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.