Appendix A. Planned Readmission Tables



Appendix A. Planned Readmission Tables Planned Readmission Algorithm- General Population TablesTable PR 1. Procedure categories that are always planned Procedure CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.064Bone marrow transplantxxxx105Kidney transplantxxxx134Cesarean section1?xxx135Forceps; vacuum; and breech delivery[1]?xxx176Other organ transplantationxxxxTable PR 2. Diagnosis categories that are always plannedDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.045Maintenance chemotherapyxxxx194Forceps delivery1?xxx196Normal pregnancy and/or delivery1?xxx254Rehabilitation xxxx Table PR 3. Potentially planned procedure categories Procedure CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.01Incision and excision of CNSx???3Laminectomy; excision intervertebral discxxxx5Insertion of catheter or spinal stimulator and injection into spinal ?xxx9Other OR therapeutic nervous system procedures?xxx10Thyroidectomy; partial or completexxxx12Other therapeutic endocrine procedures?xxx33Other OR therapeutic procedures on nose; mouth and pharynx ?xxx36Lobectomy or pneumonectomyxxxx38Other diagnostic procedures on lung and bronchus?xxx40Other diagnostic procedures of respiratory tract and mediastinum?xxx43Heart valve proceduresxxxx44Coronary artery bypass graft (CABG)xxxx45Percutaneous transluminal coronary angioplasty (PTCA)xxxx47Diagnostic cardiac catheterization; coronary arteriography?xxx48Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillatorxxxx49Other OR heart procedures?xxx51Endarterectomy; vessel of head and neckxxxx52Aortic resection; replacement or anastomosisxxxx53Varicose vein stripping; lower limb?xxx55Peripheral vascular bypassxxxx56Other vascular bypass and shunt; not heart?xxx59Other OR procedures on vessels of head and neck ?xxx60Embolectomy and endarterectomy of lower limbsx???62Other diagnostic cardiovascular procedures?xxx66Procedures on spleen?xxx67Other therapeutic procedures; hemic and lymphatic system?xxx74Gastrectomy; partial and totalxxxx78Colorectal resectionxxxx79Local excision of large intestine lesion (not endoscopic)?xxx84Cholecystectomy and common duct explorationxxxx85Inguinal and femoral hernia repairxxxx86Other hernia repair?xxx99Other OR gastrointestinal therapeutic proceduresxxxx104Nephrectomy; partial or completexxxx106Genitourinary incontinence procedures?xxx107Extracorporeal lithotripsy; urinary?xxx109Procedures on the urethra?xxx112Other OR therapeutic procedures of urinary tract?xxx113Transurethral resection of prostate (TURP)xxxx114Open prostatectomyxxxx119Oophorectomy; unilateral and bilateralxxxx120Other operations on ovary?xxx124Hysterectomy; abdominal and vaginalxxxx129Repair of cystocele and rectocele; obliteration of vaginal vault?xxx132Other OR therapeutic procedures; female organs?xxx142Partial excision bone?xxx152Arthroplasty kneexxxx153Hip replacement; total and partial?xxx154Arthroplasty other than hip or kneexxxx157Amputation of lower extremityxxxx158Spinal fusionxxxx159Other diagnostic procedures on musculoskeletal system?xxx166Lumpectomy; quadrantectomy of breastxxxx167Mastectomyxxxx169Debridement of wound; infection or burn?xxx170Excision of skin lesion??xx172Skin graft?xxx211Therapeutic radiology for cancer treatmentxxx?224Cancer chemotherapy??x?30.4, 31.74, 34.6Radical laryngectomy, revision of tracheostomy, scarification of pleura (from Proc CCS 42 - Other OR procedures on respiratory system and mediastinum)xxxx30.1, 30.29, 30.3Hemilaryngectomy, Other partial laryngectomy, Complete laryngectomy (from Proc CCS 42 - Other OR procedures on respiratory system and mediastinum)?xxx38.18Endarterectomy leg vessel (from Proc CCS 60- Embolectomy and endarterectomy of lower limbs)?xxx55.03, 55.04Percutaneous nephrostomy with and without fragmentation (from Proc CCS 103- Nephrotomy and nephrostomy)?xxx94.26, 94.27Electroshock therapy (from Proc CCS 218- Psychological and psychiatric evaluation and therapy)xxxx Table PR 4. Acute diagnosis categoriesDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.01Tuberculosis?xxx2Septicemia (except in labor)xxxx3Bacterial infection; unspecified site?xxx4Mycoses?xxx5HIV infection?xxx7Viral infection?xxx8Other infections; including parasitic?xxx9Sexually transmitted infections (not HIV or hepatitis)?xxx54Gout and other crystal arthropathies?xxx55Fluid and electrolyte disordersxxxx60Acute posthemorrhagic anemia?xxx61Sickle cell anemia?xxx63Diseases of white blood cells?xxx76Meningitis (except that caused by tuberculosis or sexually transmitted disease)?xxx77Encephalitis (except that caused by tuberculosis or sexually transmitted disease)?xxx78Other CNS infection and poliomyelitis?xxx82Paralysis?xxx83Epilepsy; convulsions?xxx84Headache; including migraine?xxx85Coma; stupor; and brain damage?xxx87Retinal detachments; defects; vascular occlusion; and retinopathyxxx89Blindness and vision defects?xxx90Inflammation; infection of eye (except that caused by tuberculosis or sexually transmitted disease)xxx91Other eye disorders?xxx92Otitis media and related conditions?xxx93Conditions associated with dizziness or vertigo?xxx97Peri-; endo-; and myocarditis; cardiomyopathyx???99Hypertension with complications???x100Acute myocardial infarctionxx??100Acute myocardial infarction (with the exception of ICD-9 codes 410.x2)xx102Nonspecific chest pain?xxx104Other and ill-defined heart disease?xxx105Conduction disordersx???106Cardiac dysrhythmiasx???107Cardiac arrest and ventricular fibrillation?xxx108Congestive heart failure; nonhypertensivex???109Acute cerebrovascular diseasexxxxDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.0112Transient cerebral ischemiaxxxx116Aortic and peripheral arterial embolism or thrombosisxxxx118Phlebitis; thrombophlebitis and thromboembolism?xxx120Hemorrhoids?xxx122Pneumonia (except that caused by TB or sexually transmitted disease)xxxx123Influenza?xxx124Acute and chronic tonsillitis?xxx125Acute bronchitis?xxx126Other upper respiratory infections?xxx127Chronic obstructive pulmonary disease and bronchiectasisxxxx128Asthma?xxx129Aspiration pneumonitis; food/vomitus??xx130Pleurisy; pneumothorax; pulmonary collapsexxxx131Respiratory failure; insufficiency; arrest (adult)xxxx135Intestinal infection?xxx137Diseases of mouth; excluding dental?xxx139Gastroduodenal ulcer (except hemorrhage)xxxx140Gastritis and duodenitis?xxx142Appendicitis and other appendiceal conditions?xxx145Intestinal obstruction without herniaxxxx146Diverticulosis and diverticulitisxxxx148Peritonitis and intestinal abscess?xxx153Gastrointestinal hemorrhagexxxx154Noninfectious gastroenteritis?xxx157Acute and unspecified renal failurexxxx159Urinary tract infectionsxxxx160Calculus of urinary tractx???165Inflammatory conditions of male genital organs?xxx168Inflammatory diseases of female pelvic organs?xxx172Ovarian cyst?xxx197Skin and subcutaneous tissue infections?xxx198Other inflammatory condition of skin?xxx201Infective arthritis and osteomyelitis (except that caused by TB or sexually transmitted disease)x???207Pathological fracturex???225Joint disorders and dislocations; trauma-relatedxxxx226Fracture of neck of femur (hip)xxxx227Spinal cord injuryxxxx228Skull and face fractures?xxx229Fracture of upper limbxxxxDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.0230Fracture of lower limbxxxx231Other fracturesx???232Sprains and strainsxxxx233Intracranial injuryxxxx234Crushing injury or internal injury?xxx235Open wounds of head; neck; and trunk?xxx237Complication of device; implant or graftxxxx238Complications of surgical procedures or medical carexxxx239Superficial injury; contusion?xxx240Burns?xxx241Poisoning by psychotropic agents?xxx242Poisoning by other medications and drugs?xxx243Poisoning by nonmedicinal substances?xxx244Other injuries and conditions due to external causes?xxx245Syncopexxxx246Fever of unknown origin?xxx247Lymphadenitis?xxx249Shock?xxx250Nausea and vomiting?xxx251Abdominal pain?xxx252Malaise and fatigue?xxx253Allergic reactions?xxx259Residual codes; unclassified?xxx650Adjustment disorders?xxx651Anxiety disorders?xxx652Attention-deficit, conduct, and disruptive behavior disorders?xxx653Delirium, dementia, and amnestic and other cognitive disorders?xxx656Impulse control disorders, NEC?xxx658Personality disorders?xxx660Alcohol-related disorders?xxx661Substance-related disorders?xxx662Suicide and intentional self-inflicted injury?xxx663Screening and history of mental health and substance abuse codes?xxx670Miscellaneous disorders?xxxAcute ICD-9 codes within Dx CCS 97: Peri-; endo-; and myocarditis; cardiomyopathy 3282Diphtheritic myocarditis?xxx3640Meningococcal carditis nos?xxx3641Meningococcal pericarditis?xxxDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.03642Meningococcal endocarditis?xxx3643Meningococcal myocarditis?xxx7420Coxsackie carditis nos?xxx7421Coxsackie pericarditis?xxx7422Coxsackie endocarditis?xxx7423Coxsackie myocarditis?xxx11281Candidal endocarditis?xxx11503Histoplasma capsulatum pericarditis?xxx11504Histoplasma capsulatum endocarditis?xxx11513Histoplasma duboisii pericarditis?xxx11514Histoplasma duboisii endocarditis?xxx11593Histoplasmosis pericarditis?xxx11594Histoplasmosis endocarditis?xxx1303Toxoplasma myocarditis?xxx3910Acute rheumatic pericarditis?xxx3911Acute rheumatic endocarditis?xxx3912Acute rheumatic myocarditis?xxx3918Acute rheumatic heart disease nec?xxx3919Acute rheumatic heart disease nos?xxx3920Rheumatic chorea w heart involvement?xxx3980Rheumatic myocarditis?xxx39890Rheumatic heart disease nos?xxx39899Rheumatic heart disease nec?xxx4200Acute pericarditis in other disease?xxx42090Acute pericarditis nos?xxx42091Acute idiopath pericarditis?xxx42099Acute pericarditis nec?xxx4210Acute/subacute bacterial endocarditis?xxx4211Acute endocarditis in other diseases?xxx4219Acute/subacute endocarditis nos?xxx4220Acute myocarditis in other diseases?xxx42290Acute myocarditis nos?xxx42291Idiopathic myocarditis?xxx42292Septic myocarditis?xxx42293Toxic myocarditis?xxx42299Acute myocarditis nec?xxx4230Hemopericardium?xxx4231Adhesive pericarditis?xxx4232Constrictive pericarditis?xxx4233Cardiac tamponade ?xxxDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.04290Myocarditis nos ?xxxAcute ICD-9 codes within Dx CCS 105: Conduction disorders4260Atrioventricular?xxx42610Atrioventricular block nos?xxx42611Atrioventricular block-1st degree?xxx42612Atrioventricular block-mobitz ii?xxx42613Atrioventricular block-2nd degree nec?xxx4262Left bundle branch hemiblock?xxx4263Left bundle branch block nec?xxx4264Right bundle branch block?xxx42650Bundle branch block nos?xxx42651Right bundle branch block/left posterior fascicular block?xxx42652Right bundle branch block/left ant fascicular block?xxx42653Bilateral bundle branch block nec?xxx42654Trifascicular block?xxx4266Other heart block?xxx4267Anomalous atrioventricular excitation?xxx42681Lown-ganong-levine syndrome?xxx42682Long qt syndrome ?xxx4269Conduction disorder nos?xxxAcute ICD-9 codes within Dx CCS 106: Dysrhythmia4272Paroxysmal tachycardia nos?xxx7850Tachycardia nos?xxx42789Cardiac dysrhythmias nec?xxx4279Cardiac dysrhythmia nos?xxx42769Premature beats nec ?xxxAcute ICD-9 codes within Dx CCS 108: Congestive heart failure; nonhypertensive 39891Rheumatic heart failure?xxx4280Congestive heart failure?xxx4281Left heart failure?xxx42820Unspecified systolic heart failure?xxx42821Acute systolic heart failure ?xxx42823Acute on chronic systolic heart failure ?xxx42830Unspecified diastolic heart failure?xxx42831Acute diastolic heart failure ?xxx42833Acute on chronic diastolic heart failure ?xxx42840Unspec combined syst & dias heart failure?xxx42841Acute combined systolic & diastolic heart failure ?xxx42843Acute on chronic combined systolic & diastolic heart failure ?xxxDiagnosis CCSDescriptionVersion 1.0Version 2.0Version 2.1Version 3.04289Heart failure nos?xxxAcute ICD-9 codes within Dx CCS 152: Pancreatic disorders5570Acute pancreatitis???xAcute ICD-9 codes within Dx CCS 149: Biliary tract disease5740Calculus of gallbladder with acute cholecystitis???x57400Calculus of gallbladder with acute cholecystitis without mention of obstruction???x57401Calculus of gallbladder with acute cholecystitis with obstruction???x5743Calculus of bile duct with acute cholecystitis???x57430Calculus of bile duct with acute cholecystitis without mention of obstruction???x57431Calculus of bile duct with acute cholecystitis with obstruction???x5746Calculus of gallbladder and bile duct with acute cholecystitis???x57460Calculus of gallbladder and bile duct with acute cholecystitis without mention of obstruction???x57461Calculus of gallbladder and bile duct with acute cholecystitis with obstruction???x5748Calculus of gallbladder and bile duct with acute and chronic cholecystitis???x57480Calculus of gallbladder and bile duct with acute and chronic cholecystitis without mention of obstruction???x57481Calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction???x5750Acute cholecystitis???x57512Acute and chronic cholecystitis???x5761Cholangitis???xColor KeyGreyPresent only in v1.0BluePresent only in v2.0TanAdded in v2.0PinkAltered in v2.1CoralAdded in v3.0GreenRemoved in v3.0PurplePresent in all versionsAppendix B. Public Comment and Expert Review ProcessWe posted the algorithm for two public comment periods, one by CMS from August 15-29, 2011 and again as part of the National Quality Forum public and member comment process from January 9-20, 2012. We received 27 comments about the planned readmission algorithm in these two public comment periods. In response, we added two procedure categories and one group of ICD-9 codes to the list of potentially planned procedures. We also added one discharge diagnosis group to the list of acute diagnoses and complications of care list (Appendix A).Between January, 2012 and March, 2012 we contacted 15 surgical and procedural specialty societies to identify experts for further consultation and refinement of the algorithm. Eleven societies recommended a total of 30 experts, of whom 17 from 9 societies reviewed relevant portions of the algorithm. We also consulted with 10 additional surgeons recommended by affiliates of the Center for Outcomes Research & Evaluation. The expert consultants reviewed relevant portions of the algorithm in separate specialty-specific groups. Each group review followed a structured process that involved: 1) a standardized introduction defining “planned” and “unplanned” readmissions, 2) review of the procedure category list relevant to that specialty, 3) review of data about most frequent procedure categories occurring during readmissions in the hospital-wide readmission cohort, along with the most common diagnosis categories for each procedure, 4) group discussion about appropriate potentially planned/unplanned status for each of the procedures. Disagreements were resolved by consensus. In response to feedback from these experts, we made the following changes to the list of potentially planned procedures: added 27 procedure CCS categories, added groups of ICD-9 codes from two additional procedure CCS categories, added three individual ICD-9 codes from a procedure CCS category from which we had already listed several individual ICD-9 codes, and removed two procedure CCS categories. In addition, we added two procedure CCS categories and two diagnosis CCS categories defining maternity patients to the list of always planned procedures and diagnoses respectively so that the algorithm could be used in all-payer data. Finally, we made the following changes to the list of acute diagnoses and complications of care: added 73 diagnosis CCS categories and removed 8 diagnosis groups, four of which were split at the ICD-9 level into acute and chronic diagnoses. The resulting algorithm is referred to as version 2.0 (Appendix A). In September, 2012, the original algorithm (v1.0) was used in confidential national reporting of the hospital-wide readmission measure. Hospitals commenting on the measure noted two additional procedure categories that could potentially be planned as well as one acute diagnosis category that had been omitted from the list. These changes were added to the v2.0 algorithm, and the algorithm that resulted from these additional updates is referred to as v2.1.Appendix C: Screenshot of abstraction database. Yellow highlights indicate fields to be completed by abstractor.Appendix D. Most common planned procedures/conditions in validation cohort compared to national cohort, based on algorithm version 2.SDescriptionValidation rankValidation cases, NNational rankNational cases, N47Diagnostic cardiac catheterization; coronary arteriography145114,776224Cancer chemotherapy24084,655157Amputation of lower extremity33156,06449Other OR heart procedures43065,76148Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator52528,91243Heart valve procedures620104,277999Maintenance Chemo720192,59478Colorectal resection81994,47099Other OR gastrointestinal therapeutic procedures917142,99584Cholecystectomy and common duct exploration101646,188169Debridement of wound; infection or burn1116123,623158Spinal fusion1216202,50644Coronary artery bypass graft (CABG)131474,870142Partial excision bone1414162,91486Other hernia repair1514182,66867Other therapeutic procedures; hemic and lymphatic system1613133,301211Therapeutic radiology for cancer treatment1712251,73245Percutaneous transluminal coronary angioplasty (PTCA)181137,01455Peripheral vascular bypass1911222,2493Laminectomy; excision intervertebral disc2010172,797In italics: Procedures among the 20 most common planned procedures in the validation sample that are not among the 20 most common nationally. ................
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