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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 Procedure-Specific
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
CORONARY ARTERY BYPASS GRAFT (STS NQF Endorsed Codes)
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
36.15
Single internal mammary coronary artery bypass
36.16
Double internal mammary coronary artery bypass
36.17
Abdominal-coronary artery bypass
36.19
Other bypass anastomosis for heart revascularization
Age 18 years and older
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PERCUTANEOUS CORONARY INTERVENTION (JCAHO codes)
Number of patients undergoing PCTA or receiving stents, 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)
36.06
Insertion of coronary artery stent(s)
36.07
Insertion of drug-eluting coronary artery stent(s)
Age 18 years and older
AORTIC VALVE REPLACEMENT SURGERY (STS NQF Endorsed Codes)
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
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
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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 you to set volume thresholds for this Leap
Age 20 years and older
ABDOMINAL AORTIC ANEURYSM REPAIR
Number of patients undergoing abdominal aortic aneurysn repair, ICD9 PROCEDURE CODES:
38.34
Resection of aorta with anastomosis
38.44
Resection of aorta, abdominal, with replacement
38.64
Excision of aorta
39.71
Endovascular implantation of graft in the abdominal aorta
39.25
Aorta-iliac-fem bypass
Age 18 years and older
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 or 39.25 regardless of diagnosis codes.
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PANCREATECTOMY
Number of patients undergoing pancreatectomies, ICD9 PROCEDURE CODES:
52.51
Proximal pancreatectomy
52.53
Radical subtotal pancreatectomy
52.6
Total pancreatectomy
52.7
Radical pancreaticoduodenectomy
Age 18 years and older
ESOPHAGECTOMY
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
. . . regardless of diagnosis code(s)
or
43.99
Total gastrectomy, other (which includes esophagogastrectomy NOS)
. . . but this procedure code must be in conjunction with one or more of the following diagnosis codes:
and
any one or more cancer ICD9 DIAGNOSIS CODE(S) -- required only for procedure code 43.99
150.x
150.x Malignant neoplasm of esophagus, including
150.0
150.0 Cervical esophagus
150.1
150.1 Thoracic esophagus
150.2
150.2 Abdominal esophagus
150.3
150.3 Upper proximal third of esophagus
150.4
150.4 Middle third of esophagus
150.5
150.5 Distal third of esophagus
150.8
150.8 Malignant neoplasm of esophagus, other specified part
150.9
150.9 Esophagus unspecified
230.1
230.1 Carcinoma in situ, esophagus
Age 18 years and older
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EHIGH-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
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
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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
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.
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