Patient Safety Indicator 11 (PSI 11) Postoperative ...

[Pages:63]AHRQ Quality IndicatorsTM (AHRQ QITM) ICD-10-CM/PCS Specification v2021

Patient Safety Indicator 11 (PSI 11) Postoperative Respiratory Failure Rate July 2021 Hospital-Level Indicator Type of Score: Rate

Prepared by: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services qualityindicators.

DESCRIPTION Postoperative respiratory failure (secondary diagnosis), prolonged mechanical ventilation, or intubation cases per 1,000 elective surgical discharges for patients ages 18 years and older. Excludes cases with principal diagnosis for acute respiratory failure; cases with secondary diagnosis for acute respiratory failure present on admission; cases with any diagnosis of tracheostomy present on admission; cases in which tracheostomy is the only operating room procedure or in which tracheostomy occurs before the first operating room procedure; cases with malignant hyperthermia; cases with neuromuscular disorders; cases with degenerative neurological disorders; cases with laryngeal, oropharyngeal or craniofacial surgery involving significant risk of airway compromise; cases with esophageal surgery, a lung cancer procedure, or lung transplant; cases admitted for treatment of respiratory diseases; and obstetric discharges.

[NOTE: The software provides the rate per hospital discharge. However, common practice reports the measure as per 1,000 discharges. The user must multiply the rate obtained from the software by 1,000 to report events per 1,000 hospital discharges.]

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

NUMERATOR Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with either: ? any secondary ICD-10-CM diagnosis code for acute postprocedural respiratory failure (ACURF2D*); ? an ICD-10-PCS procedure code for a mechanical ventilation for greater than 96 consecutive hours (PR9672P*) that occurs zero or more days after the first major operating room procedure (based on days from admission to procedure) if the day of both procedures is available ? an ICD-10-PCS procedure code for a mechanical ventilation for 24 - 96 consecutive hours (PR9671P*) that occurs two or more days after the first major operating room procedure (based on days from admission to procedure) if the day of both procedures is available ? any ICD-10-PCS procedure code for an intubation (PR9604P*) that occurs one or more days after the first major operating room procedure (based on days from admission to procedure) if the day of both procedures is available

DENOMINATOR Elective surgical discharges (Appendix E: SURGI2R) for patients ages 18 years and older, with any listed ICD-10-PCS procedure code for an operating room procedure (Appendix A: ORPROC) . Elective surgical discharges are defined by specific MS-DRG codes with admission type recorded as elective (SID ATYPE=3).

Appendix A - Operating Room Procedure Codes Appendix E - Surgical Discharge MS-DRGs

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

DENOMINATOR EXCLUSIONS Exclude cases: ? with a principal ICD-10-CM diagnosis code (or secondary diagnosis present on admission) for acute respiratory failure (ACURF3D* ) ? with any listed ICD-10-CM diagnosis code present on admission for tracheostomy (TRACHID* ) ? where the only operating room procedure is tracheostomy (TRACHIP* ) ? where a procedure for tracheostomy (TRACHIP* ) occurs before the first operating room procedure ? with any listed ICD-10-CM diagnosis code for malignant hyperthermia (MALHYPD* ) ? with any listed ICD-10-CM diagnosis code for neuromuscular disorder (NEUROMD* ) ? with any listed ICD-10-CM diagnosis code for degenerative neurological disorder (DGNEUID*) ? with any listed ICD-10-PCS procedure code for laryngeal or pharyngeal, nose, mouth, pharynx or facial surgery involving significant risk of airway compromise (NUCRANP* ) ? with any listed ICD-10-PCS procedure code for esophageal surgery (PRESOPP* ) ? with any listed ICD-10-PCS procedure code for lung cancer (LUNGCIP* ) ? with any listed ICD-10-PCS procedure code for lung transplant (LUNGTRANSP* ) ? MDC 4 (diseases/disorders of respiratory system) ? MDC 14 (pregnancy, childbirth, and puerperium) ? MDC 15 (newborns and other neonates with conditions originating in perinatal period) ? with an ungroupable DRG (DRG=999) ? with missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), or principal diagnosis (DX1=missing)

* See below for code list

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

Acute postprocedural respiratory failure diagnosis codes: (ACURF2D)

J95821

Acute postprocedural respiratory failure J95822

Acute and chronic postprocedural respiratory failure

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

Mechanical ventilation for greater than 96 consecutive hours procedure code: (PR9672P)

5A1955Z Respiratory ventilation, greater than 96 consecutive hours

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

Mechanical ventilation for 24-96 consecutive hours procedure codes: (PR9671P)

5A1945Z Respiratory ventilation, 24-96 consecutive hours

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

Intubation procedure codes: (PR9604P)

0BH13EZ Insertion of endotracheal airway into trachea, percutaneous approach

0BH17EZ Insertion of endotracheal airway into trachea, via natural or artificial opening

0BH18EZ

Insertion of endotracheal airway into trachea, via natural or artificial opening endoscopic

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AHRQ QITM ICD-10-CM/PCS Specification v2021 PSI 11 Postoperative Respiratory Failure Rate qualityindicators.

Acute respiratory failure diagnosis codes: (ACURF3D) J95821 Acute postprocedural respiratory failure J9620

J95822 J9600 J9601

Acute and chronic postprocedural respiratory failure Acute respiratory failure, unspecified whether with hypoxia or hypercapnia Acute respiratory failure with hypoxia

J9621 J9622 J9690

J9602 J9610

J9611 J9612

Acute respiratory failure with hypercapnia Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

J9691 J9692

Chronic respiratory failure with hypoxia Z9911

Chronic respiratory failure with hypercapnia

Z9912

Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia Acute and chronic respiratory failure with hypoxia Acute and chronic respiratory failure with hypercapnia Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia Respiratory failure, unspecified with hypoxia Respiratory failure, unspecified with hypercapnia

Dependence on respirator [ventilator] status Encounter for respirator [ventilator] dependence during power failure

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