**Agency for Healthcare Research and Quality**

**Patient Safety Indicators (PSI)**

**ICD-9-CM and DRG Coding Updates to Version 2.1, Revision 3**

**January 17, 2005**

The following changes were implemented in version 2.1, revision 3 of the
Patient Safety Indicator (PSI) software code (both SAS and SPSS) and
reflect changes to indicator definitions based on updates to ICD-9-CM
and DRG 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 Patient Safety Indicators. With this
software update, the PSI software definitions now incorporate ICD-9-CM
codes valid from October 1, 1994 through September 30, 2005.

+-------+------------+-------------+----------------------------------+
| **    | **         | ***C        | ***Change***                     |
| *Indi | *Indicator | omponent*** |                                  |
| cator | Name       |             |                                  |
| Modu  | (#)***     |             |                                  |
| le*** |            |             |                                  |
+=======+============+=============+==================================+
| PSI   | Decubitus  | Numerator   | Added new (FY2005) codes 707.00  |
|       | Ulcer (PSI |             | "unspecified site", 707.01       |
|       | #3)        | (inclusion, | "elbow", 707.02 "upper back",    |
|       |            | decubitus   | 707.03 "lower back", 707.04      |
|       |            | ulcer)      | "hip", 707.05 "buttock", 707.06  |
|       |            |             | "ankle", 707.07 "heel" and       |
|       |            |             | 707.09 "site, other" to the      |
|       |            |             | numerator inclusion criteria for |
|       |            |             | decubitus ulcer.                 |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible.                      |
+-------+------------+-------------+----------------------------------+
| PSI   | Failure to | Denominator | Added new (FY2005) codes 453.40  |
|       | Rescue     |             | "unspecified site", 453.41       |
|       |            | (inclusion, | "proximal" and 453.42 "distal"   |
|       | (PSI #4)   | DVT/PE)     | to the denominator inclusion     |
|       |            |             | criteria for venous embolism and |
|       |            |             | thrombosis of deep vessels of    |
|       |            |             | the lower extremity.             |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible.                      |
+-------+------------+-------------+----------------------------------+
| PSI   | Pos        | Numerator   | Added new (FY2005) codes 453.40  |
|       | toperative |             | "unspecified site", 453.41       |
|       | DVT/PE     | (inclusion, | "proximal" and 453.42 "distal"   |
|       |            | DVT/PE)     | to the numerator inclusion       |
|       | (PSI #12)  |             | criteria for venous embolism and |
|       |            |             | thrombosis of deep vessels of    |
|       |            |             | the lower extremity.             |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible.                      |
+-------+------------+-------------+----------------------------------+
| PSI   | Pos        | Denominator | For discharges beginning in FY   |
|       | toperative |             | 2005, ICD-9-CM code 44.99 "other |
|       | Wound      | (inclusion, | gastric operation" is added to   |
|       | Dehiscence | abd         | the denominator definition of    |
|       |            | ominopelvic | abdominopelvic surgery because   |
|       | (PSI #14)  | surgery)    | laparoscopic procedures that     |
|       |            |             | previously dominated this code   |
|       |            |             | were re-assigned to other codes. |
|       |            |             |                                  |
|       |            |             | Note: Revision 3 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 include ICD-9-CM     |
|       |            |             | code 44.99 in the denominator    |
|       |            |             | for discharges occurring on or   |
|       |            |             | after 10/1/2004. However, ICD-9  |
|       |            |             | code 44.99 will not be retained  |
|       |            |             | in the denominator if the data   |
|       |            |             | elements year and quarter of     |
|       |            |             | discharge are not available or   |
|       |            |             | if the user selects the option   |
|       |            |             | not to retain code 44.99 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 increase in the      |
|       |            |             | denominator and resulting        |
|       |            |             | increase in the rate due to the  |
|       |            |             | significant risk of wound        |
|       |            |             | dehiscence in the open           |
|       |            |             | procedures retained in this      |
|       |            |             | code.                            |
+-------+------------+-------------+----------------------------------+
| PSI   | Multiple   | Surgical    | Added new (FY2005) DRG codes     |
|       | Indicators | discharges  | 541-543 to the surgical          |
|       |            | denominator | discharges inclusion criteria    |
|       |            | inclusion   | for the applicable PSIs: 1, 3,   |
|       |            |             | 5-13, 15-16, 21-23, and 25-26.   |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible                       |
+-------+------------+-------------+----------------------------------+
| PSI   | Multiple   | Surgical    | Added new (FY2005) major         |
|       | Indicators | discharges  | operating procedure codes to the |
|       |            | denominator | surgical discharges inclusion    |
|       |            | inclusion   | criteria for the applicable PSIs |
|       |            |             | (see above for the list of       |
|       |            |             | PSIs). See the document          |
|       |            |             | "Operating Room Procedure Codes" |
|       |            |             | at                               |
|       |            |             | <http://www.qualityindic         |
|       |            |             | ators.ahrq.gov/psi_download.htm> |
|       |            |             | for a list of these ICD-9 codes. |
|       |            |             | The new codes can be identified  |
|       |            |             | locating the reference date of   |
|       |            |             | introduction "Oct 04" behind the |
|       |            |             | ICD-9 code and description.      |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible                       |
+-------+------------+-------------+----------------------------------+
| PSI   | Multiple   | Co          | Added new (FY2005) codes 347.00  |
|       | Indicators | morbidity   | "narcolepsy w/o cataplexy",      |
|       |            |             | 347.01 "w/ cataplexy", 347.10    |
|       |            | (other      | "narcolepsy in conditions        |
|       |            | n           | classified elsewhere w/o         |
|       |            | eurological | cataplexy" and 347.11 "w/        |
|       |            | disorders)  | cataplexy" to the co morbidity   |
|       |            |             | inclusion criteria for other     |
|       |            |             | neurological disorders. Added    |
|       |            |             | new (FY2005) DRG code 543 to the |
|       |            |             | co morbidity exclusion criteria  |
|       |            |             | for other neurological           |
|       |            |             | disorders.                       |
|       |            |             |                                  |
|       |            |             | Expected impact on rate:         |
|       |            |             | negligible                       |
+-------+------------+-------------+----------------------------------+