January 30, 2023 Release Notes

FY2023 Hospital Acquired Condition (HAC) Updates

CMS has published an updated version of the ICD-10 CMS Hospital Acquired Conditions (HAC) for CMS FY2023. With this January release, the updated ICD-10 HACs, effective starting with October 1, 2022 discharges, have been implemented in the QualityAdvisor application.

HAC Diagnoses

30 diagnoses added to HAC 5- FALLS AND TRAUMA (effective with 10/1/2022 discharges)
1 diagnosis deleted from HAC 13- SURGICAL SITE INFECTION (SSI) FOLLOWING CARDIAC IMPLANTABLE ELECTRONIC DEVICE (CIED) PROCEDURES (effective with 10/1/2022 discharges)

HAC Procedures

8 procedures added for the following HACs (effective with 10/1/2022 discharges):

4 procedures added to HAC 10- DEEP VEIN THROMBOSIS (DVT) / PULMONARY EMBOLISM (PE) WITH TOTAL KNEE OR HIP REPLACEMENT

4 procedures added to HAC 12- SURGICAL SITE INFECTION - CERTAIN ORTHOPEDIC PROCEDURES OF SPINE, SHOULDER AND ELBOW

22 procedures deleted from HAC 12- SURGICAL SITE INFECTION - CERTAIN ORTHOPEDIC PROCEDURES OF SPINE, SHOULDER AND ELBOW (effective with 10/1/2022 discharges)

Additional Notes:

Patients discharged from October 1, 2022 and forward group to the FY2023 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., 10/1/2017, 10/1/2018, 10/1/2019, 10/1/2020, 10/1/2021, and/or 10/1/2022)
All Fiscal Year HAC lists are available in Chapter 8 of the Methodologies Guide

FY2023 Potential Inpatient Complications (PIC) Updates

This January release includes the FY2023 Potential Inpatient Complications (PIC) list defined by Premier. A summary of the updates is listed below, and the detailed PIC list is available in the ICD-10 Knowledge Center as well as in Chapter 8 of the Methodologies Guide.

PIC Diagnoses

36 PIC diagnoses are added (effective with 10/1/2022 discharges):

3 diagnoses added for PIC 109 - Other Infections

4 diagnoses added for PIC 404 - Acid-Base Disturbance

1 diagnosis added for PIC 1009 - Other Respiratory Complications

10 diagnoses added for PIC 1603 - Respiratory Complication of Newborn

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

4 diagnoses deleted from the following PICs (expires 9/30/2022):

1 diagnosis expired for PIC 109- Other Infections

1 diagnosis expired for PIC 404- Acid-Base Disturbance

2 diagnoses expired for PIC 1603- Respiratory Complication of Newborn

PIC Procedures

No PIC procedures are added with this release.

No PIC procedures are expired with this release.

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, 2022 and forward will group to the FY2023 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., 10/1/2017, 10/1/2018, 10/1/2019, 10/1/2020, 10/1/2021, and/or 10/1/2022)

AHRQ v2022 with Risk-Adjusted ICD-10 for PSI, PSI-90, IQI, and Custom Query Analyses

QualityAdvisor is now updated with AHRQ version 2022 for Standard Analyses and Custom Query for IQI and PSI (Facility & Peer). This version represents CMS FY2022.

This version supports all retrospective coding, and new coding effective with CMS FY 2022 (10/1/21 and forward)
The version supports coding up to 9/30/2022

Summary Notes:

AHRQ v2022 is now the default prompt selection for AHRQ PSI, and PSI-90 reporting for the analyses mentioned above
AHRQ v2022 is retroactive to 10/1/2017 in QualityAdvisor, and includes CMS supported coding through 9/30/2022
Premier Statistics provided are for v2022 and are based on 10/1/2021 - 9/30/2022
Risk-adjustment was provided by AHRQ within v2022 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

AHRQ v2022 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

Note: AHRQ v2020 is retired for PSI and PSI-90 Total Inpatient, but AHRQ v2019 is maintained for IQI

PSI Analyses Notes

Premier Statistics for v2022 are based on 10/1/2021 - 9/30/2022
All of the same numerator and count measures based on v2022 are also included within the Patient Qualifications prompt
V2020 has been retired, v2022 has been added as the new report default and caution messages are updated to reflect v2022 software supported timeframe

PSI-90 Total Inpatient Analysis Notes

The same v2022 software used for the PSI – Standard Analysis is used for this PSI-90 Total Inpatient report and includes a PSI-90 Composite. The v2022 Technical Specifications can be used as reference documentation for the PSI individual measures

This is an all payer version, all inpatient, flexible timeframe report

Important IQI Analyses Notes

AHRQ v2022 removed APR-DRGs from risk adjustment and replaced them with CCSRs. Due to this change in methodology, and also due to the fact that v2020 and v2021 were not implemented for IQI, results should not be compared with one another

Two measures were retired with the release of AHRQ V2021 which was not implemented within QualityAdvisor. Therefore, the following measures are not included within the v2022 updated version:
- IQI 32 Acute Myocardial Infarction (AMI) Mortality Rate, without Transfer Cases
- IQI 34 Vaginal Birth After Cesarean (VBAC) Rate

A v2019 report option will be maintained for IQI. Measure calculations are provided for current discharges to enable transition time away from the version. However, users should use caution and be aware that the supported software timeframe includes coding for discharges through 9/30/2019

AHRQ COVID Risk adjustment and Exclusion Logic for v2021 and v2022 updates

Risk Adjustment update:

COVID-19 Cases Removed for Risk Adjustment v2022

Since AHRQ had not yet released a risk-adjusted version which includes COVID-19 discharges, the v2022 implementation will exclude COVID-19 for both PSI and IQI. Premier plans to implement a risk-adjusted AHRQ version including COVID-19 discharges as soon as AHRQ makes one available.

Exclusion logic updates:

During testing of PSI v2022, an issue was identified with the implementation of the COVID exclusion rules impacting the PSI v2021. The incorrect exclusion rule required the presence of U07.1 on all COVID patients. The table below illustrates the discharge quarter, incorrect and implemented logic and the updated corrected logic. This update will be applied to the following PSI and PSI-90 reporting:

AHRQ v2021 PSI Standard Analysis and Custom Query for Facility and Peer

AHRQ v2021 PSI-90 for Total Inpatient

The update will also be included with the new AHRQ v2022 PSI, PSI-90 Total Inpatient and IQI versions planned for release this coming weekend.

Note: This update is not applicable to AHRQ v11 PSI-90 for CMS HACRP because that version is based on AHRQ v2020. AHRQ v2020 includes coding through March 31, 2020 which is pre-COVID.

COVID-19 ICD-10 Codes:

B97.29 OTH CORONAVIRUS CAUSE DZ ELSEWHERE
J12.82 PN D/T CORONOVIRUS DISEASE 2019
U07.1 COVID-19

Premier’s implementation has been updated to align with the AHRQ COVID exclusion logic as follows:

Time Period	Original Logic	Corrected Logic	Impact
1Q 2020	B97.29 and U07.1	B97.29	Discharge records with ONLY the B97.29 will now be excluded
2Q - 4Q 2020	B97.29 and U07.1	B97.29 and U07.1	Discharge records with ONLY the B97.29 or U07.1 will now be excluded
>2020	J12.82 and U07.1	J12.82 and U07.1	Discharge records with ONLY the J12.82 or U07.1 will now be excluded.

AHRQ Reference Documentation:

https://qualityindicators.ahrq.gov/Downloads/Resources/COVID19_UserNote_July2021.pdf

https://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V2022/TechSpecs/PSI_Appendix_N.pdf

This update could impact PSI v2021 previously reported results. Some hospitals may see a decrease in reported numerator or denominator results.