diagnosis Related Groups (DRGs)
PSI 03 Pressure Ulcer Rate
PSI 04 Death Rate among Surgical Inpatients with Serious Treatable Conditions
PSI 05 Retained Surgical Item or Unretrieved Device Fragment Count
PSI 06 Iatrogenic Pneumothorax Rate
PSI 07 Central Venous Catheter-Related Blood Stream Infection Rate
PSI 08 Postoperative Hip Fracture Rate
PSI 09 Perioperative Hemorrhage or Hematoma Rate
PSI 10 Postoperative Physiologic and Metabolic Derangement Rate
PSI 11 Postoperative Respiratory Failure Rate
PSI 12 Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate
PSI 13 Postoperative Sepsis Rate
PSI 14 Postoperative Wound Dehiscence Rate
PSI 15 Accidental Puncture or Laceration Rate
PSI 16 Transfusion Reaction Count
PSI 17 Birth Trauma Rate – Injury to Neonate
PSI 18 Obstetric Trauma Rate – Vaginal Delivery With Instrument
PSI 19 Obstetric Trauma Rate – Vaginal Delivery Without Instrument
PSI 21 Retained Surgical Item or Unretrieved Device Fragment Rate
PSI 22 Iatrogenic Pneumothorax Rate
PSI 23 Central Venous Catheter-Related Blood Stream Infection Rate
PSI 24 Postoperative Wound Dehiscence Rate
PSI 25 Accidental Puncture or Laceration Rate
PSI 26 Transfusion Reaction Rate
PSI 27 Postoperative Hemorrhage or Hematoma Rate
PSI 90 Patient Safety for Selected Indicators

* This will not have a proposed mapping of ICD-10-CM or ICD-10-PCS codes.


PSI Appendices

PSI A Operating Room Procedure Codes*
PSI B Medical Discharge DRGs*
PSI C Medical Discharge MS-DRGs*
PSI D Surgical Discharge DRGs*
PSI E Surgical Discharge MS-DRGs*
PSI F Infection Diagnosis Codes
PSI G Trauma Diagnosis Codes
PSI H Cancer Diagnosis Codes
PSI I Immunocompromised State Diagnosis and Procedure Codes
PSI J Admission Codes for Transfers*
PSI K Self-Inflicted Injury Diagnosis Codes
PSI L Spine Surgery Procedure Codes
PSI M Definitions of Neonate, Newborn, Normal Newborn, and Outborn

* This will not have a proposed mapping of ICD-10-CM or ICD-10-PCS codes.


Pediatric Quality Indicators (NQI and PDI)

NQI 01 Neonatal Iatrogenic Pneumothorax Rate
NQI 02 Neonatal Mortality Rate
NQI 03 Neonatal Blood Stream Infection Rate
PDI 01 Accidental Puncture or Laceration Rate
PDI 02 Pressure Ulcer Rate
PDI 03 Retained Surgical Item or Unretrieved Device Fragment Count
PDI 05 Iatrogenic Pneumothorax Rate
PDI 06 RACHS-1 Pediatric Heart Surgery Mortality Rate
PDI 07 RACHS-1 Pediatric Heart Surgery Volume
PDI 08 Perioperative Hemorrhage or Hematoma Rate
PDI 09 Postoperative Respiratory Failure Rate
PDI 10 Postoperative Sepsis Rate
PDI 11 Postoperative Wound Dehiscence Rate
PDI 12 Central Venous Catheter-Related Blood Stream Infection Rate
PDI 13 Transfusion Reaction Count
PDI 14 Asthma Admission Rate
PDI 15 Diabetes Short-term Complications Admission Rate
PDI 16 Gastroenteritis Admission Rate
PDI 17 Perforated Appendix Admission Rate
PDI 18 Urinary Tract Infection Admission Rate
PDI 19 Pediatric Safety for Selected Indicators
PDI 90 Pediatric Quality Overall Composite
PDI 91 Pediatric Quality Acute Composite
PDI 92 Pediatric Quality Chronic Composite

PDI Appendices

PDI A Operating Room Procedure Codes*
PDI B Surgical DRGs*
PDI C Surgical MS-DRGs*
PDI D Medical DRGs*
PDI E Medical MS-DRGs*
PDI F High-Risk Immunocompromised State Diagnosis and Procedure Codes
PDI G Intermediate-Risk Immunocompromised State Diagnosis Codes
PDI H Infection Diagnosis Codes
PDI I Definitions of Neonate, Newborn, Normal Newborn, and Outborn
PDI J Admission Codes for Transfers*
PDI K Stratification*
PDI L Low Birth Weight Categories

* This will not have a proposed mapping of ICD-10-CM or ICD-10-PCS codes.

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