ICD-10 Focused Populations (Current)

For patient discharges beginning 10/1/2020

QualityAdvisor maintains two versions of the CMS defined focused populations (Current and Historical). As new CMS defined focused population definitions are implemented in the application each year, the current CMS defined focused population definitions will shift over to the Historical prompt selection, and remain available for reporting purposes.

Note: Unless the population definition specifies principal diagnosis and/or procedure, the first 25 ICD codes are considered when patients are grouped to a focused population in QualityAdvisor.

Refer to the CMS Readmission and Mortality, and Premier-Defined Populations (Current) ICD-10 Code Appendix/Tables as of October 2025

You can refer to either the CMS or TJC websites (below) to see the Core Measure population specification manuals and code appendices:

• CMS.gov Quality Net

• The Joint Commission

The following Focused Populations are available:

Type of Population	ICD-10 Population Algorithms
CMS Readmission and Mortality Populations*	Acute Myocardial Infarction (FY26) Chronic Obstructive Pulmonary Disease (COPD) (FY23 — FY26) Coronary Artery Bypass Graft (FY26) Heart Failure (FY26) Pneumonia (FY26) Total Hip Arthroplasty and/or Total Knee Arthroplasty (FY26)
CMS Mortality Populations*	Stroke (FY23 — FY26)
Core Measure Populations	Perinatal Care - Core Measure Severe Sepsis/Septic Shock Bundle - Core Measure Stroke - Core Measure
Premier-Defined Populations	Abdominal Aortic Aneurysm Repair Adult Asthma Cardiac CV Surgery (except CABG) Carotid Procedures/Interventions Children's Asthma Care - Retired Core Measure Colon Surgery COVID-19 - Inpatient COVID-19 - Outpatient Hip Fracture Hysterectomy Percutaneous Coronary Intervention PR: Newborn PR: Vaginal Delivery Pregnancy and Related Conditions Severe Sepsis with or without Septic Shock Spinal Fusion Cervical/Other Upper Back & Neck Procedures Spinal Fusion Dorsal/Lumbar Spine Vascular Surgery

*Note:The CMS Readmission and Mortality focused populations are provided to narrow populations to a clinical condition and closely align to Yale’s definition for the payment programs.  However, since QualityAdvisor’s use of a focused population can span beyond the scope of a 30-day readmission or mortality calculation, Premier made certain allowances to maximize the patient population beyond these measures.  In other words, the focused populations within QualityAdvisor can be used for metrics not limited to the readmission or mortality outcome.  To more closely align with the CMS measure specifications for the focused populations, it may be necessary to apply additional filter criteria via the reporting prompts to narrow your population further (i.e. age, payer, and discharge status).

Excluded Populations

The following populations are excluded from being grouped:

• Skilled Nursing

• Long Term Care

• Rehab

• Hospice

• Same Day Surgery

• Emergency

• Observation

• Diagnostic Testing

• Recurring/Series

• Pre-Surgical Testing

• Home Health

• Clinic

• Organ Donor