December 16, 2024 Release Notes

QualityAdvisor is now updated with AHRQ version 2024 for Standard Analyses and Custom Query for IQI and PSI (Facility & Peer). This version represents CMS FY2024.

• AHRQ v2024 supports all retrospective coding, and new coding effective with CMS FY 2024 (10/1/23 and forward)

• The version supports coding up to 9/30/2024

• A v2023 report option will be maintained for all total inpatient PSI, IQI, and PSI-90 report versions

Report Notes:

• AHRQ v2024 is now the default prompt selection for AHRQ PSI, IQI, and PSI-90 reporting for the analyses mentioned above

• AHRQ v2024 is retroactive to 10/1/2019 in QualityAdvisor, and includes CMS supported coding through 9/30/2024

• Premier Statistics provided are for v2024 and are based on 10/1/2023 - 9/30/2024

• Risk-adjustment was provided by AHRQ within v2024 by using the Health Care Cost and Utilization Project (HCUP) reference population

• As with previous AHRQ versions, Premier will pass the first 35 diagnosis and 30 procedure codes through the software
• Individual PSI Technical Specification Updates include CMS annual coding updates (for ICD, MS-DRG and MDC), and POA exempt code updates

• Since risk-adjustment was added with v2023, AHRQ no longer provides the option to exclude COVID-19 patients from the software. Therefore, COVID-19 patients will continue to be included in results and risk-adjustment provided with v2024

New: Standard Secondary Payer is now added within the "Drill to Numerator Patients" and "Drill to Denominator Patients" options for PSI, IQI, and PSI-90 Total Inpatient reports for both v2023 and v2024 both Facility and Peer report versions.

AHRQ v2024 is now available on the following analyses:

• PSI – Standard Analysis, and Custom Query for Facility and Peer
• IQI – Standard Analysis, and Custom Query for Facility and Peer
• PSI-90 Total Inpatient – Standard Analysis (Facility only)

Note: AHRQ v2022 is retired for PSI, IQI, and PSI-90 Total Inpatient.

PSI Specific Changes:

• PSI-09 (Postoperative Hemorrhage or Hematoma Rate) — Excludes patients with medication-related coagulopathies present on admission (e.g., attributable to anticoagulant or antithrombotic medications) or thrombolytic medications administered for emergent indications

• PSI-12 (Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate) and PSI-13 (Postoperative Sepsis Rate) — Exclude patients with long preoperative delay (more than ten days), who likely developed the event before surgery

• PSI-04, PSI-09, PSI-10, PSI-11, PSI-12, and PSI-13— Revised operating room procedures (ORPROC) to remove selected drainage procedures performed via natural or artificial opening without an endoscope

• PSI-15 (Abdominopelvic Accidental Puncture of Laceration Rate) — Refined ABDOMI15P to align with ORPROC update

PSI-90 Total Inpatient Analysis Notes:

• Measure weights updated based on AHRQ v2024

• The same v2024 software used for the PSI – Standard Analysis is used for this PSI-90 Total Inpatient report and includes a PSI-90 Composite. The v2024 Technical Specifications can be used as reference documentation for the PSI individual measures

IQI Specific Changes:

IQI-30 (Percutaneous Coronary Intervention (PCI) Mortality Rate) — Revised the denominator to include percutaneous coronary interventions other than coronary artery dilation since these are percutaneous coronary intervention (PCI) procedures

 

The new HAC FY2025 reporting option has been added to the PSI-90 for CMS HAC Reduction Program - Facility standard analysis. The version is called v14.

Summary Overview

• The performance period for this software is July 1, 2021 - June 30, 2023

• The SAS software is modified by CMS (recalibrated) for the Fee-For-Service reference patient population specifically for the FY2025 program and is called Version 14

• The recalibrated version 14.0 software is modified so that software parameters (i.e., risk-adjustment coefficients, signal variance, and component weights in the Recalibrated PSI 90 Composite) derived from the reference population for CMS PSIs based on based on 24 months of Medicare FFS discharge data (July 1, 2020 to June 30, 2022)

• CMS v14.0 PSI software incorporates updated measure technical specifications consistent with AHRQ PSI software v2023 and is compatible with fiscal year 2023 ICD-10-CM/PCS coding

• COVID-19 discharges will continue to be included with this version

• Premier uses the CMS software and replication instructions to provide this reporting option in alignment with the program as closely as possible:

25 diagnosis and 25 procedure codes are passed through the software

Medicare only patients

• Premier population statistics are based on the same Winsorized z-scoring methodology documented by CMS for the performance period timeframe:

Premier Median

Premier 75th Percentile

• Minimum Discharge Rule

As with the previous version (v13), v14 incorporates the minimum discharge rule. A hospital will only receive a CMS PSI-90 composite value if it meets both of the following criteria:

1. Has 1 or more PSI component with at least 25 discharges

2. Has 7 or more component PSI measures with at least 3 discharges each

If a hospital does not meet both of these criteria, the CMS PSI-90 composite will display dashes ("--") as a null value.

New: Standard Secondary Payer is now added within the "Drill to Numerator Patients" and "Drill to Denominator Patients" options for the PSI-90 for CMS HAC Reduction Program - Facility standard analysis for both v13 and v14.

Note: The FY2023 v13 option for this analysis remains available.

Please see PSI-90 for CMS HAC Reduction Program for more detailed information.

 

With this December release, we have revised the CMS HAC and PIC documents as posted in this Help Guide. Previously we posted separate PDF documents for the CMS HAC and PIC lists. Going forward, both the CMS HAC and PIC lists are combined together in the same documents to add better clarity with grouping and exclusions.

The new CMS HAC and PIC Methodology document allows you to see both the CMS HAC and PIC in one document, whether it uses Primary and/or secondary Diagnosis codes or Procedure codes, and the associated Methodology and Exclusions.

For Example:

The new CMS HAC and PIC List document allows you to see the masters list of Potential Inpatient Complications, including whether it is a CMS HAC or not, the ICD-10 code (including Types and Classes), the Effective Dates, and the Expiration Dates.

For Example:

Notes:

• The documents are posted as Excel spreadsheets, allowing you to use included filters

• When trying to identify CMS HACs, filter on the specific HAC you are looking for in column C

• The inclusion of Effective and Expiration dates eliminates the need for us to post separate HAC documents for each fiscal year

• The documents are posted in both the ICD-10 Knowledge Center and in Chapter 8 of the Methodology Guide

 

CMS has published an updated version of the ICD-10 CMS Hospital Acquired Conditions (HAC) for CMS FY2025.  With this December release, the updated ICD-10 HACs, effective starting with October 1, 2024 discharges, have been implemented in the QualityAdvisor application.

HAC Diagnoses

• Four HAC diagnoses added (effective with 10/1/2024 discharges)

HAC 10 — Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) with Total Knee or Hip Replacement

• No HAC diagnosis deleted 

HAC Procedures

• Four HAC procedures added

HAC 12 — Surgical Site Infection - Certain Orthopedic Procedures of Spine, Shoulder and Elbow

• No HAC procedures deleted

Additional Notes:

• Patients discharged from October 1, 2024 and forward group to the FY2025 CMS HAC list

• Analyses impacted by this change include: Complications Comparison (Facility and Peer), Complications Distribution (ICD-10 for both Facility and Peer), and CMS Hospital Acquired Conditions (Facility)

• Reports run for time periods that cross over multiple fiscal years will see a mix of the different CMS HAC versions (i.e., 10/1/2019, 10/1/2020, 10/1/2021, 10/1/2022, 10/1/2023, and/or 10/1/2024)

 

This December release includes the FY2025 Potential Inpatient Complications (PIC) list defined by Premier. A summary of the updates is listed below:

PIC Diagnoses

• 18 PIC diagnoses are added (effective with 10/1/2024 discharges):

3 PIC diagnosis added for 401- Other Hypoglycemia

1 PIC diagnosis added for 602- Encephalopathy

4 PIC diagnoses added for 903- Pulmonary Embolism

6 PIC diagnoses added for 1902- Adverse Drug Event (ADE)

4 PIC diagnoses added for 1908- Complication of Surgical Wound or Wound Healing incl. Hematoma

• Three PIC diagnosis descriptions are changed (effective with 10/1/2024 discharges)

602 - Encephalopathy, ICD-10 Code G93.42

903 - Pulmonary Embolism, ICD-10 Code I26.93

903 - Pulmonary Embolism, ICD-10 Code I26.94

• One PIC diagnosis is expired (effective with 10/1/2024 discharges)

1908 - Complication of Surgical Wound or Wound Healing incl. Hematoma

PIC Procedures

• No PIC procedures are added

• No PIC procedures are expired

Additional Notes

• Analyses impacted by this change include: Complications Comparison (Facility and Peer) and Complications Distribution (ICD-10 for both Facility and Peer)
  

• Patients discharged from October 1, 2024 and forward will group to the FY2025 PIC list

• Reports run for time periods that cross over multiple fiscal years will see a mix of the different PIC fiscal year versions (i.e., 10/1/2019, 10/1/2020, 10/1/2021, 10/1/2022, 10/1/2023, and/or 10/1/2024)

 

The following updates are included with this December release:

• The latest Yale methodology for THA/TKA Complication Measure uses the FY2025 THA/TKA CMS Readmission and Mortality focused population to identify patients included in the cohort. Detailed information on the CMS/Yale 2024 Procedure-Specific Complication Measure Updates and Specifications for THA/TKA can be accessed on the https://www.qualitynet.org/inpatient/measures/complication/methodology page.

• The IQR Benchmarks are updated based on FY24 results

 

Within the ICU Outcomes Comparison report, we have disabled the ability to remove MS-DRG from the row when drilling.

 

With this December release we have completed the annual Perinatal coding updates. The updates include:

New ICD-10 Code Tables

• All new ICD-10 Code Table Created for Vaginal Delivery Procedure Codes

• All new ICD-10 Code Table Created for Cesarean Delivery Diagnosis Codes

• All new ICD-10 Code Table Created for Cesarean Delivery Procedure Codes

Diagnosis Codes Added

• Severe Maternal Morbidity (SMM) Diagnosis Codes - 4 Digit — One new diagnosis code added

• Severe Maternal Morbidity (SMM) Diagnosis Codes - 5 and 6 Digit — 27 new diagnosis codes added

• Maternal Hemorrhage Diagnosis Codes — Three diagnosis codes added

• Maternal VTE Diagnosis Codes — Four diagnosis codes added

• Neonatal Abstinence Syndrome (NAS) Diagnosis Codes — Two diagnosis codes added

Diagnosis Codes Deleted

• Severe Maternal Morbidity (SMM) Diagnosis Codes - 5 and 6 Digit — Three diagnosis codes deleted

Neonatal Abstinence Syndrome (NAS) Renamed

The existing Neonatal Abstinence Syndrome (NAS) metric is renamed to Neonatal Abstinence Syndrome (NAS) Including Exposure to Substances. As a result, all Excluding NAS outcome measures are now based on Neonatal Abstinence Syndrome (NAS) Including Exposure to Substances.

• Complications O/E

• Mortality O/E

• Readmissions O/E

• Geometric LOS O/E

• Complications – Outcome Cases

• Mortality – Outcome Cases

• Readmissions – Outcome - Cases

• Geometric LOS – Outcomes Cases

• Complications Observed – Cases