ICD-9-CM Code Crosswalk for Hospital Condition-Specific Readmission Measures
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1 ICD-9-CM Code Crosswalk for Hospital Condition-Specific Readmission Measures Purpose: To compare the ICD-9-CM used by the Centers for Medicare & Medicaid Services (CMS) conditionspecific readmission measures used in the Hospital Inpatient Quality Reporting Program and publicly reported on Hospital Compare with the disease-specific measures included in the and Readmissions Report provided by the CMS Quality Innovation Network (QIN) National Coordinating Center (QIN-NCC) and distributed by the Quality Innovation Network Quality Improvement Organizations (). This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-C3-41/
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3 Method QIO - Care Transition Inpatient Quality Reporting (IQR)* Use/Purpose Measures Measure hospital performance over time for quality improvement effort impact Condition-specific (AMI, HF, Pneumonia, DM, others to be added over time) and all-condition (Hospital- Wide Readmission) CMS Readmission Measures Profile hospital performance for public reporting Condition-specific (AMI, HF, Pneumonia, Hip/Knee Replacement, COPD, Stroke) and all-condition (Hospital-Wide Readmission) Hospital Readmissions Reduction Program (HRRP)* Profile hospital performance for payment Condition-Specific (AMI, HF, Pneumonia, Hip/Knee Replacement and COPD) Risk adjustment** No risk adjustment Hospital-level 30-day all-cause risk Hospital-level 30-day all-cause risk standardized readmission measures standardized readmission measures Inpatient Psychiatric Hospitals and Included beginning 8/1/2014 Excluded Excluded Units Critical Access Hospitals (CAHs)** Included Included** Excluded Readmission definition** Data timeframe** Measures displayed Every readmission is counted within a 30-day period of a hospital discharge. Each subsequent readmission is also counted as an index admission. Categories of AMI, HF, PNE, and DM are based on any of the index hospitalization diagnosis codes and readmissions are for all causes. Timeframe for a calendar year includes beneficiaries with a discharge date between January 1 and December 31 of that year with 30 days added to calculate readmissions. Not currently publicly displayed The condition-specific readmission measures assign readmission status as a dichotomous yes/no value regardless of the number of times the patient was readmitted during the 30-day postdischarge time period. For HWR measure, readmission is also eligible to be counted as a new index admission if it meets all other eligibility criteria. For condition-specific measures, index hospitalizations are identified using 3 years of data; for Hospital-Wide Readmission measure 1 year of data. Rationale: 3 years of data increases sample size and improves statistical precision of estimate for conditionspecific measures. One year of data provides a sufficient number of cases per hospital to estimate the HWR measure. Annually on Hospital Compare Same as for IQR Same as for IQR Posted on CMS Hospital Readmissions Reduction Program website. Availability of Patient data Hospital-Specific Reports transmitted Report provided by each hospital s QINto hospitals annually prior to public QIO quarterly reporting Hospital-Specific Reports transmitted to hospitals annually prior to public reporting * See measures finalized in the FY 2014 IPPS/LTCH PPS Final rule posted at: Medicare > Medicare Fee-for-Service Payment > Acute Inpatient PPS > FY2014 IPPS Final Rule Home Page ** For methodology details, see: Measure Methodology Reports: Readmission Measures
4 Acute Myocardial Infarction (AMI) ICD-9-CM Acute myocardial infarction of anterolateral wall Acute myocardial infarction of anterolateral wall, episode of care Acute myocardial infarction of anterolateral wall, initial episode of care IQR and HRRP Measures Acute myocardial infarction of anterolateral wall, subsequent episode of care Acute myocardial infarction of other anterior wall Acute myocardial infarction of other anterior wall, episode of care Acute myocardial infarction of other anterior wall, initial episode of care Acute myocardial infarction of other anterior wall, subsequent episode of care Acute myocardial infarction of inferolateral wall Acute myocardial infarction of inferolateral wall, episode of care Acute myocardial infarction of inferolateral wall, initial episode of care Acute myocardial infarction of inferolateral wall, subsequent episode of care Acute myocardial infarction of inferoposterior wall Acute myocardial infarction of inferoposterior wall, episode of care Acute myocardial infarction of inferoposterior wall, initial episode of care Acute myocardial infarction of inferoposterior wall, subsequent episode of care Acute myocardial infarction of other inferior wall Acute myocardial infarction of other inferior wall, episode of care Acute myocardial infarction of other inferior wall, initial episode of care Acute myocardial infarction of other inferior wall, subsequent episode of care Acute myocardial infarction of other lateral wall Acute myocardial infarction of other lateral wall, episode of care Acute myocardial infarction of other lateral wall, initial episode of care Acute myocardial infarction of other lateral wall, subsequent episode of care Acute myocardial infarction; true posterior wall infarction
5 ICD-9-CM True posterior wall infarction, episode of care True posterior wall infarction, initial episode of care True posterior wall infarction, subsequent episode of care Acute myocardial infarction; subendocardial infarction Subendocardial infarction, episode of care Subendocardial infarction, initial episode of care Subendocardial infarction, subsequent episode of care Acute myocardial infarction of other specified sites Acute myocardial infarction of other specified sites, episode of care Acute myocardial infarction of other specified sites, initial episode of care Acute myocardial infarction of other specified sites, subsequent episode of care Acute Myocardial Infarction (AMI) IQR and HRRP Measures Unspecified site Acute myocardial infarction of site, episode of care Acute myocardial infarction of site, initial episode of care Acute myocardial infarction of site, subsequent episode of care Post myocardial infarction syndrome Intermediate coronary syndrome Other acute and subacute forms of ischemic heart disease Acute coronary occlusion without myocardial infarction Other acute and subacute forms of ischemic heart disease Angina decubitus Prinzmetal angina Other and angina pectoris
6 ICD-9-CM IQR and HRRP Measures Rheumatic heart failure (congestive) Malignant hypertensive heart disease with heart failure Benign hypertensive heart disease with heart failure Unspecified hypertensive heart disease with heart failure Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV or Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage IV or end stage renal disease Hypertensive heart and chronic kidney disease,, with heart failure and with chronic kidney disease stage I through stage IV, or Hypertensive heart and chronic kidney disease,, with heart failure and chronic kidney disease stage V or end stage renal disease Heart Failure (HF) Congestive heart failure, Left heart failure Systolic heart failure, Acute systolic heart failure Chronic systolic heart failure Acute or chronic systolic heart failure Diastolic heart failure, Acute diastolic heart failure
7 Heart Failure (HF) ICD-9-CM IQR and HRRP Measures Chronic diastolic heart failure Acute or chronic diastolic heart failure Combined systolic and diastolic heart failure, Acute combined systolic and diastolic heart failure Chronic combined systolic and diastolic heart failure Acute or chronic combined systolic and diastolic heart failure Heart failure,
8 ICD-9-CM IQR and HRRP Measures Salmonella pneumonia Primary pneumonic plague Secondary pneumonic plague Pneumonic plague, Pulmonary tularemia Pulmonary anthrax Pulmonary diseases due to other mycobacteria Pulmonary actinomycotic infection Varicella (hemorrhagic) pneumonitis Post measles pneumonia Ornithosis with pneumonia Q fever Candidiasis of lung Primary coccidioidomycosis (pulmonary) Chronic pulmonary coccidioidomycosis Pulmonary coccidioidomycosis, Infection by Histoplasma capsulatum, pneumonia Infection by Histoplasma duboisii, pneumonia Histoplasmosis,, pneumonia Pneumonitis due to toxoplasmosis Pneumocystosis Pneumonia due to adenovirus Pneumonia due to respiratory syncytial virus Pneumonia due to parainfluenza virus Pneumonia due to SARS-associated coronavirus Pneumonia due to other virus not elsewhere classified Viral pneumonia, 481 Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] Pneumonia (PNE)
9 ICD-9-CM Pneumonia (PNE) IQR and HRRP Measures Pneumonia due to Klebsiella pneumoniae Pneumonia due to Pseudomonas Pneumonia due to Hemophilus influenzae (H. influenzae) Pneumonia due to Streptococcus Pneumonia due to Streptococcus, Pneumonia due to Streptococcus, group A Pneumonia due to Streptococcus, group B Pneumonia due to other Streptococcus Pneumonia due to Staphylococcus Pneumonia due to Staphylococcus, Methicillin susceptible pneumonia due to Staphylococcus aureus Methicillin resistant pneumonia due to Staphylococcus aureus Other Staphylococcus pneumonia Pneumonia due to other specified bacteria Pneumonia due to anaerobes Pneumonia due to escherichia coli [E. coli] Pneumonia due to other gram-negative bacteria Pneumonia due to Legionnaires' disease Pneumonia due to other specified bacteria Bacterial pneumonia, 483 Pneumonia due to other specified organism Pneumonia due to mycoplasma pneumoniae Pneumonia due to chlamydia Pneumonia due to other specified organism Pneumonia in cytomegalic inclusion disease Pneumonia in whooping cough Pneumonia in anthrax
10 ICD-9-CM Pneumonia (PNE) IQR and HRRP Measures Pneumonia in aspergillosis Pneumonia in other systemic mycoses Pneumonia in other infectious diseases classified elsewhere 485 Bronchopneumonia, organism 486 Pneumonia, organism Influenza with pneumonia Influenza due to identified 2009 H1N1 influenza virus with pneumonia Abscess of lung Rheumatic pneumonia
11 ICD-9-CM Obstructive chronic bronchitis with (acute) exacerbation Obstructive chronic bronchitis with acute bronchitis IQR Measures Other chronic bronchitis Unspecified chronic bronchitis Other emphysema Chronic obstructive asthma, Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive asthma with status asthmaticus Chronic obstructive asthma with (acute) exacerbation Chronic airway obstruction, not elsewhere classified Acute respiratory failure (Principal diagnosis when combined with a secondary diagnosis of COPD with exacerbation [491.21, , , or ]) Other pulmonary insufficiency, not elsewhere classified (Principal diagnosis when combined with a secondary diagnosis of COPD with exacerbation [491.21, , , or ]) Acute and chronic respiratory failure (Principal diagnosis when combined with a secondary diagnosis of COPD with exacerbation [491.21, , , or ]) Respiratory arrest (Principal diagnosis when combined with a secondary diagnosis of COPD with exacerbation [491.21, , , or ])
12 Stroke ICD-9-CM Occlusion and stenosis of basilar artery with cerebral infarction Occlusion and stenosis of carotid artery with cerebral infarction 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 IQR Measures Occlusion and stenosis of precerebral artery with cerebral infarction Cerebral thrombosis with cerebral infarction Cerebral embolism with cerebral infarction Cerebral artery occlusion, with cerebral infarction
13 Diabetes Mellitus (DM) ICD-9-CM Secondary diabetes mellitus without mention of complication, not stated as, or Secondary diabetes mellitus without mention of complication, Secondary diabetes mellitus with ketoacidosis, not stated as, or Secondary diabetes mellitus with ketoacidosis, Secondary diabetes mellitus with hyperosmolarity, not stated as, or Secondary diabetes mellitus with hyperosmolarity, CMS 30-Day Risk-Standardized Readmission Measures Secondary diabetes mellitus with other coma, not stated as, or Secondary diabetes mellitus with other coma, Secondary diabetes mellitus with renal manifestations, not stated as, or Secondary diabetes mellitus with renal manifestations, Secondary diabetes mellitus with ophthalmic manifestations, not stated as, or Secondary diabetes mellitus with ophthalmic manifestations, Secondary diabetes mellitus with neurological manifestations, not stated as, or Secondary diabetes mellitus with neurological manifestations, Secondary diabetes mellitus with peripheral circulatory disorders, not stated as, or Secondary diabetes mellitus with peripheral circulatory disorders, Secondary diabetes mellitus with other specified manifestations, not stated as, or Secondary diabetes mellitus with other specified manifestations, Secondary diabetes mellitus with complication, not stated as, or Secondary diabetes mellitus with complication,
14 Diabetes Mellitus (DM) ICD-9-CM Diabetes mellitus without mention of complication, type II or type, not stated as Diabetes mellitus without mention of complication, type I [juvenile type], not stated as Diabetes mellitus without mention of complication, type II or type, Diabetes mellitus without mention of complication, type I [juvenile type], CMS 30-Day Risk-Standardized Readmission Measures Diabetes with ketoacidosis, type II or type, not stated as Diabetes with ketoacidosis, type I [juvenile type], not stated as Diabetes with ketoacidosis, type II or type, Diabetes with ketoacidosis, type I [juvenile type], Diabetes with hyperosmolarity, type II or type, not stated as Diabetes with hyperosmolarity, type I [juvenile type], not stated as Diabetes with hyperosmolarity, type II or type, Diabetes with hyperosmolarity, type I [juvenile type], Diabetes with other coma, type II or type, not stated as Diabetes with other coma, type I [juvenile type], not stated as Diabetes with other coma, type II or type, Diabetes with other coma, type I [juvenile type], Diabetes with renal manifestations, type II or type, not stated as Diabetes with renal manifestations, type I [juvenile type], not stated as Diabetes with renal manifestations, type II or type, Diabetes with renal manifestations, type I [juvenile type], Diabetes with ophthalmic manifestations, type II or type, not stated as Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as
15 Diabetes Mellitus (DM) ICD-9-CM Diabetes with ophthalmic manifestations, type II or type, Diabetes with ophthalmic manifestations, type I [juvenile type], Diabetes with neurological manifestations, type II or type, not stated as Diabetes with neurological manifestations, type 1 [juvenile type], not stated as Diabetes with neurological manifestations, type II or type, CMS 30-Day Risk-Standardized Readmission Measures Diabetes with neurological manifestations, type 1 [juvenile type], Diabetes with peripheral circulatory disorders, type II or type, not stated as Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as Diabetes with peripheral circulatory disorders, type II or type, Diabetes with peripheral circulatory disorders, type I [juvenile type], Diabetes with other specified manifestations, type II or type, not stated as Diabetes with other specified manifestations, type I [juvenile type], not stated as Diabetes with other specified manifestations, type II or type, Diabetes with other specified manifestations, type I [juvenile type], Diabetes with complication, type II or type, not stated as Diabetes with complication, type I [juvenile type], not stated as Diabetes with complication, type II or type, Diabetes with complication, type I [juvenile type], Abnormal glucose Impaired fasting glucose
16 ICD-9-CM Diabetes Mellitus (DM) CMS 30-Day Risk-Standardized Readmission Measures Impaired glucose tolerance test (oral) Other abnormal glucose Glycosuria Acetonuria V45.85 Insulin pump status V53.91 Fitting and adjustment of insulin pump V65.46 Encounter for insulin pump training
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