November 7, 2006
Evidence-based Hospital Referral (EBHR) Coding Specifications for Volume
Volume Standard Codes
Use these specifications to count the volume of Evidence-Based Hospital Referral surgery
procedures, when responding to the Leapfrog Hospital Quality and Safety Survey.
Do not use these codes for measuring and reporting the Nationally-Endorsed ProcedureSpecific Process Measures of Quality; use the separate specifications for those indicators.
Patient populations used for the Process Measures typically DIFFER from patient included
here in the volume counts.
For each EBHR surgery listed below you will find associated ICD9 codes for the count of patients
with these procedures. While it is expected that most procedures would be indicated as a
principal procedure given their severity, if the procedure code is found in a secondary position,
the patient can be counted if the code qualifies according to the definition.
Use only ICD9 codes as indicated below. When calculating hospital volumes, count the number
of patients with any one or more of these procedure codes for that EBHR procedure, subject to
the other inclusion/exlcusion criteria below. Patient age restrictions apply to all procedures.
Additionally, presence or absence of certain diagnosis codes may further determine whether the
patient qualifies to be counted.
The count for the volume measures can include emergent cases as well as “elective” scheduled
cases.
If you have questions about the AHRQ Quality Indicators volume measures shown below please
refer to the following website for more information:
http://www.qualityindicators.ahrq.gov/iqi_overview.htm
ESOPHAGECTOMY (AHRQ IQI 1)
Number of patients undergoing esophagectomies, ICD9 PROCEDURE CODES:
42.4, 42.4X
Excision of esophagus, regardless of diagnosis code
42.5, 42.5X
Intrathoracic anastomosis of esophagus, regardless of diagnosis code
42.6, 42.6X
Antesternal anastomosis of esophagus, regardless of diagnosis code
Age 18 years and older
Exclusions:
MDC 14 (pregnancy, childbirth, and puerperium)
MDC 15 (newborns and other neonates)
PANCREATECTOMY (AHRQ IQI 2)
Number of patients undergoing pancreatectomies, ICD9 PROCEDURE CODES:
52.6
Total pancreatectomy
52.7
Radical pancreaticoduodenectomy
Age 18 years and older
November 7, 2006
Exclusions:
MDC 14 (pregnancy, childbirth, and puerperium)
MDC 15 (newborns and other neonates)
ABDOMINAL AORTIC ANEURYSM REPAIR (AHRQ IQI 4)
Number of patients undergoing abdominal aortic aneurysm repair, ICD9 PROCEDURE CODES:
38.34
38.44
38.64
39.71
Resection of aorta with anastomosis
Resection of aorta, abdominal, with replacement
Excision of aorta
Endovascular implantation of graft in the abdominal aorta
AND
ICD-9-CM DIAGNOSIS CODE
44.13
Ruptured Abdominal Aortic Aneurysm
44,14
Abdominal Aortic Aneurysm
Age 18 years and older
Exclusions:
MDC 14 (pregnancy, childbirth, and puerperium)
MDC 15 (newborns and other neonates)
Note: The goal of this standard is to increase the number of patients who have ELECTIVE
abdominal aortic aneurysm repair at high volume hospitals. The standard focuses on elective
procedures because patients whose AAA's have already ruptured (who need emergency surgery)
cannot necessarily be safely transferred to another hospital. In addition, there is less evidence
that the choice of hospital matters for emergency AAA (getting the operation as fast as possible
may be more important). The standard only applies to a hospital if it does ELECTIVE AAA
repairs; otherwise answer No to Question __ and do not report volume of AAA repairs.
However, the measurement of a hospital's annual volume includes both its elective cases and its
emergency cases (since they are all AAA repairs). Thus, a hospital's annual volume is
determined by using any procedures coded 38.34, 38.44, 38.64, 39.71 in conjunction with either
of the codes below.
CORONARY ARTERY BYPASS GRAFT (AHRQ IQI 5)
Number of Patients Undergoing CABG surgery, ICD9 PROCEDURE CODES:
36.10
Bypass anastomosis for heart revascularization
36.11
Aortocoronary bypass of one coronary artery
36.12
Aortocoronary bypass of two coronary arteries
36.13
Aortocoronary bypass of three coronary arteries
36.14
Aortocoronary bypass of four or more coronary arteries
November 7, 2006
36.15
36.16
36.17
36.19
Single internal mammary coronary artery bypass
Double internal mammary coronary artery bypass
Abdominal-coronary artery bypass
Other bypass anastomosis for heart revascularization
Age 18 years and older
Exclusions
MDC 14 (pregnancy, childbirth, and puerperium)
MDC 15 (newborns and other neonates)
PERCUTANEOUS CORONARY INTERVENTION (AHRQ IQI 6)
Number of patients undergoing PCTA or receiving stents for AMI diagnosis, ICD9 PROCEDURE
CODES
00.66
Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy
(code effective 10/1/2005)
36.01
Single vessel percutaneous transluminal coronary angioplasty without mention of
thrombolytics (code discontinued 10/1/2005)
36.02
Single vessel percutaneous transluminal coronary angioplasty with mention of
thrombolytics (code discontinued 10/1/2005)
36.05
Multiple vessel PTCA at the same session with or without mention of thrombolytics
(code discontinued 10/1/2005)
Age 18 years and older
Exclusions
MDC 14 (pregnancy, childbirth, and puerperium)
MDC 15 (newborns and other neonates)
AORTIC VALVE REPLACEMENT SURGERY
Number of patients undergoing aortic valve replacement surgery, ICD9 PROCEDURE CODES:
35.21
Replacement of aortic valve with tissue graft
35.22
Other replacement of aortic valve
Age 20 years and older
BARIATRIC SURGERY
Number of patients undergoing inpatient bariatric surgery, ICD9 PROCEDURE CODES:
Gastric bypass
44.31
High or “Mason” gastric bypass
44.39
Gastroenterostomy not elsewhere classified
44.69
Gastroplasty (includes vertical banded gastroplasty and adjustable gastric banding)
Malabsorptive
-- Duodenal switch
43.89
Sleeve gastrectomy
November 7, 2006
45.50
Small bowel to small bowel anastomosis
45.51
Small bowel segment isolation
45.90
Intestine to intestine anastomosis not otherwise specified
45.91
Intestinal isolation not otherwise specified
-- Biliopancreatic diversion
43.7
Partial gastrectomy with jejunal anastomosis
45.5
Small bowel to small bowel anastomosis
45.51
Small bowel segment isolation
45.90
Intestine to intestine anastomosis not otherwise specified
45.91
Intestinal isolation not otherwise specified
-- Isolated intestinal bypass
45.50
Small bowel to small bowel anastomosis
45.51
Small bowel segment isolation
45.90
Intestine to intestine anastomosis not otherwise specified
45.91
Intestinal isolation not otherwise specified
Gastrectomy
43.89
Sleeve
43.5
Proximal
43.6
Distal
Other
44.93
Gastric bubble insertion
44.99
Gastric operation not elsewhere classified
Editor’s note: These codes are under further review for consistency with:
 ACS NSQIP bariatric procedure coding
 Medicare-covered bariatric surgeries
 Consistency with evidence to set volume thresholds for this Leap
Age 20 years and older
November 7, 2006
HIGH-RISK DELIVERIES (COMPLICATED NEWBORNS)
Note: Use the remainder of this document only to determine if your hospital electively
admits high-risk deliveries or complicated newborns.
Do NOT use these codes to count any volume.
Average daily census in the NICU is regardless of the baby's diagnosis.
DELIVERY <1500 GRAMS OR <32 WEEKS GESTATION
ICD9 DIAGNOSIS CODES
764.01-764.05
Light for dates without mention of malnutrition--<500 gms.-1499 gms.
764.11-764.15
Light for dates with signs of fetal malnutrition--<500 gms. - 1499 gms.
764.21-764.25
Fetal malnutrition without mention of “light for dates”--<500 gms. -1499 gms.
764.91-764.95
Fetal growth retardation, unspecified--<500gms. - 1499 gms.
765.0x
Extreme immaturity (usually BW <1000gm or gestation < 28 weeks
765.11-765.15
Other preterm infants, --<500 gms-1499 gms
765.21-765.26
Gestation age<33 weeks
DELIVERY WITH CONGENITAL ANOMALIES
ICD9 DIAGNOSIS CODES
424.0-429.3
Cardiac Conditions
exclude 427.5
519.4, 553.3
Disorders of the Diaphragm; Congenital diaphragmatic hernia
741.XX
741.XX Spina bifida
742.0X
742.0X Encephalocele
742.2
742.2 Reduction deformities of brain
742.3
742.3 Congenital hydrocephalus
742.4
742.4 Other specified anomalies of brain
742.5
742.5 Other specified anomalies of spinal cord
742.8
742.8 Other specified anomalies of nervous system
742.9
742.9 Unspecified anomaly of brain, spinal cord, and nervous system
745.XX
745.XX Bulbus cordis anomalies and anomalies of cardiac septic closure
746-746.85
746-746.85 Other congenital anomalies of the heart
747.1X-747.9
747.1X-747.9 Congenital anomalies of the circulatory system
748.XX
748.XX Congenital anomalies of respiratory system
750.3
750.3 Tracheoesophageal fistula, esophageal atresia and stenosis
750.4
750.4 Other specified anomalies of esophagus
750.6
750.6 Congenital hiatus hernia
751.XX
751.XX Other congenital anomalies of digestive system
753.1X
753.1X Cystic kidney disease
753.3
753.3 Other specified anomalies of kidney
756.6
753.6 Atresia and stenosis of urethra and bladder neck
756.4
756.4 Chondrodystrophy
756.51
756.51 Osteogenesis imperfecta
756.55
756.55 Chondroectodermal dysplasia
756.59
756.59 Other osteodystrophies
756.6
756.6 Anomalies of diaphragm
756.7X
756.7X Anomalies of abdominal wall
756.89
756.89 Other specified anomalies of muscle, tendon, fascia, and connective
tissue
November 7, 2006
759.9
756.9 Other and unspecified anomalies of musculoskeletal system
Note: The use of codes for cardiac conditions for congenital anomalies (424.0-429.3, excluding
427.5) have been added to the list of congenital anomalies because previous research has found
that they are used in newborn discharge abstracts to describe conditions that really are
congenital anomalies.