Hospital Readmission and ADE Measures Report for Medicare FFS Beneficiaries: Measurement Specifications

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1 Hospital Readmission and ADE Measures Report for Medicare FFS Beneficiaries: Measurement Specifications 1 2b 2c 2d HOSPITAL ALL-CAUSE READMISSION RATES BY QUARTER Principal Diagnosis: AMI 2a Principal Diagnosis: CHF Principal Diagnosis: PNE RATES BY QUARTER, Principal diagnosis: COPD All live discharges from acute care/critical access hospitals. Exclude death and transfer. from acute care/critical access hospitals with principal Dx: ICD9- '41001','41011','41021','41031','41041','41051', '41061','41071','41081','41091' ICD10- 'I2101','I2102','I2109','I2111','I2119','I2121','I2129', 'I213','I214', 'I220', 'I221','I222','I228','I229' from acute care/critical access hospitals with principal Dx: ICD9- '39891','40201','40211','40291','40401','40403','4041 1','40413','40491','40493','4280','4281','42820','4282 1','42822','42823','42830','42831','42832','42833, '42840','42841','42842','42843','4289' ICD10- 'I0981','I110','I130','I132','I501','I5020','I5021','I5022', 'I5023','I5030',I5031','I5032','I5033','I5040','I5041', 'I5042','I5043','I509' 'Exclude death and transfer. Include all live with principal Dx: ICD9- '4800','4801','4802','4803','4808','4809','481','4820', '4821','4822','48230','48231','48232','48239','48240', '48241','48242','48249','48281','48282','48283', '48284','48289','4829','4830','4831','4838','485','486', '4870','48811', '5070' ICD10- 'J120','J121','J122','J1281','J1289','J129','J13','J181', 'J150','J151',1J14','J154','J154','J153','J154','J1520', 'J15211','J15212','J1529','J158','J155','J156','A481', 'J158','J159','J157','J160','J168','J180','J189',J1100', 'J129','J1008','J690' from acute care/critical access hospitals with principal Dx: ICD9- '490', '4910', '4911', '4918', '4919', '4920', '4928', '49120', '49121', '49122', '4940', '4941', '496' ICD10- 'J40', 'J410', 'J411', 'J418', 'J42', 'J430', 'J431', 'J432', 'J438','J439', 'J440', 'J441', 'J449', 'J470', 'J471', 'J479'

2 2e Principal Diagnosis: Stroke/Transient Ischemic Attack from acute care/critical access hospitals with principal Dx: ICD9- '430', '431', '43301', '43311', '43321', '43331', '43381', '43391', '43400', '43401','43410', '43411', '43490', '43491', '4350', '4351', '4353', '4358', '4359', '436', '99702' (EXCLUSION: If any of the qualifying claims have: 800 <= DX Code <= 8049, 850 <= DX Code <= 8541 in any DX position then EXCLUDE) ICD10- 'G450', 'G451', 'G452', 'G458', 'G459', 'G460', 'G461', 'G462', 'G9731', 'G9732', 'I6000', 'I6001', 'I6002', 'I6010', 'I6011', 'I6012', 'I6020', 'I6021', 'I6022', 'I6030', 'I6031', 'I6032', 'I604', 'I6050', 'I6051', 'I6052', 'I606', 'I607', 'I608', 'I609', 'I610', 'I611', 'I612', 'I613', 'I614', 'I615', 'I616', 'I618', 'I619', 'I6300', 'I6302', 'I63011', 'I63012', 'I63019', 'I63031', 'I63032', 'I63039', 'I6309', 'I6310', 'I63111','I63112', 'I63119', 'I6312', 'I63131', 'I63132', 'I63139', 'I6319', 'I6320', 'I63211', 'I63212', 'I63219', 'I6322', 'I63231', 'I63232', 'I63239', 'I6329', 'I6330', 'I63311', 'I63312', 'I63319', 'I63321', 'I63322', 'I63329', 'I63331', 'I63332', 'I63339', 'I63341', 'I63342', 'I63349', 'I6339', 'I6340', 'I63411', 'I63412', 'I63419', 'I63421', 'I63422', 'I63429', 'I63431', 'I63432', 'I63439', 'I63441','I63442', 'I63449', 'I6349', 'I6350', 'I63511', 'I63512', 'I63519', 'I63521', 'I63522','I63529', 'I63531', 'I63532', 'I63539', 'I63541', 'I63542', 'I63549', 'I6359', 'I636', 'I638', 'I639', 'I6601', 'I6602', 'I6603', 'I6609', 'I6611', 'I6612', 'I6613', 'I6619', 'I6621', 'I6622', 'I6623', 'I6629', 'I663', 'I668', 'I669', 'I67841', 'I67848', 'I6789', 'I97810', 'I97811', 'I97820', 'I97821' (EXCLUSION: If any of the qualifying claims have any of the following codes in any DX position than EXCLUDE: S0190XA, S020XXA, S020XXB, S0210XA, S0210XB, S02110A- S0113A, S02110B- S02113B, S02118B - S02118B, S02119A - S02119B, S0219XA, S0219XB, S022XXA, S022XXB, S023XXA, S023XXB, S02400A - S02402A, S02400B, S02402B, S02411A - S02413A, S02411B - S02413B, S0242XA, S0242XB, S02600A, S02600B, S02609A, S02609B, S0261XA - S0267XA, S0269XA, S0261XB - S0267XB, S0269XB, S028XXA, S028XXB, S0291XA, S0291XB, S0292XA, S0292XB, S060X0A- S060X9A, S061X0A - S061X9A, S062X0A- S062X9A, S06300A - S06389A, S064XOA - S064X9A, S065X0A - S065X9A, S066X0A - S066X9A, S06810A - S06829A, S06890A - S06899A, S069X0A - S069X9A then EXCLUDE)

3 2f 2g Principal Diagnosis: Septicemia Principal Diagnosis: Diabetes from acute care/critical access hospitals with principal Dx: ICD9- '0380', '0381', '03810', '03811', '03812', '03819', '03842', '03840', '03841', '03843', '03844', '03849', '0031', '0202', '0223', '0362', '0382', '0383', '0545', '0388', '0389','449', '77181', '7907', '99591', '99592' ICD10- 'A021','A207','A227','A394','A409','A412','A4101', 'A4102','A411','A403','A414','A4150','A413','A4151', 'A4152','A4153','A4159','A4189','A419','B007','I76', 'P369','R7881','A419','R6520','A267','A327','A392', 'A393','A400','A401','A408','A4181','A427','A5486', 'B377','P360','P3610','P3619','P362','P3630','P3639', 'P364','P365','P368' from acute care/critical access hospitals with principal Dx: ICD9- '24900', '24901', '24910', '24911', '24920', '24921', '24930', '24931', '24940', '24941','24950', '24951', '24960', '24961', '24970', '24971', '24980', '24981', '24990', '24991','25000', '25001', '25002', '25003', '25010', '25011', '25012', '25013', '25020', 25021','25022', '25023', '25030', '25031', '25032', '25033', '25040', '25041', '25042', '25043', '25050', '25051', '25052', '25053', '25060', '25061', '25062', '25063', '25070', '25071', '25072', '25073', '25080', '25081', '25082', '25083', '25090', '25091', '25092', '25093','3572', '36201', '36202', '36203', '36204', '36205', '36206', '36641' ICD10- 'E0800', 'E0801', 'E0810', 'E0811', 'E0821', 'E0822', 'E0829', 'E08311', 'E08319', 'E08321','E08329', 'E08331', 'E08339', 'E08341', 'E08349', 'E08351', 'E08359', 'E0836', 'E0839', 'E0840', 'E0841', 'E0842', 'E0843', 'E0844', 'E0849', 'E0851', 'E0852', 'E0859', 'E08610', 'E08618', 'E08620', 'E08621', 'E08622', 'E08628', 'E08630', 'E08638', 'E08641', 'E08649', 'E0865', 'E0869', 'E088', 'E089', 'E0900', 'E0901', 'E0910', 'E0911', 'E0921', 'E0922', 'E0929', 'E09311', 'E09319','E09321', 'E09329', 'E09331', 'E09339', 'E09341', 'E09349', 'E09351', 'E09359', 'E0936', 'E0939', 'E0940', 'E0941', 'E0942', 'E0943', 'E0944', 'E0949', 'E0951', 'E0952', 'E0959', 'E09610', 'E09618', 'E09620', 'E09621', 'E09622', 'E09628', 'E09630', 'E09638', 'E09641', 'E09649', 'E0965', 'E0969', 'E098', 'E099', 'E1010', 'E1011', 'E1021', 'E1022', 'E1029', 'E10311', 'E10319', 'E10321', 'E10329', 'E10331', 'E10339', 'E10341', 'E10349', 'E10351', 'E10359', 'E1036', 'E1039', 'E1040', 'E1041', 'E1042', 'E1043', 'E1044', 'E1049', 'E1051', 'E1052', 'E1059', 'E10610', 'E10618', 'E10620', 'E10621', 'E10622', 'E10628', 'E10630', 'E10638', 'E10641', 'E10649', 'E1065', 'E1069', 'E108', 'E109', 'E1100', 'E1101', 'E1121',

4 2h Principal Procedure: THA/TKA 'E1122', 'E1129', 'E11311', 'E11319', 'E11321', 'E11329', 'E11331', 'E11339', 'E11341', 'E11349', 'E11351', 'E11359', 'E1136', 'E1139', 'E1140', 'E1141', 'E1142', 'E1143', 'E1144', 'E1149', 'E1151', 'E1152', 'E1159', 'E11610', 'E11618', 'E11620', 'E11621', 'E11622', 'E11628', 'E11630', 'E11638', 'E11641', 'E11649', 'E1165', 'E1169', 'E118', 'E119', 'E1300', 'E1301', 'E1310', 'E1311', 'E1321', 'E1322', 'E1329', 'E13311','E13319', 'E13321', 'E13329', 'E13331', 'E13339', 'E13341', 'E13349', 'E13351', 'E13359', 'E1336', 'E1339', 'E1340', 'E1341', 'E1342', 'E1343', 'E1344', 'E1349', 'E1351', 'E1352', 'E1359', 'E13610', 'E13618', 'E13620', 'E13621', 'E13622', 'E13628', 'E13630', 'E13638', 'E13641', 'E13649','E1365', 'E1369', 'E138', 'E139' from acute care/critical access hospitals with principal procedure codes: ICD9- '8151', '8154' ICD10- '0SR90J9','0SR90JA','0SR90JZ','0SRB0J9','0SRB0JA', '0SRB0JZ','0SRC07Z','0SRC0JZ','0SRC0KZ','0SRD07Z', '0SRD0JZ','0SRD0KZ','0SRT07Z','0SRT0JZ','0SRT0KZ', '0SRU07Z','0SRU0JZ','0SRU0KZ','0SRV07Z','0SRV0JZ', '0SRV0KZ','0SRW07Z','0SRW0JZ','0SRW0KZ' with the following exclusions: 1. Principal or secondary Dx '73310', '73314', '73315', '73319', '73381', '73382', '73395', '73396', '73397', '8080', '8081', '8082', '8083', '80841', '80842', '80843', '80844', '80849', '80851', '80852', '80853', '80854', '8088', '82000', '82001', '82002', '82003', '82009', '82010', '82011', '82012', '82013', '82019', '82020', '82021', '82022', '82030', '82031', '82032', '8208', '8209', '82100', '82101', '82110', '82111', '82120', '82122', '82123', '82129', '82130', '82131','82132','82133','82139','M8440XA','M84459, 'M84453A','M84419A','M84479A','M8448XA', 'S42009P','S42209P','S4290XP','S5290XP','S5290XQ', 'S5290XR','S6290XP','S7290XP','S7290XQ','S7290XR', 'S82009P','S82009Q','S82009R','S8290XP','S8290XQ', 'S8290XR','S92909P','S92919P','S0291XK','S0292XK', 'S12000K','S12001K','S12100K','S12101K','S12200K', 'S12201K','S12300K','S12301K','S12400K','S12401K', 'S12500K','S12501K','S12600K','S12601K','S229XXK', 'S329XXK','S42009K','S42209K','S4290XK','S5290XK', 'S5290XM','S5290XN','S6290XK','S7290XK','S7290XM,'S7290XN','S8290XK','S8290XM','S8290XN','S92909K','S92919K','M4840XA','M4841XA','M4842XA', 'M4843XA','M4844XA','M4845XA','M4846XA','M4847 XA','M4848XA','M8430XA','M84319A','M84329A', 'M84339A','M84343A','M84373A','M8438XA', 'M84359A','M84353A','S32409A','S32409B', 'S32501A','S32502A','S32509A','S32501B','S32502B', 'S32509B','S32309A','S32609A','S32810A','S32811A', 'S3282XA','S3289XA','S32309B','S32609B','S32810B', 'S32811B','S3282XB','S3289XB','S329XXA','S329XXB', 'S72023A','S72026A','S72033A','S72036A','S72043A',

5 'S72046A','S72099A','S72019B','S72019C','S72023B', 'S72023C','S72026B','S72026C','S72033B','S72033C', 'S72036B','S72036C','S72043B','S72043C','S72046B', 'S72046C','S72099B','S72099C','S72109A','S72143A', 'S72146A','S7223XA','S7226XA','S72109B','S72109C', 'S72143B','S72143C','S72146B','S72146C','S7223XB', 'S7223XC','S7226XB','S7226XC','S72009A','S72009B', 'S72009C','S7290XA','S72309A', S7290XB','S7290XC', 'S72309B','S72309C','S72409A','S72413A','S72416A', 'S72443A','S72446A','S72453A','S72456A','S72499A', 'S72409B','S72409C','S72413B','S72413C','S72416B', 'S72416C','S72443B','S72443C','S72446B','S72446C', 'S72453B','S72453C','S72456B','S72456C','S72499B', 'S72499C'or 2. Secondary Procedure '8152','0SRA009','0SRA00A','0SRA00Z','0SRA019', '0SRA01A','0SRA01Z','0SRA039','0SRA03A','0SRA03Z', '0SRA07Z','0SRA0J9','0SRA0JA','0SRA0JZ','0SRA0KZ', '0SRE009','0SRE00A','0SRE00Z','0SRE019','0SRE01A', '0SRE01Z','0SRE039','0SRE03A','0SRE03Z','0SRE07Z', '0SRE0J9','0SRE0JA','0SRE0JZ','0SRE0KZ','0SRR019', '0SRR01A','0SRR01Z','0SRR039','0SRR03A','0SRR03Z',' 0SRR07Z','0SRR0J9','0SRR0JA','0SRR0JZ','0SRR0KZ',\'0 SRS019','0SRS01A','0SRS01Z','0SRS039','0SRS03A','0S RS03Z','0SRS07Z','0SRS0J9','0SRS0JA','0SRS0JZ', '0SRS0KZ' or 3. Secondary Procedure '8153', '8155', '8159', '0070', '0071', '0072', '0073', '0080', '0081', '0082','0083','0084', 0SP90JZ','0SPB0JZ','0SR9019', '0SR901A','0SR901Z','0SR9029','0SR902A','0SR902Z', '0SR9039','0SR903A','0SR903Z','0SR90J9','0SR90JA', '0SR90JZ','0SRB019','0SRB01A','0SRB01Z','0SRB029', '0SRB02A','0SRB02Z','0SRB039','0SRB03A','0SRB03Z', '0SRB0J9','0SRB0JA','0SRB0JZ','0SP90JZ','0SPB0JZ', '0SRA009','0SRA00A','0SRA00Z','0SRA019','0SRA01A', '0SRA01Z','0SRA039','0SRA03A','0SRA03Z','0SRA0J9', '0SRA0JA','0SRA0JZ','0SRE009','0SRE00A','0SRE00Z', '0SRE019','0SRE01A','0SRE01Z','0SRE039','0SRE03A', '0SRE03Z','0SRE0J9','0SRE0JA','0SRE0JZ','0SP90JZ', '0SPB0JZ','0SRR019','0SRR01A','0SRR01Z','0SRR039', '0SRR03A','0SRR03Z','0SRR0J9','0SRR0JA','0SRR0JZ', '0SRS019','0SRS01A','0SRS01Z','0SRS039','0SRS03A', '0SRS03Z','0SRS0J9','0SRS0JA','0SRS0JZ','0SP909Z', '0SPB09Z','0SU909Z','0SUA09Z','0SUB09Z','0SUE09Z', '0SUR09Z','0SUS09Z','0SPC0JZ','0SPC4JZ','0SPD0JZ', '0SPD4JZ','0SRC0JZ','0SRD0JZ','0SPC0JZ','0SPD0JZ', '0SRV0JZ','0SRW0JZ','0SPC09Z','0SPC0JZ','0SPC4JZ', '0SPD09Z','0SPD0JZ','0SPD4JZ','0SRT0JZ','0SRU0JZ', '0SUC0JZ','0SUC4JZ','0SUD0JZ','0SUD4JZ','0SUT09Z', '0SUU09Z','0QPD0JZ','0QPD3JZ','0QPD4JZ','0QPF0JZ', '0QPF3JZ','0QPF4JZ','0QRD0JZ','0QRD3JZ','0QRD4JZ',' 0QRF0JZ','0QRF3JZ','0QRF4JZ','0QUD0JZ','0QUD3JZ',' 0QUD4JZ','0QUF0JZ','0QUF3JZ','0QUF4JZ','0SUC09C',' 0SUD09C','0SPC09Z','0SPD09Z','0SUV09Z','0SUW09Z', '0SW90JZ','0SW93JZ','0SW94JZ','0SWB0JZ','0SWB3JZ '0SWB4JZ','0SWC0JZ','0SWC3JZ','0SWC4JZ', '0SWD0JZ','0SWD3JZ','0SWD4JZ','0SWF0JZ', '0SWF3JZ','0SWF4JZ,'0SWG0JZ','0SWG3JZ',

6 '0SWG4JZ','0SWH0JZ','0SWH3JZ','0SWH4JZ', '0SWJ0JZ','0SWJ3JZ','0SWJ4JZ','0SWK0JZ','0SWK3JZ', '0SWK4JZ','0SWL0JZ','0SWL3JZ','0SWL4JZ', '0SWM0JZ','0SWM3JZ','0SWM4JZ','0SWN0JZ', '0SWN3JZ','0SWN4JZ','0SWP0JZ','0SWP3JZ', '0SWP4JZ','0SWQ0JZ','0SWQ3JZ','0SWQ4JZ' or 4. Secondary Procedure '0085','0086','0087','0SUA0BZ','0SUE0BZ','0SUR0BZ', '0SUS0BZ','0SUR0BZ','0SUS0BZ','0SUA0BZ','0SUE0BZ' or 5. Principal Dx '99640', '99641', '99642', '99643', '99644', '99645', '99646', '99647', '99649', '99677', '99678','T84498A','T84039A','T84029A','T84019A', 'T84049A','T84059A','T84069A','T84099A','T84119A', 'T84129A','T84199A','T84498A','T8481XA','T8482XA', 'T8483XA','T8484XA','T8485XA','T8486XA','T8489XA', 'T849XXA','T8481XA','T8482XA','T8483XA','T8484XA', 'T8485XA','T8486XA','T8489XA','T849XXA' or 6. Principal Dx '1706', '1707', '1709', '1953', '1955', '1985', '1990', 'C414','C4020','C419','C763','C7650','C7951','C7952',' C800' or 7. Secondary Procedure '7865', '7866', '7867', '8005', '8006','8009', '0QP604Z','0QP605Z','0QP634Z','0QP635Z','0QP644Z','0QP645Z','0QP704Z','0QP705Z','0QP734Z', '0QP735Z','0QP744Z','0QP745Z','0QP804Z','0QP805Z','0QP834Z','0QP835Z','0QP844Z','0QP845Z', '0QP904Z','0QP905Z','0QP934Z','0QP935Z','0QP944Z','0QP945Z','0QPB04Z','0QPB05Z','0QPB34Z', '0QPB35Z','0QPB44Z','0QPB45Z','0QPC04Z','0QPC05Z','0QPC34Z','0QPC35Z','0QPC44Z','0QPC45Z', '0QPD04Z','0QPD05Z','0QPD34Z','0QPD35Z', '0QPD44Z','0QPD45Z','0QPF04Z','0QPF05Z','0QPF34Z','0QPF35Z','0QPF44Z','0QPF45Z','0QPG04Z', '0QPG05Z','0QPG34Z','0QPG35Z','0QPG44Z', '0QPG45Z','0QPH04Z','0QPH05Z','0QPH34Z', '0QPH35Z','0QPH44Z','0QPH45Z','0QPJ04Z','0QPJ05Z','0QPJ34Z','0QPJ35Z','0QPJ44Z','0QPJ45Z','0QPK04Z', '0QPK05Z','0QPK34Z','0QPK35Z','0QPK44Z','0QPK45Z','0SP909Z','0SP90JZ','0SP93JZ','0SP94JZ','0SPB09Z', '0SPB0JZ','0SPB3JZ','0SPB4JZ','0SPC09Z','0SPC0JZ', '0SPC3JZ','0SPC4JZ','0SPD09Z','0SPD0JZ','0SPD3JZ', '0SPD4JZ','0RP00JZ','0RP03JZ','0RP04JZ','0RP10JZ', '0RP13JZ','0RP14JZ','0RP30JZ','0RP33JZ','0RP34JZ', '0RP40JZ','0RP43JZ','0RP44JZ','0RP50JZ','0RP53JZ', '0RP54JZ','0RP60JZ','0RP63JZ','0RP64JZ','0RP90JZ', '0RP93JZ','0RP94JZ','0RPA0JZ','0RPA3JZ','0RPA4JZ', '0RPB0JZ','0RPB3JZ','0RPB4JZ','0SP00JZ','0SP03JZ', '0SP04JZ','0SP20JZ','0SP23JZ','0SP24JZ','0SP30JZ', '0SP33JZ','0SP34JZ','0SP40JZ','0SP43JZ','0SP44JZ', '0SP50JZ','0SP53JZ','0SP54JZ','0SP60JZ','0SP63JZ', '0SP64JZ','0SP70JZ','0SP73JZ','0SP74JZ','0SP80JZ', '0SP83JZ','0SP84JZ'

7 3a 3b 3c 3d 3e 3f 4a 4b 4c 4d Discharge Disposition of Initial Hospitalization: Home Discharge Disposition of Initial Hospitalization: SNF Discharge Disposition of Initial Hospitalization: HHA Discharge Disposition of Initial Hospitalization: Hospice Discharge Disposition of Initial Hospitalization: Rehab Discharge Disposition of Initial Hospitalization: Other Length of Stay (LOS) of Initial Hospitalization: 1-3 days Length of Stay (LOS) of Initial Hospitalization: 4-7 days Length of Stay (LOS) of Initial Hospitalization: 8-14 days Length of Stay (LOS) of Initial Hospitalization: days with discharge disposition: home with discharge disposition: SNF with discharge disposition: HHA with discharge disposition: Hospice with discharge disposition: Rehab with discharge disposition: Other with 1 to 3 days LOS with 4 to 7 days LOS with 8 to 14 days LOS with 15 to 21 days LOS readmissions to acute care/critical

8 4e 5a 5b 5b 5c Length of Stay (LOS) of Initial Hospitalization: 21+ days Race: White Race: Non-White (all except NJ) Race: Black (NJ only) Race: Hispanic (NJ only) from acute care/critical access hospitals for more than 21 days LOS from acute care/critical access hospitals with Race as White from acute care/critical access hospitals with Race as non-white from acute care/critical access hospitals with Race as Black from acute care/critical access hospitals with Race as Hispanic 5d 5e Race: Asian (NJ only) Race: Other (NJ only) HOSPITAL Adverse Drug Event Per 1,000 Inpatient Discharges Among High- Risk Medication (HRM) Beneficiaries BY QUARTER from acute care/critical access hospitals with Race as Asian from acute care/critical access hospitals with Race as Other Exclude transfer. Include all discharges from acute care/critical access hospitals All discharges in the denominator with primary Dx or primary E code: Insulin and Hypoglycemics ICD9_ '2510','E9323','99657','99523','9623','78909','78907',' 78906','78905','78904','78903','78902','78901','7890 0','78702','78701','7851','7823','7808','78039','78009','5770','5362','3688','36207','3331','2762','2512', '2511','25020','25012','25010' ICD10_ 'T383X6S','T383X6D','T383X6A','T383X5S','T383X5D',' T383X5A','T383X4S','T383X4D','T383X4A','T383X1S',' T383X1D','T383X1A','E160','T85624S','T85624D','T85 624A','T85633S','T85633D','T85633A','T85614S','T856 14D','T85614A','T85694S','T85694D','T85694A','R103 0','R102','R1010','R1084','R1013','R1033','R1032','R1 031','R1012','R1011','R109','R110','R112','R569','R55', 'R401','R400','E11351','E11341','E11331','E11321','E1 1311','E10351','E10341','E10331','E10321','E10311','E 1100','E1165','E1169','R002','R609','R601','R600','R61 ','K858','K851','K850','K859','G43A1','G43A0','R1110',' H5372','H5371','H538','G252','G251','G250','E872', 'E162','E161' Anticoagulants ICD9 '53200','53140','85306','85305','85304','85303', '85302','85300','59972','59971','36362','28559', '85246','85245','85244','85243','85242','85240', '85226','85225','85224','85223','85222','85220', '85206','85205','85204','85203','85202','85200', 6a

9 '5849','79092','5781','9981','99520','E9804','9645', '9643','9642','E9343','E9342','E8582','78701','78630', '78550','7848','7847','7827','719','71919','71918', '71917','71916','71915','71914','71913','71912', '71911','71910','6262','59970','5967','5738','53783', '56985','5780','5789','56935','56881','56213','56212', '56203','56202','53561','53551','53541','53531', '53521','53511','53460','53440','53420','53400', '53360','53340','53320','53300','53200','53160', '53140','53140','53120','53100','53021','45620', '4558','4555','4552','4560','4590','458','4589','4588', '45821','4580','432','4329','4321','4320','431','430', '4230','37923','37742','37632','37481','37272','3688', '36441','36363','36361','36281','3361','2869','2867', '28659','2851','2463','53501','5693','6271','6266', '59971','78639' ICD10_ 'K2901','K2991','K2951','K645','S06369D','S06369A', 'S06359S','S06359D','S06359A','S06349S','S06349D', 'S06349A','S06368S','S06368D','S06368A','S06367S', 'S06367D','S06367A','S06366S','S06366D','S06366A', 'S06358S','S06358D','S06358A','S06357S','S06357D', 'S06357A','S06356S','S06356D','S06356A','S06348S', 'S06348D','S06348A','S06347S','S06347D','S06347A', 'S06346S','S06346D','S06346A','S06365S','S06365D', 'S06365A','S06355S','S06355D','S06355A','S06345S', 'S06345D','S06345A','S06364S','S06364D','S06364A', 'S06363S','S06363D','S06363A','S06354S','S06354D', 'S06354A','S06353S','S06353D','S06353A','S06344S', 'S06344D','S06344A','S06343S','S06343D','S06343A', 'S06362S','S06362D','S06362A','S06361S','S06361D', 'S06361A','S06352S','S06352D','S06352A','S06351S', 'S06351D','S06351A','S06342S','S06342D','S06342A',' S06341S','S06341D','S06341A','S06360S','S06360D', 'S06360A','S06350S','S06350D','S06350A','S06340S', 'S06340D','S06340A','R0489','R049','R042','M2508', 'M25076','M25075','M25074','M25073','M25072', 'M25071','M25069','M25062','M25061','M25059', 'M25052','M25051','M25049','M25042','M25041', 'M25039','M25032','M25031','M25029','M25022', 'M25021','M25019','M25012','M25011','M2500', 'R312','R311','R310','R319,'K286','K284','K282', 'K280','K276','K274','K272','K270','K256','K252', 'K250','H31329','H31323','H31322','H31321', 'H31319','H31313','H31312','H31311','H31309', 'H31303','H31302','H31301','D68318','D68311', 'K266','K264','K262','K260','S064X9S','S064X9D', 'S064X9A','S064X8S','S064X8D','S064X8A','S064X7S', 'S064X7D','S064X7A','S064X6S','S064X6D','S064X6A', 'S064X5S','S064X5D','S064X5A','S064X4S','S064X4D', 'S064X4A','S064X3S','S064X3D','S064X3A','S064X2S', 'S064X2D','S064X2A','S064X1S','S064X1D','S064X1A', 'S064X0S','S064X0D','S064X0A','S065X9S','S065X9D', 'S065X9A','S065X8S','S065X8D','S065X8A','S065X7S', 'S065X7D','S065X7A','S065X6S','S065X6D','S065X6A', 'S065X5S','S065X5D','S065X5A','S065X4S','S065X4D',

10 'S065X4A','S065X3S','S065X3D','S065X3A','S065X2S', 'S065X2D','S065X2A','S065X1S','S065X1D','S065X1A', 'S065X0S','S065X0D','S065X0A','S066X9S','S066X9D', 'S066X9A','S066X8S','S066X8D','S066X8A','S066X7S', 'S066X7D','S066X7A','S066X6S','S066X6D','S066X6A', 'S066X5S','S066X5D','S066X5A','S066X4S','S066X4D', 'S066X4A','S066X3S','S066X3D','S066X3A','S066X2S', 'S066X2D','S066X2A','S066X1S','S066X1D','S066X1A', 'S066X0S','S066X0D','S066X0A','T4596XS','T4596XD', 'T4596XA','T4595XS','T4595XD','T4595XA','T4594XS', 'T4594XD','T4594XA','T4591XS','T4591XD','T4591XA', 'T458X6S','T458X6D','T458X6A','T458X5S','T458X5D', 'T458X5A','T458X4S','T458X4D','T458X4A','T458X1S', 'T458X1D','T458X1A','T457X6S','T457X6D','T457X6A',' T457X5S','T457X5D','T457X5A','T457X4S','T457X4D',' T457X4A','T457X1S','T457X1D','T457X1A','T45696S', 'T45696D','T45696A','T45695S','T45695D','T45695A', 'T45694S','T45694D','T45694A','T45691S','T45691D', 'T45691A','T45616S','T45616D','T45616A','T45615S', 'T45615D','T45615A','T45614S','T45614D','T45614A', 'T45611S','T45611D','T45611A','T45606S','T45606D', 'T45606A','T45605S','T45605D','T45605A','T45604S', 'T45604D','T45604A','T45601S','T45601D','T45601A', 'T45526S','T45526D','T45526A','T45525S','T45525D', 'T45525A','T45524S','T45524D','T45524A','T45521S', 'T45521D','T45521A','T45516S','T45516D','T45516A', 'T45515S','T45515D','T45515A','T45514S','T45514D', 'T45514A','T45511S','T45511D','T45511A','K2961', 'K643','K642','K641','K640','K649','K648','K643', 'K642','K641','K640','K649','K648','I629','I6203', 'I6202','I6201','I6200','I621','I619','I618','I616','I615', 'I614','I613','I612','I611','I610','R791','K5521','K661', 'K5793','K5781','K5733','K5721','K5791','K5731', 'K5753','K5741','K5713','K5701','K5711','K31811', 'K2981','K2971','K2921','K2941','K254','K2211', 'I8511','H4313','H4312','H4311','H4310','H47029', 'H47023','H47022','H47021','H05239','H05233', 'H05232','H05231','H0289','H1133','H1132','H1131', 'H1130','H2103','H2102','H2101','H2100','H3563', 'H3562','H3561','H3560','T8888XXA','T8888XXS', 'T8888XXD','N99821','N99820','N9962','N9961', 'M96831','M96830','M96811','M96810','L7622', 'L7621','L7602','L7601','K91841','K91840','K9162', 'K9161','J95831','J95830','J9562','J9561','I9762', 'I97618','I97611','I97610','I9742','I97418','I97411', 'I97410','H9542','H9541','H9522','H9521','H59329', 'H59323','H59322','H59321','H59319','H59313', 'H59312','H59311','H59129','H59123','H59122', 'H59121','H59119','H59113','H59112','H59111', 'G9752','G9751','G9732','G9731','E3602','E3601', 'D7822','D7821','D7802','D7801','R041','R040','R233', 'N179','K922','K921','K920','K7689','K761','K625', 'R58','I8501','K644','I230','I312','H538','G9519', D689','D688','D684','D6832','D62','E0789','I9581', 'I952','I959','I9589','I951','I609','I608','I607','I606', 'I6052','I6051','I6050','I604','I6032','I6031','I6030',

11 6b HOSPITAL Adverse Drug Events Per 1,000 ED visits Among High-Risk Medication (HRM) Beneficiaries BY QUARTER All ED visits from acute care/critical access hospitals [rev_cntr_cd in ('0450' '0451' '0452' '0456' '0459' '0981')] 'I6022','I6021','I6020','I6012','I6011','I6010','I6002', 'I6001','I6000' Opiates/Narcotics ICD9_ '78802','78829','9701','E9352','E9351','E8502', 'E8501','96509','96502','96500','7991','79902', '79901','78609','78609','78605','78603','78550', '78262','7810','78065','7804','7802','7801','7089', '7088','59984','5372','51882','51881','496','4589', '45829','4580','4580','42789','3393','3332','32741', '2922','99529','78703','78702','78701','78097','7808', '78009','780','6989','56409','56402','56401','56400', '5277','37942','30473','30472','30471','30470', '30403','30402','30401','78001','30400' ICD10_ 'R4020','T483X5A','R0902 ','R330 ','F1199 ','F1129 ', 'F11921 ','F11221 ','F11951 ','F11251 ','F11950 ', 'F11250 ','T40696S','T40696D','T40696A','T40695S', 'T40695D','T40695A','T40694S','T40694D','T40694A', 'T40691S','T40691D','T40691A','T40606S','T40606D', 'T40606A','T40605S','T40605D','T40605A','T40604S', 'T40604D','T40604A','T40601S','T40601D','T40601A', 'T404X6S','T404X6D','T404X6A','T404X5S','T404X5D', 'T404X5A','T404X4S','T404X4D','T404X4A','T404X1S', 'T404X1D','T404X1A','T402X6S','T402X6D','T402X6A', 'T402X5S','T402X5D','T402X5A','T402X4S','T402X4D', 'T402X4A','T402X1S','T402X1D','T402X1A','T403X6S', 'T403X6D','T403X6A','T403X5S','T403X5D','T403X5A', 'T403X4S','T403X4D','T403X4A','T403X1S','T403X1D', 'T403X1A','T400X6S','T400X6D','T400X6A','T400X5S', 'T400X5D','T400X5A','T400X4S','T400X4D','T400X4A', 'T400X1S','T400X1D','T400X1A','R579 ','F1920 ', 'F1920 ','F1120 ','F1120 ','T403X5S','T403X5D', 'T403X5A','T402X5S','T402X5D','T402X5A','T400X5S', 'T400X5D','T400X5A','R0901 ','R1112 ','R1111 ', 'R1110 ','R110','R112','R0689 ','R0683 ','R063 ', 'R0609 ','R0600 ','R0602 ','R0681 ','R232 ','R4182 ', 'R680 ','R401 ','R400 ','N135','N2889','N368 ','K5909', 'K5902','K5901','K5900 ','J80 ','J9692 ','J9691 ','J9690, 'J9602 ','J9601 ','J9600 ','I9581 ','I952 ','R001 ','I498 ', 'H5703 ','G4751 ','F1921 ','F1920 ','F1121 ','F1120 ', 'R092 ','R290 ','R259 ','R253 ','R252 ','R251 ','R250', 'R61','R42','R55','R443','R442','R440','L509','L508', 'L506','L299','K315','K117','I959','I951','G4441', 'G4440','G253','F11929','F11920','F11229','F11220', 'J449' All ED visits in the denominator with primary Dx or primary E code: Insulin and Hypoglycemics ICD9_ '2510','E9323','99657','99523','9623','78909','78907', '78906','78905','78904','78903','78902','78901', '78900','78702','78701','7851','7823','7808','78039', '78009','5770','5362','3688','36207','3331','2762', '2512','2511','25020','25012','25010'

12 ICD10_ 'T383X6S','T383X6D','T383X6A','T383X5S','T383X5D', 'T383X5A','T383X4S','T383X4D','T383X4A','T383X1S', 'T383X1D','T383X1A','E160','T85624S','T85624D', 'T85624A','T85633S','T85633D','T85633A','T85614S', 'T85614D','T85614A','T85694S','T85694D','T85694A', 'R1030','R102','R1010','R1084','R1013','R1033', 'R1032','R1031','R1012','R1011','R109','R110','R112', 'R569','R55','R401','R400','E11351','E11341','E11331', 'E11321','E11311','E10351','E10341','E10331', 'E10321','E10311','E1100','E1165','E1169','R002', 'R609','R601','R600','R61','K858','K851','K850','K859', 'G43A1','G43A0','R1110','H5372','H5371','H538', 'G252','G251','G250','E872','E162','E161' Anticoagulants ICD9 '53200','53140','85306','85305','85304','85303', '85302','85300','59972','59971','36362','28559', '85246','85245','85244','85243','85242','85240', '85226','85225','85224','85223','85222','85220', '85206','85205','85204','85203','85202','85200', '5849','79092','5781','9981','99520','E9804','9645', '9643','9642','E9343','E9342','E8582','78701','78630', '78550','7848','7847','7827','719','71919','71918', '71917','71916','71915','71914','71913','71912', '71911','71910','6262','59970','5967','5738','53783', '56985','5780','5789','56935','56881','56213','56212', '56203','56202','53561','53551','53541','53531', '53521','53511','53460','53440','53420','53400', '53360','53340','53320','53300','53200','53160', '53140','53140','53120','53100','53021','45620', '4558','4555','4552','4560','4590','458','4589','4588', '45821','4580','432','4329','4321','4320','431','430', '4230','37923','37742','37632','37481','37272','3688', '36441','36363','36361','36281','3361','2869','2867', '28659','2851','2463','53501','5693','6271','6266', '59971','78639' ICD10_ 'K2901','K2991','K2951','K645','S06369D','S06369A', 'S06359S','S06359D','S06359A','S06349S','S06349D', 'S06349A','S06368S','S06368D','S06368A','S06367S', 'S06367D','S06367A','S06366S','S06366D','S06366A', 'S06358S','S06358D','S06358A','S06357S','S06357D', 'S06357A','S06356S','S06356D','S06356A','S06348S', 'S06348D','S06348A','S06347S','S06347D','S06347A', 'S06346S','S06346D','S06346A','S06365S','S06365D', 'S06365A','S06355S','S06355D','S06355A','S06345S', 'S06345D','S06345A','S06364S','S06364D','S06364A', 'S06363S','S06363D','S06363A','S06354S','S06354D',' S06354A','S06353S','S06353D','S06353A','S06344S', 'S06344D','S06344A','S06343S','S06343D','S06343A', 'S06362S','S06362D','S06362A','S06361S','S06361D', 'S06361A','S06352S','S06352D','S06352A','S06351S', 'S06351D','S06351A','S06342S','S06342D','S06342A', 'S06341S','S06341D','S06341A','S06360S','S06360D', 'S06360A','S06350S','S06350D','S06350A','S06340S',

13 'S06340D','S06340A','R0489','R049','R042','M2508', 'M25076','M25075','M25074','M25073','M25072', 'M25071','M25069','M25062','M25061','M25059', 'M25052','M25051','M25049','M25042','M25041', 'M25039','M25032','M25031','M25029','M25022', 'M25021','M25019','M25012','M25011','M2500', 'R312','R311','R310','R319,'K286','K284','K282', 'K280','K276','K274','K272','K270','K256','K252', 'K250','H31329','H31323','H31322','H31321', 'H31319','H31313','H31312','H31311','H31309', 'H31303','H31302','H31301','D68318','D68311', 'K266','K264','K262','K260','S064X9S','S064X9D', 'S064X9A','S064X8S','S064X8D','S064X8A','S064X7S', 'S064X7D','S064X7A','S064X6S','S064X6D','S064X6A', 'S064X5S','S064X5D','S064X5A','S064X4S','S064X4D', 'S064X4A','S064X3S','S064X3D','S064X3A','S064X2S', 'S064X2D','S064X2A','S064X1S','S064X1D','S064X1A', 'S064X0S','S064X0D','S064X0A','S065X9S','S065X9D', 'S065X9A','S065X8S','S065X8D','S065X8A','S065X7S', 'S065X7D','S065X7A','S065X6S','S065X6D','S065X6A', 'S065X5S','S065X5D','S065X5A','S065X4S','S065X4D', 'S065X4A','S065X3S','S065X3D','S065X3A','S065X2S', 'S065X2D','S065X2A','S065X1S','S065X1D','S065X1A', 'S065X0S','S065X0D','S065X0A','S066X9S','S066X9D', 'S066X9A','S066X8S','S066X8D','S066X8A','S066X7S', 'S066X7D','S066X7A','S066X6S','S066X6D','S066X6A', 'S066X5S','S066X5D','S066X5A','S066X4S','S066X4D', 'S066X4A','S066X3S','S066X3D','S066X3A','S066X2S', 'S066X2D','S066X2A','S066X1S','S066X1D','S066X1A', 'S066X0S','S066X0D','S066X0A','T4596XS','T4596XD', 'T4596XA','T4595XS','T4595XD','T4595XA','T4594XS', 'T4594XD','T4594XA','T4591XS','T4591XD','T4591XA', 'T458X6S','T458X6D','T458X6A','T458X5S','T458X5D', 'T458X5A','T458X4S','T458X4D','T458X4A','T458X1S', 'T458X1D','T458X1A','T457X6S','T457X6D','T457X6A', 'T457X5S','T457X5D','T457X5A','T457X4S','T457X4D', 'T457X4A','T457X1S','T457X1D','T457X1A','T45696S', 'T45696D','T45696A','T45695S','T45695D','T45695A', 'T45694S','T45694D','T45694A','T45691S','T45691D', 'T45691A','T45616S','T45616D','T45616A','T45615S', 'T45615D','T45615A','T45614S','T45614D','T45614A', 'T45611S','T45611D','T45611A','T45606S','T45606D', 'T45606A','T45605S','T45605D','T45605A','T45604S', 'T45604D','T45604A','T45601S','T45601D','T45601A', 'T45526S','T45526D','T45526A','T45525S','T45525D', 'T45525A','T45524S','T45524D','T45524A','T45521S', 'T45521D','T45521A','T45516S','T45516D','T45516A', 'T45515S','T45515D','T45515A','T45514S','T45514D', 'T45514A','T45511S','T45511D','T45511A','K2961', 'K643','K642','K641','K640','K649','K648','K643', 'K642','K641','K640','K649','K648','I629','I6203', 'I6202','I6201','I6200','I621','I619','I618','I616','I615', 'I614','I613','I612','I611','I610','R791','K5521','K661', 'K5793','K5781','K5733','K5721','K5791','K5731', 'K5753','K5741','K5713','K5701','K5711','K31811', 'K2981','K2971','K2921','K2941','K254','K2211',

14 'I8511','H4313','H4312','H4311','H4310','H47029', 'H47023','H47022','H47021','H05239','H05233', 'H05232','H05231','H0289','H1133','H1132','H1131', 'H1130','H2103','H2102','H2101','H2100','H3563', 'H3562','H3561','H3560','T8888XXA','T8888XXS', 'T8888XXD','N99821','N99820','N9962','N9961', 'M96831','M96830','M96811','M96810','L7622', 'L7621','L7602','L7601','K91841','K91840','K9162', 'K9161','J95831','J95830','J9562','J9561','I9762', 'I97618','I97611','I97610','I9742','I97418','I97411', 'I97410','H9542','H9541','H9522','H9521','H59329', 'H59323','H59322','H59321','H59319','H59313', 'H59312','H59311','H59129','H59123','H59122', 'H59121','H59119','H59113','H59112','H59111', 'G9752','G9751','G9732','G9731','E3602','E3601', 'D7822','D7821','D7802','D7801','R041','R040','R233', 'N179','K922','K921','K920','K7689','K761','K625', 'R58','I8501','K644','I230','I312','H538','G9519', 'D689','D688','D684','D6832','D62','E0789','I9581', 'I952','I959','I9589','I951','I609','I608','I607','I606', 'I6052','I6051','I6050','I604','I6032','I6031','I6030', 'I6022','I6021','I6020','I6012','I6011','I6010','I6002', 'I6001','I6000') Opiates/Narcotics ICD9_ '78802','78829','9701','E9352','E9351','E8502', 'E8501','96509','96502','96500','7991','79902', '79901','78609','78609','78605','78603','78550', '78262','7810','78065','7804','7802','7801','7089', '7088','59984','5372','51882','51881','496','4589', '45829','4580','4580','42789','3393','3332','32741', '2922','99529','78703','78702','78701','78097','7808', '78009','780','6989','56409','56402','56401','56400', '5277','37942','30473','30472','30471','30470', '30403','30402','30401','78001','30400' ICD10_ 'R4020','T483X5A','R0902 ','R330 ','F1199 ','F1129 ', F11921 ','F11221 ','F11951 ','F11251 ','F11950 ', 'F11250 ','T40696S','T40696D','T40696A','T40695S', 'T40695D','T40695A','T40694S','T40694D','T40694A', 'T40691S','T40691D','T40691A','T40606S','T40606D', 'T40606A','T40605S','T40605D','T40605A','T40604S', 'T40604D','T40604A','T40601S','T40601D','T40601A', 'T404X6S','T404X6D','T404X6A','T404X5S','T404X5D', 'T404X5A','T404X4S','T404X4D','T404X4A','T404X1S', 'T404X1D','T404X1A','T402X6S','T402X6D','T402X6A', 'T402X5S','T402X5D','T402X5A','T402X4S','T402X4D', 'T402X4A','T402X1S','T402X1D','T402X1A','T403X6S', 'T403X6D','T403X6A','T403X5S','T403X5D','T403X5A', 'T403X4S','T403X4D','T403X4A','T403X1S','T403X1D', 'T403X1A','T400X6S','T400X6D','T400X6A','T400X5S', 'T400X5D','T400X5A','T400X4S','T400X4D','T400X4A', 'T400X1S','T400X1D','T400X1A','R579 ','F1920 ', 'F1920 ','F1120 ','F1120 ','T403X5S','T403X5D', 'T403X5A','T402X5S','T402X5D','T402X5A','T400X5S', 'T400X5D','T400X5A','R0901 ','R1112 ','R1111 ',

15 'R1110 ','R110','R112','R0689 ','R0683 ','R063 ', 'R0609 ','R0600 ','R0602 ','R0681 ','R232 ','R4182 ', 'R680 ','R401 ','R400 ','N135','N2889','N368 ','K5909', 'K5902','K5901','K5900 ','J80 ','J9692 ','J9691 ', 'J9690 ','J9602 ','J9601 ','J9600 ','I9581 ','I952 ', 'R001 ','I498 ','H5703 ','G4751 ','F1921 ','F1920 ', 'F1121 ','F1120 ','R092 ','R290 ','R259 ','R253 ','R252 ', 'R251 ','R250','R61','R42','R55','R443','R442','R440', 'L509','L508','L506','L299','K315','K117','I959','I951', 'G4441','G4440','G253','F11929','F11920','F11229', 'F11220','J449' This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI-C