Appendix B Risk Factor Definitions - PDF Document

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  1. Release Notes: AMI-9 Risk Factor Definitions Version 1.0 Note: Future updates to this appendix will be provided via the Joint Commission website while the Risk Model Information File will be available via PET. Appendix B Risk Factor Definitions (Joint Commission Performance Measurement Systems Only) AMI-9 Variable Short Name ADMSRC56 transferred from a skilled nursing facility) or Admission Source = 6 (a patient transferred from another health care facility); ADMSRC56=0 otherwise AGET5095 Patient’s age in years (truncated at 50 and 95). Truncated means that all patients less than or equal to 50 will be assigned an age of 50 and all patients greater than or equal to 95 will be assigned an age of 95. SEXR replace U with the mode for this data element using all organizations participating in this measure. AGEINT Integer Age The integer value of age. AGEINT_SEXR 1. The prefix PRF in the variable name indicates that the diagnosis code must be the primary (first) diagnosis code for the patient record. 2. The prefix CRF depicts a comorbidity measure variable. 3. All risk factors defined from ICD-9-CM codes (i.e., those with CRF, RF or PRF prefixes) are binary-type risk factors. ) 4. Individual risk factor value=1 if one or more ICD-9-CM codes in the definition column exist, or 0 otherwise. 5. All risk factors are binary-type risk factors except age variables (i.e., AGET5095 and AGEINT) which are continuous. Variable Short Name Definition ADMSRC56=1if Admission Source = 5 (patient Admission Source = 5 or 6 Age truncated 50-95 SEXR=1 if Sex=F; SEXR=0 if Sex=M; When Sex =U, Sex = M or F Integer Age by Sex interaction The integer variable AGEINT is multiplied by the variable SEXR. Definition ICD-9-CM Diagnosis Codes 410.01, 410.11 PRF203A Site of Infarct - Anterior or Anterolateral Site of Infarct - Subendocardial Diabetes Mellitus PRF203S RF05 410.71 250.01- 250.03, 250.10-250.93, 648.00- 648.04 305.1 V15.82 140.0–208.91 RF06C RF06HX RF10 Current Smoker History of Smoking Cancer Specifications Manual for National Hospital Quality Measures Appendix B-1

  2. Variable Short Name Definition ICD-9-CM Diagnosis Codes 437.0–437.9, 438.0-438.9 403.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00, 404.01, 404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93, 582.0-583.9, 585- 587 571.0-572.8 278.0, 278.00, 278.01 491.21, 493.20, 493.21, 496 425.0-425.9 RF12 RF14 Chronic Cerebrovascular Disease Chronic Renal Disease (w, w/o) Renal Failure RF15 RF16 RF17 RF18 Chronic Liver Disease Obesity COPD Cardiomyopathy Chronic Cardiac Conditions RF202 398.90, 398.91, 398.99, 402.00-402.91, 414.8, 414.9, 416.0-416.9, 429.1, 429.2, 429.3, 443.81, 443.89, 443.9, V12.50, V15.1 V45.82 V45.81 272.0-272.9, 414.0-414.05, 440.0-440.9 RF207 RF208 RF210 History of PTCA History of CABG Atherosclerosis and Lipid Disorders Musculoskeletal Conditions History of MI RF211 RF220 714.0-714.33, 715.00-715.98, 720.0, 721.90 412 The integer variable AGEINT is multiplied by the variable RF210 398.91, 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, 428.0 – 428.9 093.20 – 093.24, 394.0 – 397.1, 424.0 – 424.91, 746.3 – 746.6, V422, V433 416.0 – 416.9, 417.9 440.0 – 440.9, 441.0 – 441.9, 442.0 – 442.9, 443.1 – 443.9, 447.1, 557.1, 557.9, V434 401.1, 401.9, 642.00 – 642.04 401.0, 402.00, 402.10, 402.90, 403.00, 403.10, 403.90, 404.00, 404.10, 404.90, 405.01, 405.09, 405.11, 405.19, 405.91, 405.99, 642.10 - 642.24, 642.70 – 642.94 342.0 – 342.12, 342.9 – 344.9, 438.20 – 438.53 330.0 - 331.9, 332.0, 333.4, 333.5, 334.0 – 335.9, 340, 341.1 – 341.9, 345.00 – 345.11, 345.2 – 345.3 345.40 – 345.91, 348.1, 348.3 – 348.39, 780.3, 780.39, 784.3 RF210_AGEINT Integer Age by atherosclerosis and lipid interaction Congestive Heart Failure CRF401 CRF402 Valvular Disease CRF403 CRF404 Pulmonary Circulation Disorder Peripheral Vascular Disorder CRF405 CRF406 Hypertension (Uncomplicated) Hypertension (Complicated) CRF407 Paralysis CRF408 Other Neurological Specifications Manual for National Hospital Quality Measures Appendix B-2

  3. Variable Short Name Definition ICD-9-CM Diagnosis Codes 490 – 492.8, 493.00 – 493.92, 494 – 494.1, 495.0 - 505, 506.4 250.00 – 250.33, 648.00 – 648.04 CRF409 Chronic Pulmonary Disease CRF410 Diabetes w/o Chronic Complications Diabetes w/ Chronic Complications Hypothyroidism Renal Failure CRF411 250.40 – 250.93, 775.1 CRF412 CRF413 243 -244.2, 244.8, 244.9 403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 585, 586, V42.0, V45.1, V56.0 – V56.2, V56.8 070.22, 070.23, 070.32, 070.33, 070.44, 070.54, 456.0, 456.1, 456.20, 456.21, 571.0, 571.2, 571.3, 571.40 – 571.49, 571.5, 571.6, 571.8, 571.9, 572.3, 572.8,V42.7 531.41, 531.51, 531.61, 531.70, 531.71, 531.90, 531.91, 532.41, 532.51, 532.61, 532.70, 532.71, 532.90, 532.91, 533.41, 533.51, 533.61, 533.70, 533.71, 533.90, 533.91, 534.41, 534.51, 534.61, 534.70, 534.71, 534.90, 534.91, V12.71 042 – 044.9 200.00 - 202.38, 202.50 – 203.01, 203.8 – 203.81, 238.6, 273.3, V10.71, V10.72, V10.79 196.0 – 199.1 140.0 – 172.9, 174.0 – 175.9, 179 – 195.8, V10.00 – V10.59, V10.81 – V10.9 701.0, 710.0 – 710.9, 714.0 – 714.9, 720.0 – 720.9, 725 286.0 – 286.9, 287.1, 287.3 -287.5, 289.81 – 289.82 CRF414 Liver Disease CRF415 Peptic Ulcer Disease Including Bleeding CRF416 CRF417 HIV AND AIDS Lymphoma CRF418 CRF419 Metastatic Cancer Solid Tumor without Metastasis CRF420 Rheumatoid Arthritis/Collagen Vascular Diseases Coagulopathy –( note: this comorbidity should be dropped when used with the AHRQ Patient Safety Indicators Obesity Weight loss Fluid and Electrolyte Disorder – (note: this comorbidity should be dropped when used with the AHRQ Patient Safety Indicators Blood loss anemia Deficiency Anemias Alcohol Abuse CRF421 CRF422 CRF423 CRF424 278.0, 278.00, 278.01 260 – 263.9 276.0 – 276.9 CRF425 CRF426 CRF427 280.0, 648.20 – 648.24 280.1 – 281.9, 285.21 – 285.29, 285.9 291.0 – 291.3, 291.5, 291.8, 291.81, 291.89, 291.9, 303.00 – 303.93, 305.00 – 305.03, V11.3 Specifications Manual for National Hospital Quality Measures Appendix B-3

  4. Variable Short Name Definition ICD-9-CM Diagnosis Codes 292.0, 292.82 – 292.89, 292.9, 304.00 – 304.93, 305.20 – 305.93, 648.30 – 648.34, 295.00 – 298.9, 299.10, 299.11 300.4, 301.12, 309.0, 309.1, 311 CRF428 Drug Abuse CRF429 CRF430 Psychoses Depression Specifications Manual for National Hospital Quality Measures Appendix B-4

  5. Release Notes: PR-1 Risk Factor Definitions Version 1.0 Appendix B Risk Factor Definitions PR-1 Variable Short Name Definition AGET1744 Age truncated 17-44 Maternal age (truncated between 17 and 44 years). Truncated means that all patients less than or equal to 17 years old will be assigned an age of 17, while patients greater than or equal to 44 years old will be assigned an age of 44. 1. All risk factors defined from ICD-9-CM codes (i.e., those with an RF prefix) are binary-type risk factors. 2. Individual risk factor value=1 if one or more ICD-9-CM codes in the definition column exist, or 0 otherwise. 3. All risk factors are binary-type risk factors except the age variables (i.e., AGET1744) which is continuous. Variable Short Name Definition ICD-9-CM Diagnosis Codes 648.01, 648.81 305.1 278.0, 278.01, 646.11 656.31 652.01, 652.11, 652.21, 652.31, 652.41, 652.51, 652.61, 652.71, 652.81 651.01, 651.11, 651.21, 651.31, 651.41, 651.51, 651.61, 651.81, 651.91, 659.41, V27.2, V27.3, V27.4, V27.5, V27.6, V27.7, V27.9 646.51, 646.61, 647.81, 647.91, 658.41, 659.31 663.01 660.01, 660.11, 660.21, 660.31, 660.41, 660.51, 660.61, 660.71, 660.81, 660.91 642.01, 642.11, 642.21, 642.31, 642.91 RF05M RF06C RF16M RF100M RF101M Diabetes in Pregnancy Smoker Obesity Fetal Distress Abnormal Presentation RF102M Multiple Gestations RF103M Maternal Infections RF104PRO RF105M Cord Prolapse Obstructed Labor RF106M Other Hypertensions in Pregnancy Specifications Manual for National Hospital Quality Measures Appendix B-5

  6. RF107M RF108M Polyhydraminios Abnormality of Organs and Soft Tissues of the Pelvis Large Fetus (Oversize) Eclampsia, Pre-eclampsia Fetal-Maternal Hemorrhage Isoimmunization Placenta Previa w/o Hemorrhage Abruptio Placenta Antepartum Hemorrhage Herpes Simplex Virus 657.01 654.01, 654.11, 654.31, 654.41, 654.51, 654.61, 654.71, 654.81, 654.91 656.61, 653.51 642.41, 642.51, 642.61, 642.71 656.01 656.11, 656.21 641.01 641.21 641.11, 641.31, 641.81, 641.91 647.21and at least one of the following; 054.10, 054.11, 054.12, 054.19, 054.79, 054.8, 054.9 653.01, 653.11, 653.21, 653.31, 653.41, 653.51, 653.61, 653.71, 653.81, 653.91 659.01, 659.11, 661.01, 661.41, 661.11, 661.21, 662.01, 662.11, 662.21 658.01 662.01, 662.11, 662.21 73.1, 73.4 RF109M RF111M RF112M RF113M RF114M RF115M RF116M RF117M RF118M Disproportion RF119M Failure to Progress RF120M RF123M RF124M RF119M_RF124M Oligohydramnios Prolonged Labor Induction Interaction of Failure to progress and Induction Specifications Manual for National Hospital Quality Measures Appendix B-6

  7. Release Notes: PR-2 Risk Factor Definitions Version 1.0 Appendix B Risk Factor Definitions PR-2 Variable Short Name Definition SEXR Sex = M or F SEXR=1 if Sex=F; SEXR=0 if Sex=M; When Sex =U, replace U with the mode for this data element using all organizations participating in this measure. 1. All risk factors defined from ICD-9-CM codes (i.e., those with RF prefix) are binary-type risk factors. 2. Individual risk factor value=1 if one or more ICD-9-CM codes in the definition column exist, or 0 otherwise. 3. All risk factors for PR-2 are binary-type risk factors. Variable Short Name Definition ICD-9-CM Diagnosis Codes RF303 RF304 RF305 RF306 RF308 RF310 Anencephalus Patau’s Syndrome Edward’s Syndrome Agenesis of Lung Multiple Congenital Anomalies Hydrops Fetalis not due to Isoimmunization Renal Agenesis Severe Birth Asphyxia Disseminated Intravascular Coagulation in Newborn Newborn Pulmonary Hemorrhage Anomalies of Diaphragm Perinatal Intestinal Perforation Necrotizing Enterocolitis in Fetus or Newborn Inborns 740.0 758.1 758.2 748.5 759.7 778.0 RF311 RF312 RF314 753.0 768.5 776.2 RF315 RF316 RF317 RF318 770.3 756.6 777.6 777.5 RF319 V30.00, V30.01, V31.00, V31.01, V32.00, V32.01, V33.00, V33.01, V34.00, V34.01, V35.00, V35.01, V36.00, V36.01, V37.00, V37.01, V39.00, V39.01 765.01, 765.02, 765.03 RF322 Extreme immaturity – Preterm infants Other Preterm infants Less than 24 weeks of gestation Completed 24 weeks of gestation RF323 RF351 RF352 765.14, 765.15, 765.16, 765.17, 765.18 765.21 765.22 Specifications Manual for National Hospital Quality Measures Appendix B-7

  8. Variable Short Name Definition ICD-9-CM Diagnosis Codes (but, less than 25 weeks ) Completed 25-26 weeks of gestation Completed 27-28 weeks of gestation Completed 29-30 weeks of gestation Completed 31-32 weeks of gestation Completed 33-34 weeks of gestation Completed 35-36 weeks of gestation Interaction of Gestation weeks less than 24 and Extreme immaturity - Preterm infants New born with birth weight less than 500 grams RF353 765.23 RF354 765.24 RF355 765.25 RF356 765.26 RF357 765.27 RF358 765.28 RF351_RF322 RF351 multiplied by RF322 RF361 764.01, 764.11, 764.21, 764.91, 765.01, 765.11 OR Birth weight < 500 grams ICD-9-CM Code 764.02, 764.12, 764.22, 764.92, 765.02, 765.1. OR Birth Weight between 500 and 749 grams ICD-9-CM Code 764.03, 764.13, 764.23, 764.93, 765.03, 765.13 OR Birth Weight between 750 and 999 grams ICD-9-CM Code 764.04, 764.05, 764.14, 764.15, 764.24, 764.25, 764.94, 764.95, 765.04, 765.05, 765.14, 765.15 OR Birth Weight between 1000 and 1499 grams ICD-9-CM Code 764.06, 764.07, 764.16, 764.17, 764.26, 764.27, 764.96, 764.97, 765.06, 765.07, 765.16, 765.17 OR Birth Weight between 1500 and 1999 grams ICD-9-CM Code 764.08, 764.18, 764.28, 764.98, 765.08, 765.18 OR Birth Weight between 2000 and 2499 grams RF362 New born with birth weight between 500 and 749 grams RF363 New born with birth weight between 750and 999 grams RF364 New born with birth weight between 1000and 1499 grams RF365 New born with birth weight between 1500and 1999 grams RF366 New born with birth weight between 2000and 2499 grams Specifications Manual for National Hospital Quality Measures Appendix B-8

  9. Release Notes: PR-3 Risk Factor Definitions Version 1.0 Appendix B Risk Factor Definitions PR-3 Variable Short Name Definition MAGE20L Age truncated < 20 Maternal age in years less than or equal to 20. MAGE20L = 1 if maternal age < 20; MAGE20L = 0 if maternal age >20. MAGE16L Age truncated < 16 Maternal age in years less than or equal to 16. MAGE16L = 1 if maternal age < 16; MAGE16L = 0 if maternal age >16. 1. All risk factors defined from ICD-9-CM codes (i.e., those with RF prefix) are binary-type risk factors. 2. Individual risk factor value=1 if one or more ICD-9-CM codes in the definition column exist, or 0 otherwise. 3. All risk factors for PR-3 are binary-type risk factors. Variable Short Name Definition ICD-9-CM Principal and/or Other Diagnosis/Procedure Codes 652.01, 652.11, 652.21, 652.31, 652.41, 652.51, 652.61, 652.71, 652.81 651.01, 651.11, 651.21, 651.31, 651.41, 651.51, 651.61, 651.81, 651.91, 659.41, V27.2, V27.3, V27.4, V27.5, V27.6, V27.7, V27.9 653.01, 653.11, 653.21, 653.31, 653.41, 653.51, 653.61, 653.71, 653.81, 653.91 656.61 661.31 73.6 72.4, 72.51, 72.52, 72.53, 72.54, 72.6, 72.8, 72.9 RF101M Abnormal Presentation RF102M Multiple Gestations RF118M Disproportion RF109M RF301M RF302M RF303M Large Fetus (Oversize) Precipitate Labor Episiotomy Operative Vaginal Delivery not including breech, vacuum or Forceps Breech Delivery Shoulder Dystocia Vacuum Extraction Forceps Delivery RF321M RF325M RF327M RF328M 72.5 660.41 72.7, 72.71, 72.79 72.0, 72.1, 72.2, 72.3, 72.21, 72.29,72.31, 72.39 The variable RF303M is multiplied by the variable RF325M. RF303M_RF325M Interaction of Operative Vaginal Delivery and Shoulder Dystocia Specifications Manual for National Hospital Quality Measures Appendix B-9