[Table, Appendix 6 Indicator Definitions - Potential HCUP Indicators]. - Refinement of the HCUP Quality Indicators

Indicator	Numerator	Denominator	#
Volume Outcome
AAA repair volume	Discharges with ICD-9 codes 38.34, 38.44, or 38.64 in any procedure field and diagnosis of AAA (see below) in any field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable.	1
Carotid Endarterectomy volume	Discharges with ICD-9 code 38.12 in any procedure field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable	2
CABG volume	Discharges with ICD-9 codes 36.10 - 36.19 in any procedure field. Age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable	3
Esophageal resection volume	Discharges with ICD-9 codes 42.40 - 42.42 in any procedure field and diagnosis code of esophageal cancer in any field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable	4
Pancreatic resection volume	Discharges with ICD-9 codes 52.6 or 52.7 in any procedure field and diagnosis code of pancreatic cancer in any field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable	5
Pediatric heart surgery volume	Discharges with ICD-9 codes for specified heart surgery (see below) in any field, or for any heart surgery and a diagnosis of hypoplastic left heart syndrome (see below) in any field Age less than 18. See NOTE for additional exclusions Exclude MDC 14 (pregnancy, childbirth, and puerperium).	Not applicable	6
PTCA volume	Discharges with ICD-9 codes 36.01, 36.02, 36.05, or 36.06 in any procedure field. Age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Not applicable	7
Utilization - provider level
Cesarean section delivery rate	Number of C-sections per 100 deliveries (see below).	All deliveries (see below)	8
Incidental appendectomy among elderly rate	Number of incidental appendectomies per 100 elderly discharges with intra-abdominal procedure (see below).	All non-maternal/non-neonatal discharges age 65 years and older with intra-abdominal procedure in any procedure field (see below). Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	9
Bi-lateral catheterization rate	Number of simultaneous right and left heart catheterizations per 100 discharges with procedure code of heart catheterization (see below). Exclude valid indications for right sided catheterization (see below) in any diagnosis field.	All non-maternal/non-neonatal discharges with heart catheterization (see below) in any procedure field. Include only coronary artery disease (see below) Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	10
Successful vaginal birth after cesarean section (VBAC) rate	Number of vaginal births per 100 deliveries with diagnosis of previous C-section (see below).	All deliveries with previous C-section diagnosis in any diagnosis field (see below).	11
Laparoscopic cholecystectomy rate	Number of laparoscopic cholecystectomies per 100 discharges with procedure code of cholecystectomy (see below).	All non-maternal/non-neonatal discharges with cholecystectomy (see below) in any procedure field. Include only discharges with uncomplicated cases: cholecystitis and/or cholelithiasis (see below) in any diagnosis field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	12
Utilization - area level
Coronary artery bypass graft (CABG) rate	Number of CABGs (any procedure field) per 100,000 population (see below). All non-maternal/non-neonatal discharges age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 40 years and older.	13
Hysterectomy rate	Number of hysterectomies (any procedure field) per 100,000 population (see below). All non-maternal/non-neonatal discharges of females age 18 years and older. Exclude discharges with genital cancer or pelvic or lower abdominal trauma (see below) in any diagnosis field. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Female population in MSA or county, age 18 years and older.	14
Laminectomy and/or spinal fusion rate	Number of laminectomies and/or spinal fusions (any procedure field) per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 years and older.	15
PTCA rate	Number of PTCAs (any procedure field) per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 40 years and older. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 40 years and older.	16
Ambulatory Care Sensitive Conditions
Dehydration admission rate	Discharges with ICD-9 principal diagnosis code for hypovolemia per 100,000 population (see below). All non-maternal/non-neonatal discharges of age less than 65*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age less than 65. Rate can also be calculated for age 65 and older	17
Bacterial pneumonia admission rate	Discharges with ICD-9 principal diagnosis code for bacterial pneumonia per 100,000 population. All non-maternal/non-neonatal discharges of age less than 65*. Exclude discharges with diagnosis code for sickle cell anemia or HB-S disease (see below) in any field. Exclude patients <2 months (8 weeks) of age Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age less than 65. Rate can also be calculated for age 65 and older.	18
Urinary infection admission rate	Discharges with ICD-9 principal diagnosis code of urinary tract infection per 100,000 population (see below). All non-maternal/non-neonatal discharges of age less than 65*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age less than 65. Rate can also be calculated for age 65 and older.	19
Perforated appendix admission rate	Discharges with ICD-9 diagnosis code for perforations or abscesses of appendix (see below) in any field per 100 discharges with diagnosis code for appendicitis (see below). Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Number of discharges with diagnosis code for appendicitis in any field in MSA or county.	20
Angina admission rate	Discharges with ICD-9 principal diagnosis code for angina (see below) per 100,000 population. All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude discharges with a surgical procedure in any field (01.0-86.99). Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	21
Adult asthma admission rate	Discharges with ICD-9 principal diagnosis code of asthma per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	22
Chronic Obstructive Pulmonary Disease admission rate	Discharges with ICD-9 principal diagnosis code for COPD (see below) per 100,000 population. All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	23
Congestive Heart Failure admission rate	Discharges with ICD-9 principal diagnosis code for CHF (see below) per 100,000 population. All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude discharges with cardiac procedure codes (see below) in any field. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	24
Diabetes - short-term complications admission rate	Discharges with ICD-9 principal diagnosis code for short-term complications (ketoacidosis, hyperosmolarity, coma) per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	25
Diabetes - uncontrolled without complications admission rate MAY BE COMBINED WITH DIABETES SHORT-TERM COMPLICATIONS AS A SINGLE INDICATOR.	Discharges with ICD-9 principal diagnosis code for uncontrolled diabetes, without mention of a short-term or long-term complication, per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	26
Diabetes - long-term complications admission rate	Discharges with ICD-9 principal diagnosis code for long-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified) per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	27
Hypertension admission rate	Discharges with ICD-9 principal diagnosis code for hypertension per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude discharges with cardiac procedure codes (see below) in any field. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	28
Lower extremity amputation in diabetics admission rate	Discharges with ICD-9 procedure code for lower extremity amputation (see below) in any field and diagnosis code of diabetes in any field per 100,000 population (see below). All non-maternal/non-neonatal discharges of age 18 to 64 years old*. Exclude trauma (see below). Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, age 18 to 64 years old. Rate can also be calculated for age 65 and older.	29
Low birthweight rate	Number of births with ICD-9 diagnosis code for less than 2500 grams per 100 births (see below) in any field. Exclude transfer from other institution.	All births (discharges in MDC 15 - newborns and other neonates) in MSA or county.	30
Pediatric asthma admission rate	Discharges with ICD-9 principal diagnosis code of asthma per 100,000 population (see below). All non-maternal/non-neonatal discharges of under age 18. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, under age 18.	31
Pediatric gastroenteritis admission rate	Discharges with ICD-9 principal diagnosis code for gastroenteritis per 100,000 population (see below). All non-maternal/non-neonatal discharges of under age 18. Exclude transfer from other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	Population in MSA or county, under age 18.	32
In-hospital Mortality
Acute myocardial infarction mortality rate	Number of deaths per 100 discharges with diagnosis code for AMI in any field.	All non-maternal/non-neonatal discharges with diagnosis codes for AMI (see below) in any field, age 18 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	33
Congestive Heart Failure mortality rate	Number of deaths per 100 discharges with principal diagnosis code for CHF.	All non-maternal/non-neonatal discharges with principal diagnostic code for CHF (see below), age 18 years and older. Exclude discharges with cardiac procedure codes (see below) in any field Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	34
GI Hemorrhage mortality rate	Number of deaths per 100 discharges with principal diagnosis code for GI hemorrhage.	All non-maternal/non-neonatal discharges with principal diagnostic code for gastrointestinal hemorrhage (see below), age 18 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates	35
Hip fracture mortality rate	Number of deaths per 100 discharges with principal diagnosis code for hip fracture.	All non-maternal/non-neonatal discharges with principal diagnostic code for hip fracture (see below), age 18 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	36
Pneumonia mortality rate	Number of deaths per 100 discharges with principal diagnosis code for pneumonia.	All non-maternal/non-neonatal discharges with principal diagnostic code for pneumonia (see below), age 18 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates	37
Stroke mortality rate	Number of deaths per 100 discharges with principal diagnosis code for stroke.	All non-maternal/non-neonatal discharges with principal diagnostic code for stroke (see below), age 18 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates	38
Post-procedural Mortality
Abdominal aortic artery repair mortality rate	Number of deaths per 100 discharges with procedure code for AAA repair and diagnosis of AAA in any field.	All non-maternal/non-neonatal discharges with procedure code for AAA repair and diagnosis of AAA (see below) in any field. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	39
Coronary Artery Bypass Graft mortality rate	Number of deaths per 100 discharges with procedure code for CABG in any field. Age 40 years and older.	All non-maternal/non-neonatal discharges with procedure code for CABG (see below) in any field. Age 40 years and older. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates)	40
Craniotomy mortality rate	Number of deaths per 100 discharges with DRG code for craniotomy (DRG 001, Craniotomy Age > 17, Except for Trauma).	All non-maternal/non-neonatal discharges with DRG code for craniotomy (DRG 001 Craniotomy Age > 17, Except for Trauma). Exclude transfers to other institution.	41
Esophageal resection mortality rate	Number of deaths per 100 esophageal cancer discharges with procedure code for esophageal resection for in any field.	All non-maternal/non-neonatal esophageal cancer discharges with procedure code for esophageal resection (see below) in any field. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	42
Hip replacement mortality rate	Number of deaths per 100 discharges with procedure code for partial or full hip replacement in any field.	All non-maternal/non-neonatal discharges with procedure code for partial or full hip replacement. (see below) in any field. Include only discharges with uncomplicated cases: diagnosis or procedure codes for osteoarthrosis of hip. (see below) in any field. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	43
Pancreatic resection mortality rate	Number of deaths per 100 pancreatic cancer discharges with procedure code for pancreatic resection in any field.	All non-maternal/non-neonatal pancreatic cancer discharges with procedure code for pancreatic resection (see below) in any field. Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium) and MDC 15 (newborns and other neonates).	44
Pediatric heart surgery mortality rate	Number of deaths per 100 discharges with procedure code for pediatric heart surgery in any field.	All non-maternal/non-neonatal discharges less than 18 with procedure code for specified heart surgery (see below) in any field, or for any heart surgery and a diagnosis code for hypoplastic left heart syndrome (see below) in any field. See NOTE for additional exclusions Exclude transfers to other institution. Exclude MDC 14 (pregnancy, childbirth, and puerperium).	45

: NOTE (Exclusions for Pediatric Heart Surgery): 1) patients who underwent PDA ligation as a single cardiac procedure (diagnosis code 747.0 and procedure code 38.85); 2) patients with prosthetic closures of atrial septal defects (procedure codes 35.51-52, 35.71) or ventricular septal defects (codes 35.53, 35.72) or atrial septal enlargement (35.41) without concomitant use of cardiopulmonary bypass (code 39.61); 3) patients with PDA closure as single cardiac procedure (procedure code 38.85) with concomitant cardiac catheterization (codes 37.21, 37.22, 37.23, 88.42, 88.43); 4) patients with occlusion of thoracic vessel (procedure code 38.85) without congenital heart defect (diagnosis codes 745.0-747.9).

From: APPENDIX 6, Indicator Definitions

Refinement of the HCUP Quality Indicators.

Technical Reviews, No. 4.

Davies SM, Geppert J, McClellan M, et al.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 May.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.