PRIME Project 2.5 Transition to Integrated Care: Post ...



Document Control LogVersionDateDetailsV1.02/29/16Metric specifications not arranged by ProjectMetric specifications in native format without editingV2.03/7/16Metrics arranged by ProjectMetric specifications edited for PRIMEV2.14/19/16Added PRIME Eligible Population for DMPHs Added sentence requiring inclusion of individuals who meet either Population #1 or #2 criteria.Modified continuous enrollment language for PRIME Eligible Population #2 to be 12 months during the Measurement PeriodReplaced “Appendix 2” with “Table 5” in GPP footnoteRemoved the severe mental illness exclusion from 2.5.1 and 2.5.5Removed “per 100,000 population” from AHRQ PQI #90Added “discharges from the PRIME Entity” to the numerator in AHRQ PQI #90V2.25/31/16Approved by DHCSAdded exclusion of inpatient encounters in PRIME Eligible Population #1Added PRIME Eligible Population Tenure and Exclusion criteriaRevised age range of Project Target Population to be > 50 years oldAdded timeframe for age and chronic conditions in the Project Target PopulationCited definition of a chronic condition in the Project Target PopulationCorrected PQI#90/PQI#5 Numerator Exclusion Table header from “Acute Bronchitis” to “Cystic fibrosis and anomalies of the respiratory system diagnosis codes: (RESPAN)”Removed note about reporting per 100,000 population in PQI#90/PQI#8Added “Discharges from the PRIME Entity” to the numerator in PQI’s Removed from the PQI denominators - “Only discharges from the PRIME entity system should be included in the denominator”Corrected “PRIME Eligible Population” to be “Project 2.5 Target Population” in the PQI denominatorsConfirmed Age 18 and over for NQF 0418 in Summary TableDeleted language about reporting for two age groups for NQF 0418Corrected Date of Birth schedule for NQF 0018Modified language of SBIRT numerator to include “or through data reports from the EHR”Metric Questions or Feedback: A link to a form is provided. Please complete one form for each request for clarification per metric. You may submit additional requests as needed.Measurement PeriodsDemonstration Year Mid-Year Report Measurement PeriodFinal Year-End Report Measurement PeriodDY 11Not applicableJul 1, 2015 – Jun 30, 2016DY12Jan 1, 2016 – Dec 31, 2016Jul 1, 2016 – Jun 30, 2017DY13Jan 1, 2017 – Dec 31, 2017Jul 1, 2017 – Jun 30, 2018DY14Jan 1, 2018 – Dec 31, 2018Jul 1, 2018 – Jun 30, 2019DY15Jan 1, 2019 – Dec 31, 2019Jul 1, 2019 – Jun 30, 2020Note: Specifications for PRIME measures that are CMS Core measures refer to CMS value sets PRIME Eligible Population for Designated Public Hospitals (DPHs) only:The PRIME Eligible Population includes the combination of both Population #1 and Population #2. An individual does not have to meet criteria of both Population #1 and Population #2. Any individual who meets either PRIME Eligible Population #1 criteria or PRIME Eligible Population #2 criteria must be included in the PRIME Eligible Population.Population #1: Individuals of all ages with at least 2 encounters with the PRIME Entity Primary Care team during the measurement period. A Primary Care team encounter is counted if occurred with a member of the Primary Care Team from Family Medicine, Internal Medicine, or Pediatrics. The PRIME Entity may choose to include populations who are seen for primary care in a specialty clinic (e.g. HIV) Encounters include either a face-to-face visit with a primary care provider OR any encounter included in the list of eligible non-traditional service types described in the Global Payment Program (for PRIME, encounters not limited to uninsured individuals.)Only encounters with the Primary Care team in the ambulatory setting will be counted toward the above 2 encounter requirement. Encounters with primary care team members in the inpatient setting do not count toward the two primary care encounter requirement. [This does not impact the expansion of the PRIME Eligible Population to include inpatient or acute care utilization as specified by the Project Target Population criteria e.g. in Domain 3].Population #2Individuals of all ages who are in Medi-Cal Managed Care with 12 months of continuous assignment to the PRIME Entity during the Measurement Period.No more than one gap in enrollment or assignment with the PRIME Entity of up to 45 days during the Measurement Period.Individual must be enrolled in the primary plan and assigned to the PRIME Entity on the final day of the Measurement Period.PRIME Eligible Population for District Municipal Hospitals (DMPHs) only:The PRIME Eligible Population is all individuals with at least two encounters by the participating PRIME entity among Medi-Cal Beneficiaries. Tenure Criteria for DPH/DMPH PRIME Eligible Population Encountered LivesThe first of the two required primary care encounters (DPH) or Medi-Cal encounters (DMPH) must occur during the first 6 months of the measurement periodThe second required (primary care) encounter may occur at any point during the measurement period.The two (primary care) encounters during the measurement period fulfilling the PRIME Eligible Population eligibility criteria cannot occur on the same day.Exclusion Criteria for DPH/DMPH PRIME Eligible PopulationExclusion for patients no longer the responsibility of the PRIME Entity at the end of the measurement period:Any patient meeting the PRIME Eligible Population Encountered Lives criteria in a given measurement period who then experiences any of the following scenarios, will be removed from the PRIME Eligible Population for that measurement period, when the PRIME entity has documentation that before the end of the measurement period:The patient has died.The patient has changed their care to a PCP in a health system that is not the PRIME Entity.The patient has been incarcerated.Project 2.5 Target Population are those in the PRIME Eligible Population AND incarcerated in prison and/or jail that are soon-to-be released, or released in the prior 6 months, as identified by the PRIIME entity AND have at least one chronic health condition*, are > 50 years old, or both as of the date of the first encounter with the PRIME Entity during the measurement period.* Chronic medical conditions as defined by the Chronic Condition Indicator ()Summary Table2.5.2 - NQF 0018: Controlling Blood PressureSpecification Source: CMS Adult Core Set Tech SpecsNumerator: The number of patients in the denominator whose most recent BP is adequately controlled during the measurement year. For a patient’s BP to be controlled, both the systolic and diastolic BP must be <140/90 (adequate control). To determine if a patient’s BP is adequately controlled, the representative BP must be identified.Denominator: Patients 18 to 85 years of age by the end of the measurement year who had at least one outpatient encounter with a diagnosis of hypertension (HTN) during the first six months of the measurement year.2.5.4 - NQF 0418: Screening for Clinical Depression and follow-upSpecification Source: CMS Adult Core Set Tech SpecsNumerator: Patients screened for clinical depression using a standardized tool AND, if positive, a follow-up plan is documented on the date of the positive screen.Denominator: All patients aged 18 years and older2.5.5 - NQF 0028: Tobacco Assessment and CounselingSpecification Source: 2016 PQRS Individual Claims Registry Measure Specifications v11.17.15Numerator: Patients who were screened for tobacco use* at least once during the two-year measurement period AND who received tobacco cessation counseling intervention** if identified as a tobacco user. *Includes use of any type of tobacco. ** Cessation counseling intervention includes brief counseling (3 minutes or less), and/or pharmacotherapyDenominator: All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period2.5.3 - AHRQ PQI #90Specification Source: AHRQ Quality Indicators?, Version 4.5, May 2013Numerator: Discharges, for patients ages 18 years and older, that meet the inclusion and exclusion rules for the numerator in any of the following PQIs: #1, 3, 5, 7, 8, 10-16Denominator: Individuals in the PRIME Eligible Population ages 18 years and older2.5.1 - Alcohol and Drug Misuse (SBIRT)Specification Source: Alcohol and Drug Misuse (SBIRT) v. Dec 2015Numerator: Patients in the denominator who completed a full, standardized screening tool as indicated by one of the following CPT or HCPCS codes (see Appendix B for how G codes are counted)Denominator: Unique counts of patients ages 12 years as of December 31 of the measurement year who received a qualifying outpatient service during the measurement period 2.5.2 - NQF 0018: Controlling High Blood PressureA. DESCRIPTIONPercentage of individuals ages 18 to 85 who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled during the measurement period based on the following criteria:?Individuals ages 18 to 59 whose BP was <140/90 mm Hg?Individuals ages 60 to 85 with a diagnosis of diabetes whose BP was <140/90 mm Hg?Individuals ages 60 to 85 without a diagnosis of diabetes whose BP was <150/90 mm HgA single rate is reported and is the sum of all three groups. Data Collection Method: HybridGuidance for Reporting:? Report this measure for two age groups (as applicable): ages 18 to 64 and ages 65 to 85. The numerator for individuals ages 18 to 64 will include individual ages 18 to 59 who meet the first criterion added to individuals ages 60 to 64 who meet the second or third criteria. The rate for individuals ages 65 to 85 will include all individuals in that age group who meet the second or third criteria:diagnosis of diabetes with BP < 140/90 mm Hg or no diagnosis of diabetes with BP of<150/90 mm Hg.? This measure requires use of the hybrid method.B. DEFINITIONSAdequate ControlAdequate control is defined as meeting any of the following criteria:? Individuals ages 18 to 59 whose BP was <140/90 mm Hg? Individuals ages 60 to 85 with a diagnosis of diabetes whose BPwas <140/90 mm Hg? Individuals ages 60 to 85 without a diagnosis of diabetes whose BPwas <150/90 mm HgRepresentativeBPThe most recent BP reading during the measurement period (as long as it occurred after the diagnosis of hypertension was made). If multiple BP measurements occur on the same date, or are noted inthe chart on the same date, the lowest systolic and lowest diastolicBP reading should be used. If no BP is recorded during the measurement period, assume that the individual is “not controlled.”C. ELIGIBLE POPULATIONAges 18 to 85* as of the last day of the measurement period.*Date of Birth:DY11 Annual: 7/1/1930 - 6/30/1998DY12 Annual: 7/1/1931 - 6/30/1999DY13 Annual: 7/1/1932 - 6/30/2000DY14 Annual: 7/1/1933 - 6/30/2001DY15 Annual: 7/1/1934 - 6/30/2002Event/diagnosisIndividuals are identified as hypertensive if there is at least one outpatient visit (Outpatient CPT Value Set) with a diagnosis of hypertension (Essential Hypertension Value Set) during the first six months of the measurement period.In order to increase the specificity of the eligible population, only CPT codes are used to identify outpatient visits.Diabetes Flag for the NumeratorAfter the Project Target Population is identified, assign each individual a flag to identify if the individual does or does not have diabetes as identified by claims/encounter and pharmacy data (as described below). The flag is used to determine the appropriate BP threshold to use during numerator assessment (the threshold for individuals with diabetes is different than the threshold for individuals without diabetes).Assign a flag of diabetic to individuals who were identified as diabetic using claims/encounter data or pharmacy data. Use both methods to assign the diabetes flag, but an individual only needs to be identified by one method. Individuals may be identified as having diabetes during the measurement period or the year prior to the measurement period.Claims/encounter data. Individuals who met any of the following criteria during the measurement period or the year prior to the measurement period (count services that occur over both years):? At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED visits (ED Value Set), or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits.? At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set). Pharmacy data. Individuals who were dispensed insulin orhypoglycemics/antihyperglycemics on an ambulatory basis during the measurement period or the year prior to the measurement period (Table CBP-A).Assign a flag of not diabetic to individuals who do not have a diagnosis of diabetes (Diabetes Value Set), in any setting, during the measurement period or year prior to the measurement period and who meet either of the following criteria:? A diagnosis of polycystic ovaries (Polycystic Ovaries Value Set), in any setting, any time during the individual’s history through the last day of the measurement period? A diagnosis of gestational diabetes or steroid-induced diabetes (Diabetes Exclusions Value Set), in any setting, during the measurement period or the year prior to the measurement periodTable CBP-A: Prescriptions to Identify Individual with DiabetesDescriptionPrescriptionAlpha-glucosidase inhibitorsAcarboseMiglitolAmylin analogsPramlinitideAntidiabetic combinationsAlogliptin-metformin Alogliptin-pioglitazone Canaglifozin-metformin Glimepiride-pioglitazone Glimepiride-rosiglitazone Glipizide-metformin Glyburide-metformin Linagliptin-metformin Metformin-pioglitazone Metformin-repaglinide Metformin-rosiglitazone Metformin-saxagliptin Metformin-sitagliptin Sitagliptin-simvastatinInsulinInsulin aspartInsulin aspart-insulin aspart protamineInsulin detemir Insulin glargine Insulin glulisineInsulin isophane humanInsulin isophane-insulin regularInsulin lisproInsulin lispro-insulin lispro protamineInsulin regular humanMeglitinidesNateglinideRepaglinideGlucagon-like peptide-1 (GLP1) agonistsExenatide Liraglutide AlbiglutideSodium glucose cotransporter 2 (SGLT2) inhibitorCanagliflozin Dapagliflozin EmpagliflozinDescriptionPrescriptionSulfonylureasChlorpropamide Glimepiride Glipizide GlyburideTolazamide TolbutamideThiazolidinedionesPioglitazoneRosiglitazoneDipeptidyl peptidase-4 (DDP-4) inhibitorsAlogliptin Linagliptin Saxagliptin SitaglipinNote:Glucophage/metformin as a solo agent is not included because it is used to treat conditions other than diabetes; individuals with diabetes on these medications are identified through diagnosis codes only. A complete list of medications and NDC codes was posted to on November 3, 2014.D. HYBRID SPECIFICATIONDenominatorA systematic sample drawn from the Project 2.5 Target Population whose diagnosis of hypertension is confirmed by chart review.To confirm the diagnosis of hypertension, there must be a notation of one of the following in the medical record anytime during the individual’s history on or before the last day of the sixth month of the measurement period:?Hypertension?HTN?High BP (HBP)?Elevated BP (↑BP)?Borderline HTN?Intermittent HTN?History of HTN?Hypertensive vascular disease (HVD)?Hyperpiesia?HyperpiesisIt does not matter if hypertension was treated or is currently being treated. The notation indicating a diagnosis of hypertension may be recorded in any of the following documents:?Problem list (this may include a diagnosis prior to the last day of the sixth month of the measurement period or an undated diagnosis; see Note at the end of this section)?Office note?Subjective, Objective, Assessment, Plan (SOAP) note?Encounter form?Diagnostic report?Hospital discharge summaryStatements such as “rule out HTN,” “possible HTN,” “white-coat HTN,” “questionable HTN” and “consistent with HTN” are not sufficient to confirm the diagnosis if such statements are the only notations of hypertension in the medical record.Identifying the Medical RecordUse one medical record for both the confirmation of the diagnosis of hypertension and the representative BP. All eligible BP measurements recorded in the record must be considered. If a state cannot find the medical record, the individual remains in the measure denominator and is considered noncompliant for the numerator.States should use the following steps to find the appropriate medical record to review. Step 1?Identify the individual’s PCP.?If the individual had more than one PCP for the time period, identify the PCP who most recently provided care to the individual.?If the individual did not visit a PCP for the time period or does not have a PCP, identify the practitioner who most recently provided care to the individual.?If a practitioner other than the individual’s PCP manages the hypertension, the state may use the medical record of that practitioner.Step 2?Use one medical record to both confirm the diagnosis for the denominator and identify the representative BP level for the numerator. There are circumstances in which the state may need to go to a second medical record to either confirm the diagnosis or obtain the BP reading, as in the following two examples.?If an individual sees one PCP during the denominator confirmation period (on or before the last day of the sixth month of the measurement period) and another PCP after June 30, the diagnosis of hypertension and the BP reading may be identified through two different medical records.?If an individual has the same PCP for the entire measurement period, but it is clear from claims or medical record data that a specialist (e.g., cardiologist) manages the adult’s hypertension after the last day of the sixth month of the measurement period, the state may use the PCP’s chart to confirm the diagnosis and use the specialist’s chart to obtain the BP reading. For example, if all recent claims coded with 401 came from the specialist, the state may use this chart for the most recent BP reading. If the individual did not have any visit with the specialist prior to the last month of the sixth month of the measurement period, the state must go to another medical record to confirm the diagnosis.NumeratorThe number of individuals in the denominator whose most recent BP (both systolic and diastolic) is adequately controlled during the measurement period based on the following criteria:?Individuals ages 18 to 59 as of the last day of the measurement period whose BP was<140/90 mm Hg?Individuals ages 60 to 85 as of the last day of the measurement period and flagged with a diagnosis of diabetes whose BP was <140/90 mm Hg?Individuals ages 60 to 85 as of the last day of the measurement period and flagged as not having a diagnosis of diabetes whose BP was <150/90 mm Hg?To determine if an individual’s BP is adequately controlled, the representative BP must be identified.E.MEDICAL RECORD SPECIFICATIONFollow the steps below to determine representative BP. Step 1Identify the most recent BP reading noted during the measurement period. The reading must occur after the date when the diagnosis of hypertension was confirmed. Do not include BP readings:?Taken during an acute inpatient stay or an ED visit?Taken during an outpatient visit which was for the sole purpose of having a diagnostic test or surgical procedure performed (e.g., sigmoidoscopy, removal of a mole)?Obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV contrast for a radiology procedure, endoscopy)?Reported by or taken by the individualIf multiple readings were recorded for a single date, use the lowest systolic and lowest diastolic BP on that date as the representative BP. The systolic and diastolic results do not need to be from the same reading.Step 2Determine numerator compliance based on the following criteria:?Individuals ages 18 to 59 as of the last day of the measurement period whose BP was<140/90 mm Hg?Individuals ages 60 to 85 as of the last day of the measurement period and flagged with a diagnosis of diabetes whose BP was <140/90 mm Hg?Individuals ages 60 to 85 as of the last day of the measurement period and flagged as not having a diagnosis of diabetes whose BP was <150/90 mm HgThe individual is not compliant if the BP reading does not meet the specified threshold or is missing, or if there is no BP reading during the measurement period or if the reading is incomplete (e.g., the systolic or diastolic level is missing.)Step 3A single rate is reported for all three groups. Sum the numerator events from Step 2 to obtain the rate.Exclusions (optional)?Exclude from the eligible population all individuals with evidence of end-stage renal disease (ESRD) (ESRD Value Set; ESRD Obsolete Value Set) or kidney transplant (Kidney Transplant Value Set) on or prior to the last day of the measurement period. Documentation in the medical record must include a dated note indicating evidence of ESRD, kidney transplant, or dialysis.?Exclude from the eligible population all individuals with a diagnosis of pregnancy (Pregnancy Value Set) during the measurement period.?Exclude from the eligible population all individuals who had a nonacute inpatient admission during the measurement period.F.ADDITIONAL NOTESThe PRIME Entity may use an undated notation of hypertension on problem lists. Problem lists generally indicate established conditions; to discount undated entries might hinder confirmation of the denominator.2.5.4 - NQF 0418: Screening for Clinical Depression and Follow-Up PlanA. DESCRIPTIONPercentage of individuals in the Project 2.5 Target Population age 18 and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the positive screen.Data Collection Method: HybridGuidance for Reporting:This measure uses administrative data and medical record review to calculate the denominator exclusions for the measure. PRIME entities s may also choose to use medical record review to identify numerator cases.The measure steward does not provide diagnosis codes for the depression and bipolar disorder exclusions; medical record review is required to determine the exclusions.There are two G codes included in the numerator to capture whether clinical depression screening was done and if the screen was positive, whether a follow-up plan was documented.The date of encounter and screening must occur on the same date of service; if a patient has more than one encounter during the measurement period, the patient should be counted in the numerator and denominator only once based on the most recent encounter.B. DEFINITIONSScreeningCompletion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.Screening tests can predict the likelihood of someone having or developing a particular disease or condition. This measure looks for the screening being conducted in the practitioner’s office that is filing the code.StandardizedToolAn assessment tool that has been appropriately normalized and validated for the population in which it is being utilized. The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record. Some depression screening tools are: Patient Health Questionnaire (PHQ-9); Beck Depression Inventory (BDI or BDI-II); Center for Epidemiologic Studies Depression Scale (CES-D); Depression Scale (DEPS); Duke Anxiety-Depression Scale (DADS); Geriatric Depression Scale (GDS); Hopkins Symptom Checklist (HSCL); The Zung Self-Rating Depression Scale (SDS), and Cornell Scale Screening (this screening tool is used in situations where the patient has cognitive impairment and is administered through the caregiver), and PRIME MD-PHQ2.Follow-UpPlanProposed outline of treatment to be conducted as a result of clinical depression screening. Follow-up for a positive depression screening must include one (1) or more of the following:Additional evaluationSuicide risk assessmentReferral to a practitioner who is qualified to diagnose and treat depressionPharmacological interventionsOther interventions or follow-up for the diagnosis or treatment of depressionThe documented follow-up plan must be related to positive depression screening, for example: “Patient referred for psychiatric evaluation due to positive depression screening.”C. ELIGIBLE POPULATIONAgeAge 18 or older on date of encounterEvent/diagnosisIndividuals age 18 and older who had an outpatient visit(Table CDF-A) during the measurement period.D. HYBRID SPECIFICATIONDenominatorThe Project 2.5 Target Population with an outpatient visit during the measurement period (Table CDF-A).Table CDF-A. Codes to Identify Outpatient VisitsCPTHCPCS90791, 90792, 90832, 90834, 90837, 90839, 92557, 92567, 92568, 92625, 92626, 96150, 96151, 97003, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215G0101, G0402, G0438, G0439, G0444NumeratorPatients screened for clinical depression using a standardized tool AND, if positive, a follow-up plan is documented on the date of the positive screen using one of the codes in Table CDF-B.Table CDF-B. Codes to Document Clinical Depression ScreenCodeDescriptionG8431Positive screen for clinical depression using a standardized tool and a follow-up plan documentedG8510Negative screen for clinical depression using standardized tool, patient not eligible/appropriate for follow-up plan documentedExclusionsA patient is not eligible if one or more of the following conditions are documented in the patient medical record:Patient has an active diagnosis of Depression or Bipolar DisorderPatient refuses to participatePatient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health statusSituations where the patient’s functional capacity or motivation to improve may impact the accuracy of results of nationally recognized standardized depression assessment tools. For example: certain court-appointed cases or cases of deliriumIn addition, use the codes in Table CDF-C to identify other exclusions:Table CDF-C. Codes to Identify ExclusionsCodeDescriptionG8433Screening for clinical depression not documented, patient not eligible/appropriateG8940Screening for clinical depression documented, follow-up plan not documented, patient not eligible/appropriate2.5.5 - NQF 0028: Tobacco Use – Screening and Cessation InterventionDESCRIPTION:Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco userINSTRUCTIONS:This measure is to be reported once per reporting period for patients seen during the reporting period. This measure is intended to reflect the quality of services provided for preventive screening for tobacco use.Measure Reporting via Claims:CPT or HCPCS codes and patient demographics are used to identify patients who are included in the measure’s denominator. CPT Category II codes are used to report the numerator of the measure. When reporting the measure via claims, submit the appropriate CPT or HCPCS codes, and the appropriate CPT Category II code OR the CPT Category II code with the modifier. The modifiers allowed for this measure are: 1P- medical reasons, 8P- reason not otherwise specified. All measure-specific coding should be reported on the claim(s) representing the eligible encounter.Measure Reporting via Registry:CPT or HCPCS codes and patient demographics are used to identify patients who are included in the measure’s denominator. The listed numerator options are used to report the numerator of the measure.The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.DENOMINATOR:All patients aged 18 years and older in the Project 2.5 Target PopulationDenominator Criteria (Eligible Cases): PRIME Eligible PopulationANDPatients aged ≥ 18 years on date of encounterANDPatient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96150, 96151, 96152, 97003, 97004, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, 99407, G0438, G0439NUMERATOR:Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation intervention if identified as a tobacco userDefinitions:Tobacco Use – Includes use of any type of tobacco.Tobacco Cessation Intervention – Includes brief counseling (3 minutes or less), and/or pharmacotherapy.NUMERATOR NOTE: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation intervention report 4004F with 8P.Numerator Quality-Data Coding Options for Reporting Satisfactorily: Patient Screened for Tobacco Use, Identified as a User and Received InterventionPerformance Met: CPT II 4004F: Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco userORPatient Screened for Tobacco Use and Identified as a Non-User of TobaccoPerformance Met: CPT II 1036F: Current tobacco non-userORTobacco Screening not Performed for Medical ReasonsAppend a modifier (1P) to CPT Category II code 4004F to report documented circumstances that appropriately exclude patients from the denominatorMedical Performance Exclusion: 4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reasons)ORTobacco Screening OR Tobacco Cessation Intervention not Performed, Reason Not OtherwiseSpecifiedAppend a reporting modifier (8P) to CPT Category II code 4004F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.Performance Not Met: 4004F with 8P: Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified.2016 Claims/Registry Individual Measure FlowPQRS #226 NQF #0028: Preventive Care and Screening: Tobacco Use: Screening and CessationInterventionPlease refer to the specific section of the Measure Specification to identify the denominator and numerator information for use in reporting this Individual Measure.Start with DenominatorCheck Patient Age:If the Age is greater than or equal to 18 years of age on Date of Service equals No during the measurement period, do not include in Eligible Patient Population. Stop Processing.If the Age is greater than or equal to 18 years of age on Date of Service equals Yes during the measurement period, proceed to check Encounter Performed.Check Exclusion Criteria:If patient meets Exclusion Criteria, remove from DenominatorCheck Encounter Performed:If Encounter as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing.If Encounter as Listed in the Denominator equals Yes, include in the Eligible Population.Denominator Population:Denominator population is all Eligible Patients in the denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d equals 8 patients in the sample calculation.Start NumeratorCheck Patient Screened for Tobacco Use, Identified as a User and Received Intervention:If Patient Screened for Tobacco Use, Identified as a User and Received Intervention equals Yes, include in Reporting Met and Performance Met.Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter a1 equals 1 patient in Sample Calculation.If Patient Screened for Tobacco Use, Identified as User and and Received Intervention equals No, proceed to Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco.Check Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco:If Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco equals Yes, include in Reporting Met and Performance Met.Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter a2 equals 2 patients in Sample Calculation.If Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco equals No, proceed to Tobacco Screening Not performed for Medical Reason(s).Check Tobacco Screening Not Performed for Medical Reason(s):If Tobacco Screening Not Performed for Medical Reason(s) equals Yes, include in Reporting Met and Performance Exclusion.Reporting Met and Performance Exclusion letter is represented in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter b equals 2 patients in the Sample Calculation.If Tobacco Screening Not Performed for Medical Reason(s) equals No, proceed to Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified.Check Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified:If Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified equals Yes, include in the Reporting Met and Performance Not Met.Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c equals 2 patients in the Sample Calculation.If Tobacco Screening or Tobacco Cessation Intervention Not Performed, Reason Not Specified equals No, proceed to Reporting Not Met.Check Reporting Not MetIf Reporting Not Met equals No, Quality Data Code or equivalent not reported. 1 patient has been subtracted from the reporting numerator in the sample calculation.2.5.3- Prevention Quality Overall Composite PQI #90Prevention Quality Indicators #90 (PQI #90)AHRQ Quality Indicators?, Version 4.5, May 2013Area-Level IndicatorType of Score: RateDescriptionPrevention Quality Indicators (PQI) overall composite, ages 18 years and older. Includes admissions for one of the following conditions: diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, angina without a cardiac procedure, dehydration, bacterial pneumonia, or urinary tract infection.NumeratorDischarges from the PRIME entity, for patients ages 18 years and older, that meet the inclusion and exclusion rules for the numerator in any of the following PQIs:PQI #1 Diabetes Short-Term Complications Admission RatePQI #3 Diabetes Long-Term Complications Admission RatePQI #5 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission RatePQI #7 Hypertension Admission RatePQI #8 Heart Failure Admission RatePQI #10 Dehydration Admission RatePQI #11 Bacterial Pneumonia Admission RatePQI #12 Urinary Tract Infection Admission RatePQI #13 Angina Without Procedure Admission RatePQI #14 Uncontrolled Diabetes Admission RatePQI #15 Asthma in Younger Adults Admission RatePQI #16 Lower-Extremity Amputation among Patients with Diabetes RateDischarges that meet the inclusion and exclusion rules for the numerator in more than one of the above PQIs are counted only once in the composite numerator. DenominatorIndividuals in the Project 2.5 Target Population ages 18 years and olderPQI #1 Diabetes Short-Term Complications Admission RateDESCRIPTIONAdmissions for a principal diagnosis of diabetes with short‐term complications (ketoacidosis, hyperosmolarity, or coma), ages 18 years and older. Excludes obstetric admissions and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for individuals from the denominator, with a principal ICD-9-CM or ICD-10-CM diagnosis code for diabetes short-term complications (ketoacidosis, hyperosmolarity, or coma).[NOTE: By definition, discharges with a principal diagnosis of diabetes with short-term complications are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QITM software does not explicitly exclude obstetric cases.]Diabetes short-term complications diagnosis codes: (ACDIASD)ICD-9-CMDescriptionICD-10-CMDescription250.10DM KETO T2, DM CONTE10.10Type 1 diabetes mellitus with ketoacidosis without coma250.11DM KETO T1, DM CONTE10.11Type 1 diabetes mellitus with ketoacidosis with coma250.12DM KETO T2, DM UNCONTE10.641Type 1 diabetes mellitus with hypoglycemia with coma250.13DM KETO T1, DM UNCONTE10.65Type 1 diabetes mellitus with hyperglycemia250.20DM W/ HYPROSM T2, DM CONTE11.00Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic‐hyperosmolar coma (NKHHC)250.21DM W/ HYPROSM T1, DM CONTE11.01Type 2 diabetes mellitus with hyperosmolarity with coma250.22DM W/ HYPROSM T2, DM UNCNTE11.64Type 2 diabetes mellitus with hypoglycemia with coma250.23DM W/ HYPROSM T1, DM UNCNTE11.65Type 2 diabetes mellitus with hyperglycemia250.30DM COMA NEC TYP II, DM CNT250.31DM COMA NEC T1, DM CONT250.32DM COMA NEC T2, DM UNCONT250.33DM COMA NEC T1, DM UNCONTNUMERATOR EXCLUSIONSExclude Casestransfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers PQI_Appendix_A.pdfDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #3 Diabetes Long-Term Complications Admission RateDESCRIPTIONAdmissions for a principal diagnosis of diabetes with long‐term complications (renal, eye, neurological, circulatory, or complications not otherwise specified) , ages 18 years and older. Excludes obstetric admissions and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for individuals from the denominator, with a principal ICD-9-CM or ICD-10-CM diagnosis code for diabetes with long-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified). [NOTE: By definition, discharges with a principal diagnosis of diabetes with long-term complications are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]Diabetes with long-term complications diagnosis codes: (ACDIALD)ICD-9-CMDescriptionICD-10-CMDescription250.40DM RENAL COMP T2 CONTE10.21Type 1 diabetes mellitus with diabetic nephropathy250.41DM RENAL COMP T1 CONTE10.22Type 1 diabetes mellitus with diabetic chronic kidney disease250.42DM RENAL COMP T2 UNCNTE10.29Type 1 diabetes mellitus with other diabetic kidney250.43DM RENAL COMP T1 UNCNTE10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema250.50DM EYE COMP T2 CONTE10.319Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema250.51DM EYE COMP T1 CONTE10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema250.52DM EYE COMP T2 UNCNTE10.329Type 1 diabetes mellitus with mild nonproliferative250.53DM EYE COMP T1 UNCNTE10.331Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema250.60DM NEURO COMP T2 CONTE10.339Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema250.61DM NEURO COMP T1 CONTE10.341Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema250.62DM NEURO COMP T2 UNCNTE10.349Type 1 diabetes mellitus with severe nonproliferative250.63DM NEURO COMP T1 UNCNTE10.351Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema250.70DM CIRCU DIS T2 CONTE10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema250.71DM CIRCU DIS T1 CONTE10.36Type 1 diabetes mellitus with diabetic cataract250.72DM CIRCU DIS T2 UNCNTE10.39Type 1 diabetes mellitus with other diabetic ophthalmic complication250.73DM CIRCU DIS T1 UNCNTE10.40Type 1 diabetes mellitus with diabetic neuropathy, unspecified250.80DM W COMP NEC T2 CONTE10.41Type 1 diabetes mellitus with diabetic mononeuropathy250.81DM W COMP NEC T1 CONTE10.42Type 1 diabetes mellitus with diabetic polyneuropathy250.82DM W COMP NEC T2 UNCNTE10.43Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy250.83DM W COMP NEC T1 UNCNTE10.44Type 1 diabetes mellitus with diabetic amyotrophy250.90DM W COMPL NOS T2 CONTE10.49Type 1 diabetes mellitus with other diabetic neurological complication250.91DM W COMPL NOS T1 CONTE10.51Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene250.92DM W COMPL NOS T2 UNCNTE10.52Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene250.93DM W COMPL NOS T1 UNCNTE10.59Type 1 diabetes mellitus with other circulatory complicationsE10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathyE10.618Type 1 diabetes mellitus with other diabetic arthropathyE10.620Type 1 diabetes mellitus with diabetic dermatitisE10.621Type 1 diabetes mellitus with foot ulcerE10.622Type 1 diabetes mellitus with other skin ulcerE10.628Type 1 diabetes mellitus with other skin complicationsE10.630Type 1 diabetes mellitus with periodontal diseaseE10.638Type 1 diabetes mellitus with other oral complicationsE10.69Type 1 diabetes mellitus with other specified complicationE10.8Type 1 diabetes mellitus with unspecified complicationsE11.21Type 2 diabetes mellitus with diabetic nephropathyE11.22Type 2 diabetes mellitus with diabetic chronic kidney diseaseE11.29Type 2 diabetes mellitus with other diabetic kidney complicationE11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edemaE11.319Type 2 diabetes mellitus with unspecified diabeticretinopathy without macular edemaE11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE11.329Type 2 diabetes mellitus with mild nonproliferativediabetic retinopathy without macular edemaE11.331Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edemaE11.339Type 2 diabetes mellitus with moderate nonproliferativediabetic retinopathy without macular edemaE11.341Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaE11.349Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edemaE11.351Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE11.359Type 2 diabetes mellitus with proliferative diabeticretinopathy without macular edemaE11.36Type 2 diabetes mellitus with diabetic cataractE11.39Type 2 diabetes mellitus with other diabetic ophthalmic complicationE11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecifiedE11.41Type 2 diabetes mellitus with diabetic mononeuropathyE11.42Type 2 diabetes mellitus with diabetic polyneuropathyE11.43Type 2 diabetes mellitus with diabetic autonomic(poly)neuropathyE11.44Type 2 diabetes mellitus with diabetic amyotrophyE11.49Type 2 diabetes mellitus with other diabetic neurological complicationE11.51Type 2 diabetes mellitus with diabetic peripheralangiopathy without gangreneE11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangreneE11.59Type 2 diabetes mellitus with other circulatorycomplicationsE11.610Type 2 diabetes mellitus with diabetic neuropathic arthropathyE11.618Type 2 diabetes mellitus with other diabetic arthropathyE11.620Type 2 diabetes mellitus with diabetic dermatitisE11.621Type 2 diabetes mellitus with foot ulcerE11.622Type 2 diabetes mellitus with other skin ulcerE11.628Type 2 diabetes mellitus with other skin complicationsE11.630Type 2 diabetes mellitus with periodontal diseaseE11.638Type 2 diabetes mellitus with other oral complicationsE11.69Type 2 diabetes mellitus with other specifiedcomplicationE11.8Type 2 diabetes mellitus with unspecified complicationsNUMERATOR EXCLUSIONS Exclude cases:transfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers in the Project 2.5 Target Population ages 18 years and older. DENOMINATOR EXCLUSIONSNot ApplicablePQI #5 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission RateDESCRIPTIONAdmissions with a principal diagnosis of chronic obstructive pulmonary disease (COPD) or asthma, ages 40 years and older. Excludes obstetric admissions and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 40 years and older, with eithera principal ICD-9-CM or ICD-10-CM diagnosis code for COPD (excluding acute bronchitis); ora principal ICD-9-CM or ICD-10-CM diagnosis code for asthma; ora principal ICD-9-CM or ICD-10-CM diagnosis code for acute bronchitis and any secondary ICD-9-CM or ICD-10-CM diagnosis codes for COPD (excluding acute bronchitis).[NOTE: By definition, discharges with a principal diagnosis of COPD, asthma, or acute bronchitis are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]COPD (excluding acute bronchitis) diagnosis codes: (ACCOPDD)ICD-9-CMDescriptionICD-10-CMDescription491.0SIMPLE CHR BRONCHITISJ41.0Simple chronic bronchitis491.1MUCOPURUL CHR BRONCHITISJ41.1Mucopurulent chronic bronchitis491.20OBS CHR BRNC W/O ACT EXAJ41.8Mixed simple and mucopurulent chronic bronchitis491.21OBS CHR BRNC W ACT EXAJ42Unspecified chronic bronchitis491.22OBS CHR BRONC W AC BRONCJ43.0Unilateral pulmonary emphysema [MacLeod's syndrome]491.8CHRONIC BRONCHITIS NECJ43.1Panlobular emphysema491.9CHRONIC BRONCHITIS NOSJ43.2Centrilobular emphysema492.0EMPHYSEMATOUS BLEBJ43.8Other emphysema492.8EMPHYSEMA NECJ43.9Emphysema, unspecified494BRONCHIECTASISJ44.0Chronic obstructive pulmonary disease with acute respiratory infectionlower494.0BRONCHIECTAS W/O AC EXACJ44.1Chronic obstructive pulmonary disease with (acute) exacerbation494.1BRONCHIECTASIS W AC EXACJ44.9Chronic obstructive pulmonary disease, unspecified496CHR AIRWAY OBSTRUCT NECJ47.0Bronchiectasis with acute lower respiratory infectionJ47.1Bronchiectasis with (acute) exacerbationJ47.9Bronchiectasis, uncomplicatedAsthma diagnosis codes: (ACSASTD)ICD-9-CMDescriptionICD-10-CMDescription493.00EXT ASTHMA W/O STAT ASTHJ45.21Mild intermittent asthma with (acute) exacerbation493.01EXT ASTHMA W STATUS ASTHJ45.22Mild intermittent asthma with status asthmaticus493.02EXT ASTHMA W ACUTE EXACJ45.31Mild persistent asthma with (acute) exacerbation493.10INT ASTHMA W/O STAT ASTHJ45.32Mild persistent asthma with status asthmaticus493.11INT ASTHMA W STATUS ASTHJ45.41Moderate persistent asthma with (acute) exacerbation493.12INT ASTHMA W ACUTE EXACJ45.42Moderate persistent asthma with status asthmaticus493.20CH OB ASTH W/O STAT ASTHJ45.51Severe persistent asthma with (acute) exacerbation493.21CH OB ASTHMA W STAT ASTHJ45.52Severe persistent asthma with status asthmaticus493.22CH OBS ASTH W ACUTE EXACJ45.901Unspecified asthma with (acute) exacerbation493.81EXERCSE IND BRONCHOSPASMJ45.902Unspecified asthma with status asthmaticus493.82COUGH VARIANT ASTHMAJ45.990Exercise induced bronchospasm493.90ASTHMA W/O STATUS ASTHMJ45.991Cough variant asthma493.91ASTHMA W STATUS ASTHMATJ45.998Other asthma493.92ASTHMA W ACUTE EXACERBTNAcute bronchitis diagnosis codes: (ACCPD2D)ICD-9-CMDescriptionICD-10-CMDescription466.0ACUTE BRONCHITISJ20.0Acute bronchitis due to Mycoplasma pneumoniae490BRONCHITIS NOSJ20.1Acute bronchitis due to Hemophilus influenzaeJ20.2Acute bronchitis due to streptococcusJ20.3Acute bronchitis due to coxsackievirusJ20.4Acute bronchitis due to parainfluenza virusJ20.5Acute bronchitis due to respiratory syncytial virusJ20.6Acute bronchitis due to rhinovirusJ20.7Acute bronchitis due to echovirusJ20.8Acute bronchitis due to other specified organismsJ20.9Acute bronchitis, unspecifiedJ40Bronchitis, not specified as acute or chronicNUMERATOR EXCLUSIONSExclude cases: with any-listed ICD-9-CM or ICD-10-CM diagnosis codes for cystic fibrosis and anomalies of the respiratory systemtransfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing),principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers fibrosis and anomalies of the respiratory system diagnosis codes: (RESPAN)ICD-9-CMDescriptionICD-10-CMDescription277.00CYSTIC FIBROS W/O ILEUSE84.0Cystic fibrosis with pulmonary manifestations277.01CYSTIC FIBROS W ILEUSE84.11Meconium ileus in cystic fibrosis277.02CYSTIC FIBROS W PUL MANE84.19Cystic fibrosis with other intestinal manifestations277.03CYSTIC FIBROSIS W GI MANE84.8Cystic fibrosis with other manifestations277.09CYSTIC FIBROSIS NECE84.9Cystic fibrosis, unspecified516.61NEUROENDOCRINE CELL HYPERPLASIA OF INFANCYJ84.83Surfactant mutations of the lung516.62PULMONARY INTERSTITIAL GLYCOGENESISJ84.841Neuroendocrine cell hyperplasia of infancy516.63SURFACTANT MUTATIONS OF THE LUNGJ84.842Pulmonary interstitial glycogenosis516.64ALVEOLAR CAPILLARY DYSPLASIA WITH VEIN MISALIGNMENTJ84.843Alveolar capillary dysplasia with vein misalignment516.69OTHER INTERSTITIAL LUNG DISEASES OF THE CHILDHOOD J84.848Other interstitial lung diseases of childhood747.21ANOMALIES OF AORTIC ARCHP27.0Wilson-Mikity syndrome748.3LARYNGOTRACH ANOMALY NECP27.1Bronchopulmonary dysplasia originating in the perinatal period748.4CONGENITAL CYSTIC LUNGP27.8Other chronic respiratory diseases originating in the Perinatal Period748.5AGENESIS OF LUNGP27.9Unspecified chronic respiratory disease originating in the perinatal period748.60LUNG ANOMALY NOSQ25.4Other congenital malformations of aorta748.61CONGEN BRONCHIECTASISQ31.1Congenital subglottic stenosis748.69LUNG ANOMALY NECQ31.2Laryngeal hypoplasia748.8RESPIRATORY ANOMALY NECQ31.3Laryngocele748.9RESPIRATORY ANOMALY NOSQ31.5Congenital laryngomalacia750.3CONG ESOPH FISTULA/ATRESQ31.8Other congenital malformations of larynx759.3SITUS INVERSUSQ31.9Congenital malformation of larynx, unspecified770.7PERINATAL CHR RESP DISQ32.0Congenital tracheomalaciaQ32.1Other congenital malformations of tracheaQ32.2Congenital bronchomalaciaQ32.3Congenital stenosis of bronchusQ32.4Other congenital malformations of bronchusQ33.0Congenital cystic lungQ33.1Accessory lobe of lungQ33.2Sequestration of lungQ33.3Agenesis of lungQ33.4Congenital bronchiectasisQ33.5Ectopic tissue in lungQ33.6Congenital hypoplasia and dysplasia of lungQ33.8Other congenital malformations of lungQ33.9Congenital malformation of lung, unspecifiedQ34.0Anomaly of pleuraQ34.1Congenital cyst of mediastinumQ34.8Other specified congenital malformations of respiratory systemQ34.9Congenital malformation of respiratory system, unspecifiedQ39.0Atresia of esophagus without fistulaQ39.1Atresia of esophagus with tracheo‐esophageal fistulaQ39.2Congenital tracheo‐esophageal fistula without atresiaQ39.3Congenital stenosis and stricture of esophagusQ39.4Esophageal webQ89.3Situs inversusDENOMINATORIndividuals in the Project 2.5 Target Population ages 40 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #7 Hypertension Admission RateDESCRIPTIONAdmissions with a principal diagnosis of hypertension , ages 18 years and older. Excludes kidney disease combined with dialysis access procedure admissions, cardiac procedure admissions, obstetric admissions, and transfers from other institutionsNUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM or ICD-10-CM diagnosis code for hypertension.[NOTE: By definition, discharges with a principal diagnosis of hypertension are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QITM software does not explicitly exclude obstetric cases.]Hypertension diagnosis codes: (ACSHYPD)ICD-9-CMDescriptionICD-10-CMDescription401.0MALIGNANT HYPERTENSIONI10Essential (primary) hypertension401.9HYPERTENSION NOSI11.9Hypertensive heart disease without heart failure402.00MAL HYPERTEN HRT DIS NOSI12.9Hypertensive chronic kidney disease with stage 1 throughstage 4 chronic kidney disease, or unspecified chronic kidney disease402.10BEN HYPERTEN HRT DIS NOSI13.10Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease402.90HYPERTENSIVE HRT DIS NOS403.00MAL HYP REN W/O REN FAIL403.10BEN HYP REN W/O REN FAIL403.90HYP REN NOS W/O REN FAIL404.00MAL HY HT/REN W/O CHF/RF404.10BEN HY HT/REN W/O CHF/RF404.90HY HT/REN NOS W/O CHF/RFNUMERATOR EXCLUSIONSExclude cases: with any-listed ICD-9-CM or ICD-10-PCS procedure codes for cardiac procedurewith any-listed ICD-9-CM or ICD-10-CM diagnosis codes of Stage I-IV kidney disease, only if accompanied by any-listed ICD-9-CM or ICD-10-PCS procedure codes for dialysis accesstransfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age(AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers B – Cardiac Procedure Codes I-IV kidney disease diagnosis codes: (ACSHY2D)ICD-9-CMDescriptionICD_10-CMDescription403.00MAL HYP REN W/O REN FAILI12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease403.10BEN HYP REN W/O REN FAILI13.10Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease403.90HYP REN NOS W/O REN FAIL404.00MAL HY HT/REN W/O CHF/RF404.10BEN HY HT/REN W/O CHF/RF404.90HY HT/REN NOS W/O CHF/RFDialysis access procedure codes: (ACSHYPP)ICD-9-PCSDescriptionICD-10-PCSDescription38.95VEN CATH RENAL DIALYSIS031209DBypass Innominate Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach39.27DIALYSIS ARTERIOVENOSTOM031209FBypass Innominate Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach39.29VASC SHUNT & BYPASS NEC03120ADBypass Innominate Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach39.42REVIS REN DIALYSIS SHUNT03120AFBypass Innominate Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach39.43REMOV REN DIALYSIS SHUNT03120JDBypass Innominate Artery to Upper Arm Vein with Synthetic Substitute, Open Approach39.93INSERT VES‐TO‐VES CANNUL03120JFBypass Innominate Artery to Lower Arm Vein with Synthetic Substitute, Open Approach39.94REPLAC VES‐TO‐VES CANNUL03120KDBypass Innominate Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03120KFBypass Innominate Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03120ZDBypass Innominate Artery to Upper Arm Vein, Open Approach03120ZFBypass Innominate Artery to Lower Arm Vein, Open Approach031309DBypass Right Subclavian Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031309FBypass Right Subclavian Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03130ADBypass Right Subclavian Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03130AFBypass Right Subclavian Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03130JDBypass Right Subclavian Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03130JFBypass Right Subclavian Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03130KDBypass Right Subclavian Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03130KFBypass Right Subclavian Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03130ZDBypass Right Subclavian Artery to Upper Arm Vein, Open Approach03130ZFBypass Right Subclavian Artery to Lower Arm Vein, Open Approach031409DBypass Left Subclavian Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031409FBypass Left Subclavian Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03140ADBypass Left Subclavian Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03140AFBypass Left Subclavian Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03140JDBypass Left Subclavian Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03140JFBypass Left Subclavian Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03140KDBypass Left Subclavian Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03140KFBypass Left Subclavian Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03140ZDBypass Left Subclavian Artery to Upper Arm Vein, Open Approach03140ZFBypass Left Subclavian Artery to Lower Arm Vein, Open Approach031509DBypass Right Axillary Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031509FBypass Right Axillary Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03150ADBypass Right Axillary Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03150AFBypass Right Axillary Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03150JDBypass Right Axillary Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03150JFBypass Right Axillary Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03150KDBypass Right Axillary Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03150KFBypass Right Axillary Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03150ZDBypass Right Axillary Artery to Upper Arm Vein, Open Approach03150ZFBypass Right Axillary Artery to Lower Arm Vein, Open Approach031609DBypass Left Axillary Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031609FBypass Left Axillary Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03160ADBypass Left Axillary Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03160AFBypass Left Axillary Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03160JDBypass Left Axillary Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03160JFBypass Left Axillary Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03160KDBypass Left Axillary Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03160KFBypass Left Axillary Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03160ZDBypass Left Axillary Artery to Upper Arm Vein, Open Approach03160ZFBypass Left Axillary Artery to Lower Arm Vein, Open Approach031709DBypass Right Brachial Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031709FBypass Right Brachial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03170ADBypass Right Brachial Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03170AFBypass Right Brachial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03170JDBypass Right Brachial Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03170JFBypass Right Brachial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03170KDBypass Right Brachial Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03170KFBypass Right Brachial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03170ZDBypass Right Brachial Artery to Upper Arm Vein, Open Approach03170ZFBypass Right Brachial Artery to Lower Arm Vein, Open Approach031809DBypass Left Brachial Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach031809FBypass Left Brachial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03180ADBypass Left Brachial Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach03180AFBypass Left Brachial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03180JDBypass Left Brachial Artery to Upper Arm Vein with Synthetic Substitute, Open Approach03180JFBypass Left Brachial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03180KDBypass Left Brachial Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach03180KFBypass Left Brachial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03180ZDBypass Left Brachial Artery to Upper Arm Vein, Open Approach03180ZFBypass Left Brachial Artery to Lower Arm Vein, Open Approach031909FBypass Right Ulnar Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach03190AFBypass Right Ulnar Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach03190JFBypass Right Ulnar Artery to Lower Arm Vein with Synthetic Substitute, Open Approach03190KFBypass Right Ulnar Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach03190ZFBypass Right Ulnar Artery to Lower Arm Vein, Open Approach031A09FBypass Left Ulnar Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach031A0AFBypass Left Ulnar Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach031A0JFBypass Left Ulnar Artery to Lower Arm Vein with Synthetic Substitute, Open Approach031A0KFBypass Left Ulnar Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach031A0ZFBypass Left Ulnar Artery to Lower Arm Vein, Open Approach031B09FBypass Right Radial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach031B0AFBypass Right Radial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach031B0JFBypass Right Radial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach031B0KFBypass Right Radial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach031B0ZFBypass Right Radial Artery to Lower Arm Vein, Open Approach031C09FBypass Left Radial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach031C0AFBypass Left Radial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach031C0JFBypass Left Radial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach031C0KFBypass Left Radial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach031C0ZFBypass Left Radial Artery to Lower Arm Vein, Open Approach03PY07ZRemoval of Autologous Tissue Substitute from Upper Artery, Open Approach03PY0JZRemoval of Synthetic Substitute from Upper Artery, Open Approach03PY0KZRemoval of Nonautologous Tissue Substitute from Upper Artery, Open Approach03PY37ZRemoval of Autologous Tissue Substitute from Upper Artery, Percutaneous Approach03PY3JZRemoval of Synthetic Substitute from Upper Artery, Percutaneous Approach03PY3KZRemoval of Nonautologous Tissue Substitute from Upper Artery, Percutaneous Approach03PY47ZRemoval of Autologous Tissue Substitute from Upper Artery, Percutaneous Endoscopic Approach03PY4JZRemoval of Synthetic Substitute from Upper Artery, Percutaneous Endoscopic Approach03PY4KZRemoval of Nonautologous Tissue Substitute from Upper Artery, Percutaneous Endoscopic Approach03WY0JZRevision of Synthetic Substitute in Upper Artery, Open Approach03WY3JZRevision of Synthetic Substitute in Upper Artery, Percutaneous Approach03WY4JZRevision of Synthetic Substitute in Upper Artery, Percutaneous Endoscopic Approach03WYXJZRevision of Synthetic Substitute in Upper Artery, External Approach05HY33ZInsertion of Infusion Device into Upper Vein, Percutaneous Approach06HY33ZInsertion of Infusion Device into Lower Vein, Percutaneous ApproachDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and olderDENOMINATOR EXCLUSIONSNone ApplicablePQI #8 Heart Failure Admission RateDESCRIPTIONAdmissions with a principal diagnosis of heart failure , ages 18 years and older. Excludes cardiac procedure admissions, obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM or ICD-10-CM diagnosis code for heart failure.[NOTE: By definition, discharges with a principal diagnosis of heart failure are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]Heart failure diagnosis codes: (ACSCHFD)ICD-9-CMDescriptionICD-10-CMDescription398.91RHEUMATIC HEART FAILUREI09.81Rheumatic heart failure402.01MAL HYPERT HRT DIS W CHFI50.1Left ventricular failure402.11BENIGN HYP HRT DIS W CHFI50.20Unspecified systolic (congestive) heart failure402.91HYPERTEN HEART DIS W CHFI50.21Acute systolic (congestive) heart failure404.01MAL HYPER HRT/REN W CHFI50.22Chronic systolic (congestive) heart failure404.03MAL HYP HRT/REN W CHF/RFI50.23Acute on chronic systolic (congestive) heart failure404.11BEN HYPER HRT/REN W CHFI50.30Unspecified diastolic (congestive) heart failure404.13BEN HYP HRT/REN W CHF/RFI50.31Acute diastolic (congestive) heart failure404.91HYPER HRT/REN NOS W CHFI50.32Chronic diastolic (congestive) heart failure404.93HYP HT/REN NOS W CHF/RFI50.33Acute on chronic diastolic (congestive) heart failure428.0CONGESTIVE HEART FAILUREI50.40Unspecified combined systolic (congestive) and diastolic (congestive) heart failure428.1LEFT HEART FAILUREI50.41Acute combined systolic (congestive) and diastolic (congestive) heart failure428.20SYSTOLIC HRT FAILURE NOSI50.42Chronic combined systolic (congestive) and diastolic (congestive) heart failure428.21AC SYSTOLIC HRT FAILUREI50.43Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure428.22CHR SYSTOLIC HRT FAILUREI50.9Heart failure, unspecified428.23AC ON CHR SYST HRT FAIL428.30DIASTOLC HRT FAILURE NOS428.31AC DIASTOLIC HRT FAILURE428.32CHR DIASTOLIC HRT FAIL428.33AC ON CHR DIAST HRT FAIL428.40SYST/DIAST HRT FAIL NOS428.41AC SYST/DIASTOL HRT FAIL428.42CHR SYST/DIASTL HRT FAIL428.43AC/CHR SYST/DIA HRT FAIL428.9HEART FAILURE NOSNUMERATOR EXCLUSIONSExclude cases:with any-listed ICD-9-CM or ICD-10-PCS procedure codes for cardiac proceduretransfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers B – Cardiac Procedure Codes in the Project 2.5 Target Population ages 18 years and olderDENOMINSTOR EXCLUSIONSNot ApplicablePQI #10 Dehydration Admission RateDESCRIPTIONAdmissions with a principal diagnosis of dehydration , ages 18 years and older. Excludes obstetric admissions and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with eithera principal ICD-9-CM or ICD-10-CM diagnosis code for dehydration; orany secondary ICD-9-CM or ICD-10-CM diagnosis codes for dehydration and a principal ICD-9-CM or ICD-10-CM diagnosis code for hyperosmolality and/or hypernatremia, gastroenteritis, or acute kidney injury[NOTE: By definition, discharges with a principal diagnosis of dehydration, hyperosmolality and/or hypernatremia, gastroenteritis, or acute kidney injury are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QITM software does not explicitly exclude obstetric cases.]Dehydration diagnosis codes: (ACSDEHD)ICD-9-CMDescriptionICD-10-CMDescription276.5HYPOVOLEMIAE86.0Dehydration276.50VOLUME DEPLETIONE86.1Hypovolemia276.51DEHYDRATIONE86.9Volume depletion, unspecified276.52HYPOVOLEMIADehydration diagnosis codes: (HYPERID)ICD-9-CMDescriptionICD-10-CMDescription276.0HYPEROSMOLALITYE87.0Hyperosmolality and hypernatremiaDehydration diagnosis codes: (ACPGASD)ICD-9-CMDescriptionICD-10-CMDescription008.61INTES INFEC ROTAVIRUSA08.0Rotaviral enteritis008.62INTES INFEC ADENOVIRUSA08.11Acute gastroenteropathy due to Norwalk agent008.63INT INF NORWALK VIRUSA08.19Acute gastroenteropathy due to other small round008.64INT INF OTH SML RND VRUSA08.2Adenoviral enteritis008.65INTES INFEC CALCIVIRUSA08.31Calicivirus enteritis008.66INTES INFEC ASTROVIRUSA08.32Astrovirus enteritis008.67INT INF ENTEROVIRUS NECA08.39Other viral enteritis008.69ENTERITIS NOSA08.4Viral intestinal infection, unspecified008.8VIRAL ENTERITIS NOSA08.8Other specified intestinal infections009.0INFECTIOUS ENTERITIS NOSA09Infectious gastroenteritis and colitis, unspecified009.1ENTERITIS OF INFECT ORIGK52.89Other specified noninfective gastroenteritis and colitis009.2INFECTIOUS DIARRHEA NOSK52.9Noninfective gastroenteritis and colitis, unspecified009.3DIARRHEA OF INFECT ORIG558.9NONINF GASTROENTERIT NECDehydration diagnosis codes: (PHYSIDB)ICD-9-CMDescriptionICD-10-CMDescription584.5AC KIDNY FAIL, TUBR NECRN17.0Acute kidney failure with tubular necrosis584.6AC KIDNY FAIL, CORT NECRN17.1Acute kidney failure with acute cortical necrosis584.7AC KIDNY FAIL, MEDU NECRN17.2Acute kidney failure with medullary necrosis584.8ACUTE KIDNEY FAILURE NECN17.8Other acute kidney failure584.9ACUTE KIDNEY FAILURE NOSN17.9Acute kidney failure, unspecified586RENAL FAILURE NOSN19Unspecified kidney failure997.5SURG COMPL‐URINARY TRACTN99.0Postprocedural (acute) (chronic) kidney failureNUMERATOR EXCLUSIONSExclude cases:transfer from a hospital (different facility) transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith any-listed ICD-9-CM or ICD-10-CM diagnosis codes for chronic renal failurewith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers diagnosis codes: (CRENLFD)ICD-9-CMDescriptionICD-10-CMDescription403.01MAL HYP KIDNEY W CHR KIDI12.0Hypertensive chronic kidney disease kidney disease or end stage renal with stage 5 chronic disease403.11BEN HYP KIDNEY W CHR KIDI13.11Hypertensive heart and chronic kidney heart failure, with stage 5 chronic kidney disease, or end disease without stage renal disease403.91HYP KIDNEY NOS W CHR KIDI13.2Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease404.02MAL HY HRT/KID W CHR KIDN185Chronic kidney disease, stage 5404.03MAL HYP HRT/KID W HF/KIDN18.6End stage renal disease404.12BEN HYP HT/KID W CHR KID404.13BEN HYP HT/KID W HF/KID404.92HYP HT/KID NOS W CHR KID404.93HYP HRT/KID NOS W HF/KID585.5CHRON KIDNEY DIS STAGE V585.6END STAGE RENAL DISEASEDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONS Not ApplicablePQI #11 Bacterial Pneumonia Admission RateDESCRIPTIONAdmissions with a principal diagnosis of bacterial pneumonia , ages 18 years and older. Excludes sickle cell or hemoglobin-S admissions, other indications of immunocompromised state admissions, obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM or ICD-10-CM diagnosis code for bacterial pneumonia.[NOTE: By definition, discharges with a principal diagnosis of bacterial pneumonia are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QITM software does not explicitly exclude obstetric cases.]Bacterial pneumonia diagnosis codes: (ACSBACD)ICD-9-CMDescriptionICD-10-CMDescription481PNEUMOCOCCAL PNEUMONIAJ13Pneumonia due to Streptococcus pneumoniae482.2H.INFLUENZAE PNEUMONIAJ14Pneumonia due to Hemophilus influenzae482.30STREP PNEUMONIA UNSPECJ15.211Pneumonia due to Methicillin susceptible Staphylococcus aureus482.31GRP A STREP PNEUMONIAJ15.212Pneumonia due to Methicillin resistant Staphylococcus aureus482.32GRP B STREP PNEUMONIAJ153Pneumonia due to streptococcus, group B482.39OTH STREP PNEUMONIAJ154Pneumonia due to other streptococci482.41METH SUS PNEUM D/T STAPHJ157Pneumonia due to Mycoplasma pneumoniae482.42METH RES PNEU D/T STAPHJ159Unspecified bacterial pneumonia482.9BACTERIAL PNEUMONIA NOSJ160Chlamydial pneumonia483.0MYCOPLASMA PNEUMONIAJ168Pneumonia due to other specified infectious organisms483.1CHLAMYDIA PNEUMONIAJ180Bronchopneumonia, unspecified organism483.8OTH SPEC ORG PNEUMONIAJ181Lobar pneumonia, unspecified organism485BRONCOPNEUMONIA ORG NOSJ188Other pneumonia, unspecified organism486PNEUMONIA, ORGANISM NOSJ189Pneumonia, unspecified organismNUMERATOR EXCLUSIONSExclude cases:transfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith any-listed ICD-9-CM or ICD-10-CM diagnosis codes for sickle cell anemia or HB-S diseasewith any-listed ICD-9-CM or ICD-10-CM diagnosis codes or any-listed ICD-9-CM or ICD-10-PCS procedure codes for immunocompromised statewith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers C – Immunocompromised State Diagnosis and Procedure Codes cell anemia or HB-S disease diagnosis codes: (ACSBA2D)ICD-9-CMDescriptionICD-10-CMDescription282.41THLASEMA HB-S W/O CRISISD57.00Hb-SS disease with crisis, unspecified282.42THLASSEMIA HB-S W CRISISD57.01Hb-SS disease with acute chest syndrome282.60SICKLE-CELL ANEMIA NOSD57.02Hb-SS disease with splenic sequestration282.61HB-S DISEASE W/O CRISISD57.1Sickle-cell disease without crisis282.62HB-S DISEASE WITH CRISISD57.20Sickle-cell/Hb-C disease without crisis282.63SICKLE-CELL/HB-C DISEASED57.211Sickle-cell/Hb-C disease with acute chest syndrome282.64HB-S/HB-C DIS W CRISISD57.212Sickle-cell/Hb-C disease with splenic sequestration282.68HB-S DIS W/O CRISIS NECD57.219Sickle-cell/Hb-C disease with crisis, unspecified282.69SICKLE-CELL ANEMIA NECD57.40Sickle-cell thalassemia without crisisD57.411Sickle-cell thalassemia with acute chest syndromeD57.412Sickle-cell thalassemia with splenic sequestrationD57.419Sickle‐cell thalassemia with crisis, unspecifiedD57.80Other sickle‐cell disorders without crisisD57.811Other sickle‐cell disorders with acute chest syndromeD57.812Other sickle‐cell disorders with splenic sequestrationD57.819Other sickle‐cell disorders with crisis, unspecifiedDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #12 Urinary Tract Infection Admission RateDESCRIPTIONAdmissions with a principal diagnosis of urinary tract infection , ages 18 years and older. Excludes kidney or urinary tract disorder admissions, other indications of immunocompromised state admissions, obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM or ICD-10-CM diagnosis code for urinary tract infection.[NOTE: By definition, discharges with a principal diagnosis of urinary tract infection are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]Urinary tract infection diagnosis codes: (ACSUTID)ICD-9-CMDescriptionICD-10-CMDescription590.10AC PYELONEPHRITIS NOSN10Acute tubulo‐interstitial nephritis590.11AC PYELONEPHR W MED NECRN11.9Chronic tubulo‐interstitial nephritis, unspecified590.2RENAL/PERIRENAL ABSCESSN12Tubulo‐interstitial nephritis, not specified as acute or chronic590.3PYELOURETERITIS CYSTICAN15.1Renal and perinephric abscess590.80PYELONEPHRITIS NOSN15.9Renal tubulo‐interstitial disease, unspecified590.81PYELONEPHRIT IN OTH DISN16Renal tubulo‐interstitial disorders in diseases classified elsewhere590.9INFECTION OF KIDNEY NOSN28.84Pyelitis cystica595.0ACUTE CYSTITISN28.85Pyeloureteritis cystica595.9CYSTITIS NOSN28.86Ureteritis cystica599.0URIN TRACT INFECTION NOSN30.00Acute cystitis without hematuriaN30.01Acute cystitis with hematuria N30.90Cystitis, unspecified without hematuriaN30.91Cystitis, unspecified with hematuriaN39.0Urinary tract infection, site not specifiedNUMERATOR EXCLUSIONSExclude cases:transfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith any-listed ICD-9-CM or ICD-10-CM diagnosis codes for kidney/urinary tract disorderwith any-listed ICD-9-CM or ICD-10-CM diagnosis codes or any-listed ICD-9-CM or ICD-10-PCS procedure codes for immunocompromised statewith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers C – Immunocompromised State Diagnosis and Procedure Codes tract disorder diagnosis codes: (KIDNEY)ICD_9-CMDescriptionICD-10-CMDescription590.00CHR PYELONEPHRITIS NOSN11.0Nonobstructive reflux-associated chronic pyelonephritis590.01CHR PYELONEPH W MED NECRN11.1Chronic obstructive pyelonephritis593.70VESCOURETRL RFLUX UNSPCFN11.8Other chronic tubulo-interstitial nephritis593.71VESICOURETERAL REFLUX UNILTRLN11.9Chronic tubulo-interstitial nephritis, unspecified593.72VESICOURETERAL REFLUX NPHT BLTRLN13.70Vesicoureteral-reflux, unspecified593.73VESICOURETERAL REFLUX W NPHT NOSN13.71Vesicoureteral-reflux without reflux nephropathy753.0RENAL AGENESISN13.721Vesicoureteral-reflux with reflux nephropathy without hydroureter, unilateral753.10CYSTIC KIDNEY DISEAS NOSN13.722Vesicoureteral-reflux with reflux nephropathy without hydroureter, bilateral753.11CONGENITAL RENAL CYSTN13.729Vesicoureteral-reflux with reflux nephropathy without hydroureter, unspecified753.12POLYCYSTIC KIDNEY NOSN13.731Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral753.13POLYCYST KID-AUTOSOM DOMN13.732Vesicoureteral-reflux with reflux nephropathy with753.14POLYCYST KID-AUTOSOM RECN13.739Vesicoureteral-reflux with reflux nephropathy with hydroureter, unspecified753.15RENAL DYSPLASIAN13.9Obstructive and reflux uropathy, unspecified753.16MEDULLARY CYSTIC KIDNEYQ60.0Renal agenesis, unilateral753.17MEDULLARY SPONGE KIDNEYQ60.1Renal agenesis, bilateral753.19CYSTIC KIDNEY DISEAS NECQ60.2Renal agenesis, unspecified753.20OBS DFCT REN PLV&URT NOSQ60.3Renal hypoplasia, unilateral753.21CONGEN OBST URTROPLV JNCQ60.4Renal hypoplasia, bilateral753.22CONG OBST URETEROVES JNCQ60.5Renal hypoplasia, unspecified753.23CONGENITAL URETEROCELEQ60.6Potter's syndrome753.29OBST DEF REN PLV&URT NECQ61.00Congenital renal cyst, unspecified753.3KIDNEY ANOMALY NECQ61.01Congenital single renal cyst753.4URETERAL ANOMALY NECQ61.02Congenital multiple renal cysts753.5EXSTROPHY OF URNIARY BLADDERQ61.11Cystic dilatation of collecting ducts753.6ATRESIA AND STENOSIS OF URETHRA AND BLADDER NECKQ61.19Other polycystic kidney, infantile type753.8CYSTOURETHRAL ANOM NECQ61.2Polycystic kidney, adult type753.9URINARY ANOMALY NOSQ61.3Polycystic kidney, unspecifiedQ61.4Renal dysplasia MedullaryQ61.5cystic kidney Other cystic Q61.8kidney diseasesQ61.9Cystic kidney disease, unspecifiedQ62.0Congenital hydronephrosisQ62.10Congenital occlusion of ureter, unspecifiedQ62.11Congenital occlusion of ureteropelvic junctionQ62.12Congenital occlusion of ureterovesical orifice Q62.2Congenital megaureterQ62.31Congenital ureterocele, orthotopicQ62.4Agenesis of ureterQ62.5Duplication of ureterQ62.60Malposition of ureter, unspecifiedQ62.61Deviation of ureterQ62.62Displacement of ureterQ62.63Anomalous implantation of ureterQ62.69Other malposition of ureterQ62.7Congenital vesico‐uretero‐renal reflux Q62.8Other congenital malformations of ureter Q63.0Accessory kidneyQ63.1Lobulated, fused and horseshoe kidneyQ63.2Ectopic kidneyQ63.3Hyperplastic and giant kidneyQ63.8Other specified congenital malformations of kidney Q63.9Congenital malformation of kidney, unspecified Q64.10Exstrophy of urinary bladder, unspecifiedQ64.11Supravesical fissure of urinary bladder Q64.12Cloacal extrophy of urinary bladder Q64.19Other exstrophy of urinary bladder Q64.2Congenital posterior urethral valves Q64.31Congenital bladder neck obstruction Q64.32Congenital stricture of urethraQ64.33Congenital stricture of urinary meatusQ64.39Other atresia and stenosis of urethra and bladder neckQ64.5Congenital absence of bladder and urethraQ64.6Congenital diverticulum of bladderQ64.70Unspecified congenital malformation of bladder and urethraQ64.71Congenital prolapse of urethraQ64.72Congenital prolapse of urinary meatusQ64.73Congenital urethrorectal fistulaQ64.74Double urethraQ64.75Double urinary meatusQ64.79Other congenital malformations of bladder and urethraQ64.8Other specified congenital malformations of urinary systemQ64.9Congenital malformation of urinary system, unspecifiedDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #13 Angina Without Procedure Admission RateDESCRIPTIONAdmissions with a principal diagnosis of angina without a cardiac procedure, ages 18 years and older. Excludes cardiac procedure admissions, obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM or ICD-10-CM diagnosis code for angina.[NOTE: By definition, discharges with a principal diagnosis of angina are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]Angina diagnosis codes: (ACSANGD)ICD-9-CMDescriptionICD-10-CMDescription411.1INTERMED CORONARY SYNDI20.0Unstable angina411.81CORONARY OCCLSN W/O MII20.1Angina pectoris with documented spasm411.89AC ISCHEMIC HRT DIS NECI20.8Other forms of angina pectoris413.0ANGINA DECUBITUSI20.9Angina pectoris, unspecified413.1PRINZMETAL ANGINAI24.0Acute coronary thrombosis not resulting in myocardial infarction413.9ANGINA PECTORIS NEC/NOSI24.8Other forms of acute ischemic heart diseaseI24.9Acute ischemic heart disease, unspecifiedI25.110Atherosclerotic heart disease of native coronary artery with unstable angina pectorisI25.111Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm I25.118Atherosclerotic heart disease of native coronary artery with other forms of angina pectorisI25.119Atherosclerotic heart disease of native coronary artery with unspecified angina pectorisI25.700Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectorisI25.701Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasmI25.708Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectorisI25.709Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectorisI25.710Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectorisI25.711Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasmI25.718Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectorisI25.719Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectorisI25.720Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectorisI25.721Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasmI25.728Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectorisI25.729Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectorisI25.730Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectorisI25.731Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasmI25.738Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectorisI25.739Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectorisI25.750Atherosclerosis of native coronary artery of transplanted heart with unstable anginaI25.751Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasmI25.758Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectorisI25.759Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectorisI25.760Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable anginaI25.761Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasmI25.768Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectorisI25.769Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectorisI25.790Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectorisI25.791Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasmI25.798Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectorisI25.799Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectorisNUMERATOR EXCLUSIONSExclude cases:transfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith any-listed ICD-9-CM or ICD-10-PCS procedure codes for cardiac procedurewith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A – Admission Codes for Transfers B – Cardiac Procedure Codes in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #14 Uncontrolled Diabetes Admission RateDESCRIPTIONAdmissions for a principal diagnosis of diabetes without mention of short‐term (ketoacidosis, hyperosmolarity, or coma) or long‐term (renal, eye, neurological, circulatory, or other unspecified) complications , ages 18 years and older. Excludes obstetric admissions and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with a principal ICD-9-CM diagnosis code for uncontrolled diabetes without mention of a short-term or long-term complication.[NOTE: By definition, discharges with a principal diagnosis of uncontrolled diabetes without mention of short-term or long-term complications are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QI TM software does not explicitly exclude obstetric cases.]Uncontrolled diabetes without mention of a short-term or long-term complication diagnosis codes: (ACDIAUD)ICD_9-CMDescriptionICD-10-CMDescription250.02DMII WO CMP UNCNTRLDE10.65Type 1 diabetes mellitus with hyperglycemia250.03DMI WO CMP UNCNTRLDE11.65Type 2 diabetes mellitus with hyperglycemiaE10.649Type 1 diabetes mellitus with hypoglycemia without comaE11.649Type 2 diabetes mellitus with hypoglycemia without comaNUMERATOR EXCLUSIONSExclude cases:transfer from a hospital (different facility) transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A - Admission Codes for Transfers in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot ApplicablePQI #15 Asthma in Younger Adults Admission RateDESCRIPTIONAdmissions for a principal diagnosis of asthma , ages 18 to 39 years. Excludes admissions with an indication of cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 through 39 years, with a principal ICD-9-CM or ICD-10-CM diagnosis code for asthma.[NOTE: By definition, discharges with a principal diagnosis of asthma are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ QITM software does not explicitly exclude obstetric cases.]Asthma diagnosis codes: (ACSASTD)ICD-9-CMDescriptionICD-10-CMDescription493.00EXT ASTHMA W/O STAT ASTHJ45.21Mild intermittent asthma with (acute) exacerbation493.01EXT ASTHMA W STATUS ASTHJ45.22Mild intermittent asthma with status asthmaticus493.02EXT ASTHMA W ACUTE EXACJ45.31Mild persistent asthma with (acute) exacerbation493.10INT ASTHMA W/O STAT ASTHJ45.32Mild persistent asthma with status asthmaticus493.11INT ASTHMA W STATUS ASTHJ45.41Moderate persistent asthma with (acute) exacerbation493.12INT ASTHMA W ACUTE EXACJ45.42Moderate persistent asthma with status asthmaticus493.20CH OB ASTH W/O STAT ASTHJ45.51Severe persistent asthma with (acute) exacerbation493.21CH OB ASTHMA W STAT ASTHJ45.52Severe persistent asthma with status asthmaticus493.22CH OBS ASTH W ACUTE EXACJ45.901Unspecified asthma with (acute) exacerbation493.81EXERCSE IND BRONCHOSPASMJ45.902Unspecified asthma with status asthmaticus493.82COUGH VARIANT ASTHMAJ45.990Exercise induced bronchospasm493.90ASTHMA W/O STATUS ASTHMJ45.991Cough variant asthma493.91ASTHMA W STATUS ASTHMATJ45.998Other asthma493.92ASTHMA W ACUTE EXACERBTNNUMERATOR EXCLUSIONSExclude Cases:transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilitywith any-listed ICD-9-CM or ICD-10-CM diagnosis codes for cystic fibrosis and anomalies of the respiratory systemwith missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing) Cystic fibrosis and anomalies of the respiratory system diagnosis codes: (RESPAN)ICD-9-CMDescriptionICD-10-CMDescription277.00CYSTIC FIBROS W/O ILEUSE84.0Cystic fibrosis with pulmonary manifestations277.01CYSTIC FIBROS W ILEUSE84.11Meconium ileus in cystic fibrosis277.02CYSTIC FIBROS W PUL MANE84.19Cystic fibrosis with other intestinal manifestations277.03CYSTIC FIBROSIS W GI MANE84.8Cystic fibrosis with other manifestations277.09CYSTIC FIBROSIS NECE84.9Cystic fibrosis, unspecified516.61NEUROENDOCRINE CELL HYPERPLASIA OF INFANCYJ84.83Surfactant mutations of the lung516.62PULMONARY INTERSTITIAL GLYCOGENESISJ84.841Neuroendocrine cell hyperplasia of infancy516.63SURFACTANT MUTATIONS OF THE LUNGJ84.842Pulmonary interstitial glycogenosis516.64ALVEOLAR CAPILLARY DYSPLASIA WITH VEIN MISALIGNMENT51.664ALVEOLAR CAPILLARY DYSPLASIA WITH VEIN MISALIGNMENT516.69OTHER INTERSTITIAL LUNG DISEASES OF THE CHILDHOOD J84.848Other interstitial lung diseases of childhood747.21ANOMALIES OF AORTIC ARCHP27.0Wilson-Mikity syndrome748.3LARYNGOTRACH ANOMALY NECP27.1Bronchopulmonary dysplasia originating in the perinatal period748.4CONGENITAL CYSTIC LUNGP27.8Other chronic respiratory diseases originating in the perinatal period748.5AGENSIS OF LUNGP27.9Unspecified chronic respiratory disease originating in the perinatal period748.60LUNG ANOMALY NOSQ25.4Other congenital malformations of aorta748.61CONGEN BRONCHIECTASISQ31.1Congenital subglottic stenosis748.69LUNG ANOMALY NECQ31.2Laryngeal hypoplasia748.8RESPIRATORY ANOMALY NECQ31.3Laryngocele748.9RESPIRATORY ANOMALY NOSQ31.5Congenital laryngomalacia750.3CONG ESOPH FISTULA/ATRESQ31.8Other congenital malformations of larynx759.3SITUS INVERSUSQ31.9Congenital malformation of larynx, unspecified770.7PERINATAL CHR RESP DISQ32.0Congenital laryngomalaciaQ32.2Congenital bronchomalaciaQ32.3Congenital stenosis of bronchusQ32.4Other congenital malformations of bronchusQ33.0Congenital cystic lungQ33.1Accessory lobe of lungQ33.2Sequestration of lungQ33.3Agenesis of lungQ33.4Congenital bronchiectasisQ33.5Ectopic tissue in lungQ33.6 Congenital hypoplasia and dysplacia of lungQ33.8Other congenital malformation of lungQ33.9Congenital malformation of lung, unspecifiedQ34.0Anomaly of pleuraQ34.1Congenital cyst of mediastinumQ34.8Other specified congenital malformations of respiratory systemQ34.9Congenital malformation of respiratory system, unspecifiedQ39.0 Atresia of esophagus without fistulaQ39.1Atresia of esophagus with tracheo‐esophageal fistulaQ39.2Congenital tracheo‐esophageal fistula without atresiaQ39.3Congenital stenosis and stricture of esophagusQ39.4Esophageal webQ89.3Situs inversusDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 through 39 years.DENOMINATOR EXCLUSIONSNot ApplicablePQI #16 Lower-Extremity Amputation among Patients with Diabetes RateDESCRIPTIONAdmissions for any-listed diagnosis of diabetes and any-listed procedure of lower-extremity amputation, ages 18 years and older. Excludes any-listed diagnosis of traumatic lower-extremity amputation admissions, toe amputation admission (likely to be traumatic), obstetric admissions, and transfers from other institutions.NUMERATORDischarges from the PRIME Entity, for patients ages 18 years and older, with any-listed ICD-9-CM or ICD-10-PCS procedure codes for lower-extremity amputation and any-listed ICD-9-CM or ICD-10-CM diagnosis codes for diabetesLower-extremity amputation procedure codes: (ACSLEAP)ICD-9-CMDescriptionICD-10-PCSDescription841.0LOWER LIMB AMPUTAT NOS0Y620ZZDetachment at Right Hindquarter, Open Approach841.2AMPUTATION THROUGH FOOT0Y630ZZDetachment at Left Hindquarter, Open Approach841.3DISARTICULATION OF ANKLE0Y640ZZDetachment at Bilateral Hindquarter, Open Approach841.4AMPUTAT THROUGH MALLEOLI0Y670ZZDetachment at Right Femoral Region, Open Approach841.5BELOW KNEE AMPUTAT NEC0Y680ZZDetachment at Left Femoral Region, Open Approach841.6DISARTICULATION OF KNEE0Y6C0Z1Detachment at Right Upper Leg, High, Open Approach841.7ABOVE KNEE AMPUTATION0Y6C0Z2Detachment at Right Upper Leg, Mid, Open Approach841.8DISARTICULATION OF HIP0Y6C0Z3Detachment at Right Upper Leg, Low, Open Approach841.9HINDQUARTER AMPUTATION0Y6D0Z1Detachment at Left Upper Leg, High, Open Approach0Y6D0Z2Detachment at Left Upper Leg, Mid, Open Approach0Y6D0Z3Detachment at Left Upper Leg, Low, Open Approach0Y6F0ZZDetachment at Right Knee Region, Open Approach0Y6G0ZZDetachment at Left Knee Region, Open Approach0Y6H0Z1Detachment at Right Lower Leg, High, Open Approach0Y6H0Z2Detachment at Right Lower Leg, Mid, Open Approach0Y6H0Z3Detachment at Right Lower Leg, Low, Open Approach0Y6J0Z1Detachment at Left Lower Leg, High, Open Approach0Y6J0Z2Detachment at Left Lower Leg, Mid, Open Approach0Y6J0Z3Detachment at Left Lower Leg, Low, Open Approach0Y6M0Z0Detachment at Right Foot, Complete, Open Approach0Y6M0Z4Detachment at Right Foot, Complete 1st Ray, Open ApproachDiabetes diagnosis codes: (ACSLEAD)ICD-9-CMDescriptionICD-10-CMDescription250.00DMII WO CMP NT ST UNCNTRE10.10Type 1 diabetes mellitus with ketoacidosis without coma250.01DMI WO CMP NT ST UNCNTRLE10.11Type 1 diabetes mellitus with ketoacidosis with coma250.02DMII WO CMP UNCNTRLDE10.21Type 1 diabetes mellitus with diabetic nephropathy250.03DMI WO CMP UNCNTRLDE10.22Type 1 diabetes mellitus with diabetic chronic kidney disease250.10DMII KETO NT ST UNCNTRLDE10.29Type 1 diabetes mellitus with other diabetic kidney complication250.11DMI KETO NT ST UNCNTRLDE10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema250.12DMII KETOACD UNCONTROLDE10.319Type 1 diabetes mellitus with unspecified diabetic250.13DMI KETOACD UNCONTROLDE10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema250.20DMII HPRSM NT ST UNCNTRLE10.329Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema250.21DMI HPRSM NT ST UNCNTRLDE10.331Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema250.22DMII HPROSMLR UNCONTROLDE10.339Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema250.23DMI HPROSMLR UNCONTROLDE10.341Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema250.30DMII O CM NT ST UNCNTRLDE10.349Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema250.31DMI O CM NT ST UNCNTRLDE10.351Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema250.32DMII OTH COMA UNCONTROLDE10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema250.33DMI OTH COMA UNCONTROLDE10.36Type 1 diabetes mellitus with diabetic cataract250.40DMII RENL NT ST UNCNTRLDE10.39Type 1 diabetes mellitus with other diabetic ophthalmic complication250.41DMI RENL NT ST UNCNTRLDE10.40Type 1 diabetes mellitus with diabetic neuropathy, unspecified250.42DMII RENAL UNCNTRLDE10.41Type 1 diabetes mellitus with diabetic mononeuropathy250.43DMI RENAL UNCNTRLDE10.42Type 1 diabetes mellitus with diabetic polyneuropathy250.50DMII OPHTH NT ST UNCNTRLE10.43Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy250.51DMI OPHTH NT ST UNCNTRLDE10.44Type 1 diabetes mellitus with diabetic amyotrophy250.52DMII OPHTH UNCNTRLDE10.49Type 1 diabetes mellitus with other diabetic neurological250.53DMI OPHTH UNCNTRLDE10.51Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene250.60DMII NEURO NT ST UNCNTRLE10.52Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene250.61DMI NEURO NT ST UNCNTRLDE10.59Type 1 diabetes mellitus with other circulatory complications250.62DMII NEURO UNCNTRLDE10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathy250.63DMI NEURO UNCNTRLDE10.618Type 1 diabetes mellitus with other diabetic arthropathy250.70DMII CIRC NT ST UNCNTRLDE10.620Type 1 diabetes mellitus with diabetic dermatitis250.71DMI CIRC NT ST UNCNTRLDE10.621Type 1 diabetes mellitus with foot ulcer250.72DMII CIRC UNCNTRLDE10.622Type 1 diabetes mellitus with other skin ulcer250.73DMI CIRC UNCNTRLDE10.628Type 1 diabetes mellitus with other skin complications250.80DMII OTH NT ST UNCNTRLDE10.630Type 1 diabetes mellitus with periodontal disease250.81DMI OTH NT ST UNCNTRLDE10.638Type 1 diabetes mellitus with other oral complications250.82DMII OTH UNCNTRLDE10.641Type 1 diabetes mellitus with hypoglycemia with coma250.83DMI OTH UNCNTRLDE10.649Type 1 diabetes mellitus with hypoglycemia without coma250.90DMII UNSPF NT ST UNCNTRLE10.65Type 1 diabetes mellitus with hyperglycemia250.91DMI UNSPF NT ST UNCNTRLDE10.69Type 1 diabetes mellitus with other specified complication250.92DMII UNSPF UNCNTRLDE10.8Type 1 diabetes mellitus with unspecified complications250.93DMI UNSPF UNCNTRLDE10.9Type 1 diabetes mellitus without complicationsE11.00Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic‐hyperosmolar coma (NKHHC)E11.01Type 2 diabetes mellitus with hyperosmolarity with comaE11.21Type 2 diabetes mellitus with diabetic nephropathyE11.22Type 2 diabetes mellitus with diabetic chronic kidney diseaseE11.29Type 2 diabetes mellitus with other diabetic kidney complicationE11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edemaE11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edemaE11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE11.329Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edemaE11.331Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edemaE11.339Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edemaE11.341Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaE11.349Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edemaE11.351Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edemaE11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edemaE11.36Type 2 diabetes mellitus with diabetic cataractE11.39Type 2 diabetes mellitus with other diabetic ophthalmic complicationE11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecifiedE11.41Type 2 diabetes mellitus with diabetic mononeuropathy E11.42Type 2 diabetes mellitus with diabetic polyneuropathy E11.44Type 2 diabetes mellitus with diabetic amyotrophyE11.49Type 2 diabetes mellitus with other diabetic neurological complicationE11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangreneE11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangreneE11.59Type 2 diabetes mellitus with other circulatory complicationsE11.610Type 2 diabetes mellitus with diabetic neuropathic arthropathyE11.618Type 2 diabetes mellitus with other diabetic arthropathyE11.620Type 2 diabetes mellitus with diabetic dermatitisE11.621Type 2 diabetes mellitus with foot ulcerE11.622Type 2 diabetes mellitus with other skin ulcerE11.628Type 2 diabetes mellitus with other skin complicationsE11.630Other specified diabetes mellitus with periodontal diseaseE11.638Type 2 diabetes mellitus with other oral complications E11.641Type 2 diabetes mellitus with hypoglycemia with coma E11.649Other specified diabetes mellitus with other diabetic neurological complicationE11.65Type 2 diabetes mellitus with hyperglycemiaE11.69Type 2 diabetes mellitus with other specified complicationE11.8Type 2 diabetes mellitus with unspecified complicationsE11.9Type 2 diabetes mellitus without complicationsE13.00Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic‐hyperosmolar coma (NKHHC)E13.01Other specified diabetes mellitus with hyperosmolarity with comaE13.10Other specified diabetes mellitus with ketoacidosis without comaE13.11Other specified diabetes mellitus with ketoacidosis with comaE13.21Other specified diabetes mellitus with diabetic nephropathyE13.22Other specified diabetes mellitus with diabetic chronic kidney diseaseE13.29Other specified diabetes mellitus with other diabetic kidney complicationE13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edemaE13.319Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edemaE13.321Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edemaE13.329Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edemaE13.331Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edemaE13.339Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edemaE13.341Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edemaE13.349Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edemaE13.351Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edemaE13.359Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edemaE13.36Other specified diabetes mellitus with diabetic cataractE13.39Other specified diabetes mellitus with other diabetic ophthalmic complicationE13.40Other specified diabetes mellitus with diabetic neuropathy, unspecifiedE13.41Other specified diabetes mellitus with diabetic mononeuropathyE13.42Other specified diabetes mellitus with diabetic polyneuropathyE13.43Other specified diabetes mellitus with diabetic autonomic (poly)neuropathyE13.44Other specified diabetes mellitus with diabetic amyotrophyE13.49Other specified diabetes mellitus with other diabetic neurological complicationE13.51Other specified diabetes mellitus with diabetic peripheral angiopathy without gangreneE13.52Other specified diabetes mellitus with diabetic peripheral angiopathy with gangreneE13.59Other specified diabetes mellitus with other circulatory complicationsE13.610Other specified diabetes mellitus with diabetic neuropathic arthropathyE13.618Other specified diabetes mellitus with other diabetic arthropathyE13.620Other specified diabetes mellitus with diabetic dermatitisE13.621Other specified diabetes mellitus with foot ulcer E13.622Other specified diabetes mellitus with other skin ulcer E13.630Other specified diabetes mellitus with periodontal diseaseE13.638Other specified diabetes mellitus with other oral complicationsE13.641Other specified diabetes mellitus with hypoglycemia with comaE13.649Other specified diabetes mellitus with hypoglycemia without comaE13.65Other specified diabetes mellitus with hyperglycemiaE13.69Other specified diabetes mellitus with other specified complicationE13.8Other specified diabetes mellitus with unspecified complicationsE13.9Other specified diabetes mellitus without complicationsNUMERATOR EXCLUSIONSwith any-listed ICD-9-CM or ICD-10-CM diagnosis codes for traumatic amputation of the lower extremitywith any-listed ICD-9-CM orICD-10-PCS procedure codes for toe amputationtransfer from a hospital (different facility)transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)transfer from another health care facilityMDC 14 (pregnancy, childbirth, and puerperium)with missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)Appendix A - Admission Codes for Transfers amputation of the lower extremity diagnosis codes: (ACLEA2D)ICD-9-CMDescriptionICD-10-CMDescription895.0AMPUTATION TOES78.011AComplete traumatic amputation at right hip joint, initial encounter895.1AMPUTATION TOE-COMPLICATS78.012AComplete traumatic amputation at left hip joint, initial encounter896.0AMPUTATION FOOT, UNILATS78.019AComplete traumatic amputation at unspecified hip joint, initial encounter896.1AMPUT FOOT, UNILAT-COMPLS78.021APartial traumatic amputation at right hip joint, initial encounter896.2AMPUTATION FOOT, BILATS78.022APartial traumatic amputation at left hip joint, initial encounter896.3AMPUTAT FOOT, BILAT-COMPS78.029APartial traumatic amputation at unspecified hip joint, initial encounter897.0AMPUT BELOW KNEE, UNILATS78.111AComplete traumatic amputation at level between right hip and knee, initial encounter897.1AMPUTAT BK, UNILAT‐COMPLS78.112AComplete traumatic amputation at level between left hip and knee, initial encounter897.2AMPUT ABOVE KNEE, UNILATS78.119AComplete traumatic amputation at level between unspecified hip and knee, initial encounter897.3AMPUT ABV KN, UNIL‐COMPLS78.121APartial traumatic amputation at level between right hip unspecified hip and knee, initial encounter897.4AMPUTAT LEG, UNILAT NOSS78.122APartial traumatic amputation at level between left hip and knee, initial encounter897.5AMPUT LEG, UNIL NOS‐COMPS78.129APartial traumatic amputation at level between unspecified hip and knee, initial encounter and knee, initial encounter897.6AMPUTATION LEG, BILATS78.911AComplete traumatic amputation of right hip and thigh,897.7AMPUTAT LEG, BILAT‐COMPLS78.912AComplete traumatic amputation of left hip and thigh, level unspecified, initial encounter level unspecified, initial encounterS78.919AComplete traumatic amputation of unspecified hip and thigh, level unspecified, initial encounterS78.921APartial traumatic amputation of right hip and thigh, level unspecified, initial encounterS78.922APartial traumatic amputation of left hip and thigh, level unspecified, initial encounterS78.929APartial traumatic amputation of unspecified hip and thigh, level unspecified, initial encounterS88.011AComplete traumatic amputation at knee level, right lower leg, initial encounterS88.012AComplete traumatic amputation at knee level, left lower leg, initial encounterS88.019AComplete traumatic amputation at knee level, unspecified lower leg, initial encounterS88.021APartial traumatic amputation at knee level, right lower leg, initial encounterS88.122APartial traumatic amputation at level between knee and ankle, left lower leg, initial encounterS88.129APartial traumatic amputation at level between knee and ankle, unspecified lower leg, initial encounterS88.911AComplete traumatic amputation of right lower leg, level unspecified, initial encounterS88.912AComplete traumatic amputation of left lower leg, level unspecified, initial encounterS88.919AComplete traumatic amputation of unspecified lower leg, level unspecified, initial encounterS88.921APartial traumatic amputation of right lower leg, level unspecified, initial encounterS88.922APartial traumatic amputation of left lower leg, level unspecified, initial encounterS88.929APartial traumatic amputation of unspecified lower leg, level unspecified, initial encounterS98.011AComplete traumatic amputation of right foot at ankle level, initial encounterS98.012AComplete traumatic amputation of left foot at ankle level, initial encounterS98.019AComplete traumatic amputation of unspecified foot at ankle level, initial encounterS98.021APartial traumatic amputation of right foot at ankle level, initial encounterS98.022APartial traumatic amputation of left foot at ankle level, initial encounterS98.029APartial traumatic amputation of unspecified foot at ankle level, initial encounterS98.111AComplete traumatic amputation of right great toe, initial encounterS98.112AComplete traumatic amputation of left great toe, initial encounterS98.119AComplete traumatic amputation of unspecified great toe, initial encounterS98.121APartial traumatic amputation of right great toe, initial encounterS98.122APartial traumatic amputation of left great toe, initial encounterS98.129APartial traumatic amputation of unspecified great toe, initial encounterS98.131AComplete traumatic amputation of one right lesser toe, initial encounterS98.132AComplete traumatic amputation of one left lesser toe, initial encounterS98.139AComplete traumatic amputation of one unspecified lesser toe, initial encounterS98.141APartial traumatic amputation of one right lesser toe, initial encounterS98.142APartial traumatic amputation of one left lesser toe, initial encounterS98.149APartial traumatic amputation of one unspecified lesser toe, initial encounterS98.211AComplete traumatic amputation of two or more right lesser toes, initial encounterS98.212AComplete traumatic amputation of two or more left lesser toes, initial encounterS98.219AComplete traumatic amputation of two or more unspecified lesser toes, initial encounterS98.221APartial traumatic amputation of two or more right lesser toes, initial encounterS98.222APartial traumatic amputation of two or more left lesser toes, initial encounterS98.229APartial traumatic amputation of two or more unspecified lesser toes, initial encounterS98.311AComplete traumatic amputation of right midfoot, initial encounterS98.312AComplete traumatic amputation of left midfoot, initial encounterS98.319AComplete traumatic amputation of unspecified midfoot, initial encounterS98.321APartial traumatic amputation of right midfoot, initial encounterS98.322APartial traumatic amputation of left midfoot, initial encounterS98.329APartial traumatic amputation of unspecified midfoot, initial encounterS98.911AComplete traumatic amputation of right foot, level unspecified, initial encounterS98.912AComplete traumatic amputation of left foot, level unspecified, initial encounterS98.919AComplete traumatic amputation of unspecified foot, level unspecified, initial encounterS98.921APartial traumatic amputation of right foot, level unspecified, initial encounter S98.922APartial traumatic amputation of left foot, level unspecified, initial encounterS98.929APartial traumatic amputation of unspecified foot, level unspecified initial encounterToe amputation procedure code: (TOEAMIP)ICD-9-CMDescriptionICD-10-PCSDescription84.11Toe Amputation0Y6P0Z0Detachment at Right 1st Toe, Complete, Open Approach0Y6P0Z1Detachment at Right 1st Toe, High, Open Approach0Y6P0Z2Detachment at Right 1st Toe, Mid, Open Approach 0Y6P0Z3Detachment at Right 1st Toe, Low, Open Approach0Y6Q0Z0Detachment at Left 1st Toe, Complete, Open Approach 0Y6Q0Z1Detachment at Left 1st Toe, High, Open Approach 0Y6Q0Z2Detachment at Left 1st Toe, Mid, Open Approach0Y6Q0Z3Detachment at Left 1st Toe, Low, Open Approach0Y6R0Z0Detachment at Right 2nd Toe, Complete, Open Approach0Y6R0Z1Detachment at Right 2nd Toe, High, Open Approach 0Y6R0Z2Detachment at Right 2nd Toe, Mid, Open Approach 0Y6R0Z3Detachment at Right 2nd Toe, Low, Open Approach 0Y6S0Z0Detachment at Left 2nd Toe, Complete, Open Approach 0Y6S0Z1Detachment at Left 2nd Toe, High, Open Approach 0Y6S0Z2Detachment at Left 2nd Toe, Mid, Open Approach 0Y6S0Z3Detachment at Left 2nd Toe, Low, Open Approach 0Y6T0Z0Detachment at Right 3rd Toe, Complete, Open Approach0Y6T0Z1Detachment at Right 3rd Toe, High, Open Approach 0Y6T0Z2Detachment at Right 3rd Toe, Mid, Open Approach 0Y6T0Z3Detachment at Right 3rd Toe, Low, Open Approach 0Y6U0Z0Detachment at Left 3rd Toe, Complete, Open Approach 0Y6U0Z1Detachment at Left 3rd Toe, High, Open Approach0Y6U0Z2Detachment at Left 3rd Toe, Mid, Open Approach0Y6U0Z3Detachment at Left 3rd Toe, Low, Open Approach0Y6V0Z0Detachment at Right 4th Toe, Complete, Open Approach0Y6V0Z1Detachment at Right 4th Toe, High, Open Approach0Y6V0Z2Detachment at Right 4th Toe, Mid, Open Approach0Y6V0Z3Detachment at Right 4th Toe, Low, Open Approach0Y6W0Z0Detachment at Left 4th Toe, Complete, Open Approach0Y6W0Z1Detachment at Left 4th Toe, High, Open Approach0Y6W0Z2Detachment at Left 4th Toe, Mid, Open Approach0Y6W0Z3Detachment at Left 4th Toe, Low, Open Approach0Y6X0Z0Detachment at Right 5th Toe, Complete, Open Approach0Y6X0Z1Detachment at Right 5th Toe, High, Open Approach0Y6X0Z2Detachment at Right 5th Toe, Mid, Open Approach0Y6X0Z3Detachment at Right 5th Toe, Low, Open Approach0Y6Y0Z0Detachment at Left 5th Toe, Complete, Open Approach0Y6Y0Z1Detachment at Left 5th Toe, High, Open Approach0Y6Y0Z2Detachment at Left 5th Toe, Mid, Open Approach0Y6Y0Z3Detachment at Left 5th Toe, Low, Open ApproachDENOMINATORIndividuals in the Project 2.5 Target Population ages 18 years and older.DENOMINATOR EXCLUSIONSNot applicable2.5.1 - Alcohol and Drug Misuse (SBIRT)IntroductionExecutive SummaryNote: The brief annual screen cannot be billed and is not part of the measure specifications. The full list of AMH-approved evidence based screening tools is included in Appendix A.Numerator: members in the denominator who completed a full, standardized screening tool for alcohol/ substance use, or received screening and a brief intervention, as indicated by one of the following CPT or HCPCS codes (see Appendix B for how G codes are counted) or through data reports from the EHR:99420, with diagnoses code Z13.9 – used for patients who received a full screen based on responses to the annual brief screening. There are no time limitations or requirements for this code. This is also used when a brief intervention lasting less than 15 minutes is performed.99408 – used for patients who were screened and received a brief intervention (15-30 mins).99409 – used for patients who were screened and received a brief intervention (> 30 mins).G0396 – used for patients who received alcohol and/or substance abuse (other than tobacco) structured assessment and brief intervention (15-30 minutes).G0397 – used for patients who received alcohol and/or substance abuse (other than tobacco) structured assessment and brief intervention (>30 minutes). G0442 – Annual alcohol misuse screeningG0443 – Brief face-to-face behavioral counseling for alcohol misuse.Denominator: Unique counts of individuals in the PRIME Eligible Population ages 12 years or older as of the last day of the measurement period measurement period who received a qualifying outpatient service during the measurement period.. Qualifying visits include:Office or other outpatient visits: 99201-99205, 99211-99215, 99241-99245Home visits: 99341-99345, 99347-99350Preventive medicine: 99383-99384, 99385-99387, 99393-99394, 99395-99397, 99401-99404, 99408, 99409, 99411, 99412, 99420, 99429, G0396, G0397, G0402, T1015, and diagnosis code v20.2.SBIRT for AdolescentsThe adolescent well care visit provides a strong vehicle for delivering SBIRT services to adolescents. However, providers often cite a lack of time and expertise in conducting SBIRT, and electronic SBIRT workflows are not widely available. Further, strong systems need to be in place to ensure adequate referral and follow-up for adolescents in need of additional care. Increased training on how to effectively conduct the SBIRT process within a busy family or pediatric practice or school-based health center are necessary.Implementing SBIRT with adolescents requires a unique set of considerations compared to adult populations, namely ensuring confidentiality. Adolescents are less likely to seek services or disclose information on risky behaviors if they do not believe the information will be kept confidential. Strong guidance related to sharing patient information for care coordination while balancing patient privacy is necessary. Providers should be aware of potentially sensitive information that is sent home in billing communications or shared in online patient portals and build a discussion about confidentiality into any adolescent care workflow.Clinical DefinitionsThis section provides an overview of the key clinical definitions integral to the provision of SBIRT services and the related billing definitions of such services.There are several definitions of alcohol and substance abuse and misuse, including: Alcohol Abuse: as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition is drinking that leads an individual to recurrently fail in major home, work, or school responsibilities; use alcohol in physically hazardous situations (such as while operating heavy machinery); or have alcohol-related legal or social problems.9 Alcohol Dependence/Alcoholism: as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition includes physical cravings and withdrawal symptoms, frequent consumption of alcohol in larger amounts than intended over longer periods, and a need for markedly increased amounts of alcohol to achieve intoxication. 10Alcohol Misuse: a spectrum of behaviors, including risky or hazardous alcohol use.11Substance Abuse: as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DMS-IV) is substance use that leads an individual to recurrently fail in major home, work, or school responsibilities; use substances in physical hazardous situations; or have substance-related legal problems. Substance Dependence: as defined by the DSM-IV includes physical cravings and withdrawal symptoms, frequent consumption in larger amounts than intended over longer periods, and a need for increased amounts of the substance. Dependence also includes repeated unsuccessful attempts to quit using the substance, giving up important social, occupational, or recreational activities, and continued use of the substance despite knowledge of adverse consequences.Note: OHA recognizes that DSM-V replaces abuse and dependence diagnoses with a focus on a continuum of problematic use reflected by level of function. The SBIRT measure is currently based on ICD-9 diagnosis codes and CPT/HCPCS codes. Although DSM-V is currently available, OHA has delayed implementation of DSM-V to align with implementation of ICD-10 and will update this guidance document to reflect these changes at a later date.Provider types include: Auxiliary Provider or Personnel: any individual who is acting under the supervision of a physician or licensed professional working within their scope of practice.9 American Psychiatric Association (APA).(2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, TextRevision. Washington, DC: APA, Retrieved July 22, 2013 from ncbi.nlm.books/NBK44358/10 American Psychiatric Association (APA).(2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, TextRevision. Washington, DC: APA, Retrieved July 22, 2013 from ncbi.nlm.books/NBK44358/11 Supervising Licensed Provider: this is the individual supervising the incident to service. This does not need to be the individual who performed the initial assessment and initiated the course of treatment.Brief Annual Screen (Adults)A screen is defined “a rapid, proactive procedure to identify individuals who may have a condition or be at risk for a condition before obvious manifestations occur.”12 Oregon’s approved brief annual screen for adults involves several short questions relating to drinking, drug use, and mood. Note that theadolescent brief screening and full screening have different questions and processes than adults.A brief annual screen is considered an integral part of routine preventive care and is therefore not separately reimbursable by Medicaid. There are no CPT codes for billing the brief annual screen. Brief annual screens may be administrated by providers or any other clinic staff member. They may be administered in writing, orally, or via various technologies (e.g., on the phone prior to an office visit, electronically).Image 1: OHA-recommended brief annual screening form;12 Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL), SBIRT Coding, Billing, and Reimbursement Manual. January 2010.Full Screen (Adults)A full screen more definitively categorizes an adult patient’s substance use. Full screens are indicated for patients with positive brief annual screens, and for patients with signs, symptoms, and medical conditions that suggest risky or problem drinking or drug use. A full screen places the patient on a continuum of substance use and suggests whether no intervention, brief intervention, brief treatment,or referral to treatment is appropriate. The full screen may be administrated and interpreted by avariety of health professionals (see below).The Oregon Legislature directed OHA and four other state agencies to spend increasing shares of public dollars on evidence-based services. Medicaid requires that structured, validated questionnaires be used (e.g., the Alcohol Use Disorders Inventory Test (AUDIT), the Drug Abuse Screening Test (DAST), and the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). See Appendix A for the current list of the Addiction and Mental Health Division’s (AMH) approved evidence-based screening tools. See OAR410-120-0000(75), 410-120-0000(124) and 410-120-1320(3) for additional information on evidence based practice and medical necessity.Screening for AdolescentsScreening processes and tools are unique for adolescents ages 12-17. The central tool for adolescent screening is the CRAFFT (an acronym representing screening questions in the categories Car, Relax, Alone, Forget, Family & Friends, and Trouble).The CRAFFT screening tool consists of two sections, Part A and Part B. The three questions in Part A are used, in addition to the “Car” question, as a brief screen to rule out adolescents who are at low risk for alcohol or drug misuse. The six questions in Part B can be asked as follow up (or full) screening for any at risk adolescents identified through Part A.Although the CRAFFT screening tool is designed as a two-part process, similar to the adult brief and full screenings, often the whole form is given to adolescents to fill out in one step. Additionally, many providers prefer to ask follow-up questions and offer education and brief interventions even for low-risk adolescents due to higher risks in this population, the potential of under-reporting, and developing rapport with the adolescent for future screenings and interventions.Because the CRAFFT is often used as a single-step screening process, it is unclear if it counts as a brief screening or a full screening. If the CRAFFT is completed (either partially or entirely) and: There is no discussion concerning the screening results, nor any education or brief intervention offered to the adolescents, then the tool is being used as a brief annual screen, and should not be billed / encountered. This use of the CRAFFT would not count toward the CCO incentive metric. Based on clinical judgment, the screening results were discussed with the adolescent and education or brief intervention was facilitated, then the tool is being used as a full screen, and should be billed / encountered. This use of the CRAFFT would count toward the CCO incentive metric.Note that the determining factor to differentiate the CRAFFT screening is not based on the score, but on the education or brief intervention offered and facilitated by the provider.Note that providers should also be aware of how sensitive adolescent information may be communicated back to parents / guardians via billing communication or in online patient portals, and discuss these issues with their adolescent clients.Brief InterventionBrief interventions are interactions with patients which are intended to induce a change in a health- related behavior. Brief interventions are typically used as a management strategy for patients with risky or problem drinking or drug use who are not dependent. This may include patients who qualify for a diagnosis of alcohol or drug abuse, and patients who do not quality for substance-related diagnoses. The brief intervention may be conducted by a variety of health professionals (see below).ReferralPatients who are likely alcohol or drug dependent, or would benefit from community-based behavioral health services in collaboration with the medical home, are typically referred to alcohol and drug treatment experts for more definitive, in-depth assessments, and if warranted, treatment. The referral is not an independently reimbursable service, although it is part of the SBIRT process. The referral can be made by the licensed providers, ancillary provider or other clinic staff that have received sufficient training to make an appropriate referral.A Substance Use Disorder treatment provider directory is available at; individuals enrolled in a CCO, care should be coordinated with a network provider or services.Follow-Up ServicesFollow-up services include interactions which occur after the initial intervention, treatment, or referral services, and are intended to re-assess a patient’s status, progress, promote or sustain a reduction in alcohol or drug use, and/or assess a patient’s need for additional services.13Clinical Service Definitions for BillingIn general, billable services are referred to as either administration of a full screen, or full screen andintervention services. Administering a brief annual screen is not a billable service.13 Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL), SBIRT Coding, Billing, and Reimbursement Manual. January 2010.SBIRT ServicesSBIRT services apply to all age-groups. This section provides guidance on who can conduct and bill forSBIRT services as well as suggested coding for reporting and claim submission.Who can administer and interpret the brief annual screen?A brief annual screen is not a reimbursable service. This part of the process can be done by the front desk staff or any other appropriate professional. The brief annual screen may be administered in writing, orally, or via various technologies. The non-billable, brief annual screen may be mailed to the individual to complete prior to the visit, given over the phone, online or in person.Who can administer and interpret the full screen?A full screen is a reimbursable service. It must be administered and interpreted by a licensed provider or an ancillary provider working under the general supervision of the licensed provider (see list of provider types below). The full billable SBIRT services must be provided face-to-face (in-person or via simultaneous audio and video transmission) with the patient. A physician prescription is not required for screening or intervention.Who can conduct a brief intervention?A brief intervention is a reimbursable service. It must be provided by a licensed provider or an ancillary provider working under the general supervision of the licensed provider (see list of provider types below).Licensed providers who can independently conduct and bill for SBIRT using their provider number:Physicians Physician’s Assistant Nurse Practitioners Licensed PsychologistLicensed Clinical Social WorkerNote: Licensed Professional Counselors (LPC) and Licensed Marriage and Family Therapists (LMFT) are being incorporated into the list of approved independently licensed providers, which is likely to be completed by mid-2015.Auxiliary providers or personnel who can conduct SBIRT under the general supervision of a licensed provider or Entity listed above:These provider types would bill “incident to” a licensed professional. This is not an exhaustive list.Medical Assistants and Physician AssistantsNurses, Clinical Nurse Specialists, and Registered NursesHealth Educators, Community Health Workers, and Wellness CoachesCertified Alcohol and Drug Counselors (CADC) Qualified Mental Health Professional Students or graduates entering medical profession in areas such as medical, physician assistant, nursing, addictions, counseling, social work, and psychology.SpecificationsOHA developed the specifications based on coding recommendations developed by CMS and SAMHSA, while using HEDIS specifications for identifying ambulatory outpatient care services to identify unique outpatient recipients by plan. Measure specifications are posted online at: specifications for 2015 remain based in administrative (claims) data. OHA and the SBIRT workgroup are continuing to explore options for adopting an electronic Clinical Quality Measure (eCQM) for SBIRT in 2017, pending further development from SAMHSA and the Office of the National Coordinator for Health Information Technology (ONC).Numerator: Unique counts of members age 12 years as of the last day of the measurement period who completed a full, standardized screening tool for alcohol/ substance use, or received screening and a brief intervention, as indicated by one of the following CPT or HCPCS codes codes or through data reports from the EHR:99420, with diagnosis code Z13.89 –used for patients who received a full screen based on responses to the annual brief screening. There are no time limitations or requirements for this code. This coding combination is also used when a brief intervention lasting less than 15 minutes is performed.99409 – used for patients who were screened and received a brief intervention (> 30 mins). G0396 – used for patients who received alcohol and/or substance abuse (other than tobacco) structured assessment and brief intervention (15-30 minutes).G0397 – used for patients who received alcohol and/or substance abuse (other than tobacco)structured assessment and brief intervention (>30 minutes). G0442 – Annual alcohol misuse screeningG0443 – Brief face-to-face behavioral counseling for alcohol misuse.Required exclusions for numerator: None.Deviations from cited specifications for numerator:None.Denominator: Unique count of members age 12 years as of the last day of the measurement period, and having received an outpatient service as identified by the following CPT codes:Office or other outpatient visits: 99201-99205, 99211-99215, 99241-99245Home visits: 99341-99345, 99347-99350Preventive medicine: 99383-99384, 99385-99387,99393-99394, 99395-99397, 99401-99404, 99408, 99409, 99411, 99412, 99420, 99429, G0396, G0397, G0402, T1015, and diagnosis code Z00.129.Note: the member only needs to be 12 years of age by the last day of the measurement period; some qualifying members could be 11 on the date of their outpatient service.Required exclusions for denominator: NoneDeviations from cited specifications for denominator:None. LimitationsProvision of the initial “brief” screen is not reimbursable and therefore cannot be included in claims data for measurement. Only those patients that necessitated the “full” screen or a screening and brief intervention based on responses to the brief screen can be identified in claims data with the use of the codes included in the numerator and denominator of the incentive measure.The services of “screening”, “brief intervention”, and “referral to treatment” cannot be separately identified in claims data. The “full” screening is the only portion of SBIRT that can be captured in claims data using the CPT code 99420 (Health Risk Assessment & Interpretation) for SBIRT services that do not meet the 15 minute threshold requirement of CPT codes 99408/99409 or HCPCS codes G3096/G3097 (Screening, Brief Intervention, and Referral to Treatment; 15 minutes or more). See Billing & Reimbursement.The SBIRT benefit will correspond with three CPT procedure codes. Both full screening and brief intervention will require specific diagnosis codes on the claim. See above for diagnosis, CPT, and HCPCScodes that will be identified through claims data. As this measure is under development, data collection and/or reporting may change for subsequent measurement periods.Screening FrequencyThe screening benefit is limited to medical appropriateness. Usually one screen per rolling twelve months is sufficient; however, there may be clinical indication that an additional screen is needed. Brief Intervention RequirementsIt is important to note that these are time-based codes; therefore, documentation must denote start/stop time or total face-to-face time with the patient. The total time would include the administration of the screening tool, interpretation of the tool, the intervention and time spent on a referral if applicable. Note the screening code 99420 and standalone Z13.89 diagnosis code are not time based.SBIRT services (including screening and brief intervention) that do not meet the minimum fifteen minute threshold identified by the CPT/HCPCS codes are not separately reimbursable; however, the administration and interpretation of the screening tool (99420) is reimbursable and will meet the CCO Incentive measure when submitted with the diagnosis Z13.89 (Encounter for Screening for Other Disorder, including for Alcoholism).Documentation RequirementsTo support coding and claim submission, the Medical Record must:Be complete and legible;Denote start/stop time or total face-to-face time with the patient (because some SBIRT codes are time-based codes);Document the patient’s progress, response to changes in treatment, and revisions of diagnosis; Document the rationale for ordering diagnostic and other ancillary services, or ensure that it can be easily inferred; For each patient encounter, document:Assessment, clinical impression, and diagnosis;Date and legible identity of observer/providerPhysical examination findings and prior diagnostic test results;Plan of care; andReason for encounter and relevant historyIdentify appropriate health risk factors;Include documentation to support all CPT and ICD Diagnosis codes reported on the health insurance claim;Make past and present diagnoses accessible for the treating and/or consulting physician; andSign all services provided/ orderedIn addition, providers should document what screening tool was used and the member’s responses to the screening questions. The completed screening tool should be available for review in the case of an audit. To report the full screening only under the SBIRT benefit, use CPT code 99420 with the appropriate diagnosis code that identifies the encounter for SBIRT services.The medical record must support that the coding for the services reported on the health insurance claim are correct and accurate.ExclusionsSBIRT services are not designed to address smoking and tobacco cessation services; the CPT codes specifically exclude tobacco as a substance within SBIRT. Diagnosis CodesZ13.89 Encounter for Screening for Other Disorder (in combination with CPT 99420 only)HCPCS CodesBeginning January 1, 2008, Medicare recognized two G-codes to allow for appropriate reporting and payment of alcohol and substance abuse structured assessment and interventions services that are not provided as screening services, but that are performed in the context of the diagnosis or treatment of illness or injury.Structured Assessment and Intervention Services G0396 - Alcohol and/or substance use structured screening (e.g., AUDIT, DAST), and brief intervention services; 15-30 minutes. G0397 – Alcohol and/or substance use structured screening (e.g,. AUDIT, DAST), and brief intervention services; Greater than 30 minutes.These codes should not be reported separately with an evaluation and management (E&M) for the same work/ time. If the E&M would normally include assessment and/or intervention of alcohol or substance abuse based on the patient’s clinical presentation, G0396 or G0397 should not be additionally reported.If a physician reports either of these G-codes with an E&M, utilizing an NCCI-associated modifier, the physician is certifying that the G-code service is a distinct and separate service performed during a separate time period (not necessarily a separate patient encounter) than the E&M and is a service that is not included in the E&M level of service based on the clinical reason for the E&M visit.G0396/G0397 are to be used for structured alcohol and/or substance (other than tobacco) abuse assessment and intervention services that are distinct from other clinic and emergency department visit services performed during the same encounter. However, alcohol and/or substance structured assessment or intervention services lasting less than 15 minutes should not be reported using these HCPC codes and the clinical resources expended should be included in determining the level of the visit service reported.Beginning October 14, 2011, Medicare also recognized two G codes to address screening and brief counseling for alcohol misuse.G0442 – Annual alcohol misuse screening, 15 minutes.G0443 – Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes.Medicare will cover up to four brief, face-to-face behavioral counseling interventions annually for Medicare beneficiaries for those beneficiaries who screen positive. Medicare allows payment for both G0442 and G0443 on the same date (except in rural health clinics and federal qualified health clinics), but will not pay for more than one G0443 service on the same date.Counseling provided under G0443 must be based on the Five As (Assess, Advise, Agree, Assist andArrange). Documentation in the medical record must reflect this.CPT CodesFull Screening99420 - Administration and interpretation of a health risk assessment instrument (not time based); billed as one unit regardless of time spent on screening. 99420 is separately reimbursable when performed by the same provider for the same patient on the same date of service as an E&M visit.Screening and Brief Intervention99408 - Alcohol and/or substance use structured screening (e.g., AUDIT, DAST, CRAFFT), and brief intervention services; 15-30 minutes. NOTE: 99420 (Administration and interpretation of a health risk assessment instrument) is included in the CPT code 99408 and cannot be billed together.99409 – Alcohol and/or substance use structured screening (e.g., AUDIT, DAST, CRAFFT), and brief intervention services; Greater than 30 minutes. NOTE: 99420 (Administration and interpretation of a health risk assessment instrument) is included in the CPT code 99409 and cannot be billed together.Special Note: CPT codes 99408/99409 describe services which are similar to those described by HCPCS codes G0396/G0397, but are “screening” services which are not covered under the Medicare program. Based on NCCI edits, these are not separately reimbursable when services are completed by the same provider on the same date as an E&M visit.CPT codes 99408/99409 and an Office/Home visit can be billed together only when the screening and brief intervention is handed off to a separate licensed professional or to an individual being supervised by a licensed professional separate from the provider of the office/ home visit.Preventative Visit/Preventative Counseling CPT Coding Associated with SBIRT Incentive Measure 99383-99384, 99385-99387, 99393-99394, 99395-99397 and 99401-99404Preventative visit CPT codes do not have NCCI edits associated with them and may be reimbursable on the same date of service as 99420, 99408/99409 when performed by a single licensed provider.Office or Home Visit CPT Coding Associated with SBIRT Incentive Measure 99201-99205, 99211-99215, 99241-99245, 99341-99345 and 99347-99350Office and Home visit CPT codes are associated with NCCI edits and may not be reimbursable on the same date of services as 99408/99409 when performed by a single licensed provider.ModifiersWhen billing CPT codes 99201-99215 and 99341-99350 with G0396 or G0397, the E&M service must have the accompanying modifier 25, indicating separately identifiable service. ResourcesAMH approved screening tools are available at the Addictions and Mental Health Services Home page, click on the SBIRT link resources are available through the Patient Centered Primary Care Home Institute (PCPCI),, and through the CCO Learning Collaborative, recommended resources include: The SAMHSA SBIRT protocols and Technical Assistance Publication (TAP 33) The SBIRT primary Care residency initiative The Institute for Research, Education & Training in Addictions The Center for Applied Behavioral Health Policy Brief Intervention Group B.I.G Motivational Interviewing, resources and information SBIRT – Centers for Medicare & Medicaid Services; fact sheet – MLN/MLNProducts/downloads/sbirt_factsheet_icn904084.pdf The American Academy of Pediatrics; Bright Futures Screening Handbook A: AMH Approved Evidence-Based Screening ToolsThis list of AMH approved evidence-based screening tools is current as of December 2014. To submit a new tool for AMH review, please contact SBIRT Specialist Michael Oyster atmichael.w.oyster@state.or.us or (503) 945-9813.AMH approved screening tools are available online at: does not require use of a specific screening tool or tools to qualify for the CCO incentive metric. Implementation of one or multiple screening tools is at the provider or clinic’s discretion, although health plans may have their own requirements related to which screening tools will be utilized. However, the tool(s) used must be an AMH-approved screening tool or a compilation of screening tools.Brief Annual Screen, All PatientsThis is not a Medicaid reimbursable service. Annual Questionnaire3 questions. Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) –Part A. See Screening for Adolescents on page 12 aboveFull Health Risk Assessment Screen, AdultsThis is a Medicaid reimbursable service. The Alcohol Use Disorders Identification Test (AUDIT)10 questions. The Drug Abuse Screening Test (DAST)Versions include the DAST 10 and the DAST 20. Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)8 questions. Parents, Peers, Partner, Past, Pregnancy (5Ps)8 question version that including screening for depression and domestic violence. Note a modified version of the 5Ps is being pilot tested in several local clinics. Global Appraisal of Individual Needs – Short Screener (GAIN-SS)20 questions, this is the only full screening tool for alcohol and substance use and depression.Tolerance, Worried, Eye-opener, Amnesia, K/Cut down (TWEAK)5 questions. Tolerance, Annoyed, Cut-down, Eye-opener (T-ACE)4 questions. Cut down, Annoyed, Guilty, Eye-opener (CAGE or CAGE-AID)4 questions.Full Health Risk Assessment Screen, Adolescents (age 10-17)This is a Medicaid reimbursable service. Michigan Alcohol Screening Test (MAST)22 questions. Global Appraisal of Individual Needs – Short Screener (GAIN-SS)20 questions. Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) – Part B – See Screening for Adolescents on page 12 above. 6 questions.Appendix B: Frequently Asked QuestionsWho is supposed to complete (“fill out”) the SBIRT screening tools?The brief annual screen may be conducted by a variety of health professionals or any other clinic staff member (e.g., front desk staff). The full screen may be conducted and interpreted by a variety of health professionals. Are dental providers included?No, dental providers are not included in the CCO incentive metric and dental visits are not included in the denominator. They do not use the CPT or HCPCS codes described above for billing.Does the brief annual screen count?No. Only the full screen or full screen with brief intervention services are includedCan the brief annual screen be conducted over the phone (i.e., prior to a clinic visit)?Yes. We know that some clinics are conducting the brief annual screen over the phone. Depending on the results, with the client comes in for their appointment, they are asked to fill out the appropriate full screen and the results are then reviewed with the client.Can the full screen be completed through a patient portal or through the mail, prior to a medical appointment?Yes, a patient may complete a full screen prior to a medical appointment; however, it should not be billed / encountered until the medical appointment itself, when the full screen can be scored and discussed with the patient face-to-face. The timeframe between when the patient answers the questions and the medical appointment should be relatively short (such as two weeks) so that the patient still remembers their responses and why. Otherwise, the screen may not be relevant.Can brief interventions and referral to treatment be facilitated through telehealth?YesHow should the brief annual screen be coded?The brief annual screen is not reimbursable and there are no associated billing codes. The codes listed in the document and the incentive measure specifications are not for the brief annual screen.Can CPT code 99420 be used for a brief annual screen?No. CPT code 99420 should be used for the full screen only.Are H0049 and H0050 the appropriate screening codes to report for SBIRT?The HCPCS codes H0049 and H0050 are used by Oregon Medicaid for licensed alcohol and drug treatment programs. These codes are not included in the specifications and will not count towards a SBIRT rate.Are G0396, G0397, G0442, and G0443 included?YesIs H0002 an appropriate screening code to report for SBIRT?No. H0002 is used when an AMH-approved provider such as a behaviorist, certified alcohol or drug counselor (CADC), or qualified mental health professional (QMHP) conducts a more comprehensivescreening soon after an individual seeks treatment/services. This is not an SBIRT screening.This screening indicates whether the individual is likely to have a substance use disorder and/or mental health disorder. Individuals who screen positive for substance use disorders are given a full, in-depth assessment. Individuals who screen positive for mental health disorders receive care, or are referred on to receive a full, in-depth assessment.Can combined screening tools be used (e.g., SBIRT and depression)?Yes. The recommended brief annual screening tool addresses alcohol and drug use, along with mood. A long as the brief annual screening for SBIRT asks about alcohol and drug use, other questions can be added, such as tobacco use, or domestic violence.Do combined screening tools still qualify?A brief screening tool such as the Patient Health Questionnaire (PHQ) -2 for depression that does not also include alcohol and drug use is not appropriate for use as a brief annual screening tool for SBIRT.Likewise, a brief screening tool that only asks about alcohol and drug use is not appropriate as a brief screening tool for depression.If a practice uses a combined screening tool, note that only full screenings for alcohol and drug use (such as the evidence-based tools listed in Appendix A) count towards SBIRT. A brief annual screen may warrant multiple full screens for an individual (e.g., AUDIT for alcohol use and PHQ-9 for depression). Note that the GAIN-SS tool is an evidence-based, AMH-approved screening tool that addresses both depression and substance use. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download