Agency for Healthcare Research and Quality

**Inpatient Quality Indicators (IQIs)**

**ICD-9-CM and DRG Coding Updates to Version 2.1, Revision 4**

**December 22, 2004**

The following changes were implemented in version 2.1, revision 4, of
the IQI software (both SAS and SPSS) and reflect changes to indicator
definitions based on updates to ICD-9-CM codes for Fiscal Year 2005
(effective 10-1-2004). All changes noted below have been incorporated
into the software syntax, software documentation and the Guide to
Inpatient Quality Indicators. With this software update, the IQI
software definitions now incorporate ICD-9-CM codes valid from October
1, 1994 through September 30, 2005.

+---------+-------------+--------------+------------------------------+
| ***In   | *           | ***          | ***Change***                 |
| dicator | **Indicator | Component*** |                              |
| Mo      | Name (#)*** |              |                              |
| dule*** |             |              |                              |
+=========+=============+==============+==============================+
| IQI     | Craniotomy  | Denominator  | New DRG code (FY 2005) 543   |
|         | Mortality   |              | (Craniotomy w/ implant of    |
|         | (IQI #13)   | (Inclusion,  | chemo agent or acute complex |
|         |             | Craniotomy)  | CNS principal diagnosis) was |
|         |             |              | added to the denominator     |
|         |             |              | definition of craniotomy.    |
|         |             |              |                              |
|         |             |              | Expected impact on rate:     |
|         |             |              | negligible                   |
+---------+-------------+--------------+------------------------------+
| IQI     | Stroke      | Denominator  | For discharges beginning in  |
|         | Mortality   |              | FY 2005, ICD-9-CM code 436   |
|         | (IQI #17)   | (Inclusion,  | "acute, but ill-defined      |
|         |             | Stroke)      | cerebrovascular disease" is  |
|         |             |              | dropped from the denominator |
|         |             |              | definition of stroke because |
|         |             |              | the code inclusion terms     |
|         |             |              | exclude "cerebrovascular     |
|         |             |              | accident (CVA) NOS, Stroke." |
|         |             |              |                              |
|         |             |              | Note: Revision 4 adds        |
|         |             |              | optional data elements YEAR  |
|         |             |              | (year of patient discharge)  |
|         |             |              | and DQTR (calendar quarter   |
|         |             |              | of patient discharge) to the |
|         |             |              | input data file              |
|         |             |              | specifications. If           |
|         |             |              | available, these data        |
|         |             |              | elements are used to exclude |
|         |             |              | ICD-9-CM code 436 from the   |
|         |             |              | denominator for discharges   |
|         |             |              | occurring on or after        |
|         |             |              | 10/1/2004. However, ICD-9    |
|         |             |              | code 436 will be retained in |
|         |             |              | the denominator if the data  |
|         |             |              | elements year and quarter of |
|         |             |              | discharge are not available  |
|         |             |              | or if the user selects the   |
|         |             |              | option to retain code 436    |
|         |             |              | for purposes of trending     |
|         |             |              | over time or to maintain     |
|         |             |              | historical continuity in the |
|         |             |              | rate. However, users are     |
|         |             |              | encouraged to transition to  |
|         |             |              | the new definition as soon   |
|         |             |              | as possible.                 |
|         |             |              |                              |
|         |             |              | Expected impact on rate: may |
|         |             |              | result in a decrease in the  |
|         |             |              | denominator and resulting    |
|         |             |              | increase in the rate. The    |
|         |             |              | decrease may be larger in    |
|         |             |              | the short-term depending on  |
|         |             |              | how quickly coders adapt to  |
|         |             |              | the new guidelines.          |
+---------+-------------+--------------+------------------------------+