```

[Federal Register Volume 78, Number 228 (Tuesday, November 26, 2013)]
[Notices]
[Pages 70558-70559]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-28282]

=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

Review of Proposed Changes with ICD-10-CM/PCS; Conversion of 
Quality IndicatorsTM (QIs)

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of request for public comments.

-----------------------------------------------------------------------

SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) seeks 
comments on the proposed conversion of the AHRQ Quality 
IndicatorsTM to ``International Classification of Diseases, 
10th Edition, Clinical Modification/Procedure Coding System'' (ICD-10-
CM and ICD-10-PCS) codes. These changes would be applicable to hospital 
discharges occurring on or after October 1, 2014. The proposed ICD-10-
CM/PCS codes are posted on the AHRQ QI Web site for review at: http://www.qualityindicators.ahrq.gov/icd10/default.aspx

DATES: Comments on this notice must be received no later than 5 p.m. 
EDT of December 26, 2013.

ADDRESSES: Comments can be filed via email or on paper. Write ``AHRQ QI 
ICD-10 Conversion'' on the comments.
    Postal mail addressed to AHRQ is subject to delay due to security 
screening. As a result, AHRQ encourages submission of comments via 
email. Please submit email comments to: QIComment@AHRQ.hhs.gov.
    If comments are filed on paper, write ``AHRQ QI ICD-10 Conversion'' 
on such comments and on the envelope, and mail them to the following 
address: Pam Owens, Scientific Lead, AHRQ QI Program, Center for 
Delivery, Organization and Markets, Agency for Healthcare Research and 
Quality, 540 Gaither Road, Rockville, MD 20850.
    AHRQ will remove all identifying information from the comments and 
will not provide individual responses. AHRQ will provide a summary of 
comments and actions taken as a result of those comments. The summary 
document will be posted on the AHRQ QI Web site no later than the end 
of January 2014.

FOR FURTHER INFORMATION CONTACT: Pam Owens, Agency for Healthcare 
Research and Quality, Center for Delivery, Organization and Markets, 
540 Gaither Road, Rockville, MD 20850, Email: pam.owens@AHRQ.hhs.gov, 
Phone: (301) 427-1412.

SUPPLEMENTARY INFORMATION: A structured approach was adopted for

[[Page 70559]]

converting the existing AHRQ QI specifications from ICD-9-CM to ICD-10-
CM/PCS, incorporating coding expertise, clinical expertise, and health 
services research/quality measurement expertise. This process is 
summarized in a document available for review at: http://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2013/ICD-10%20Report%2007-15-2013.pdf
    Each current AHRQ QI technical specification with ICD-9-CM codes 
must be converted to ICD-10-CM/PCS codes. In each AHRQ QI technical 
specification, there can be one or more clinical concepts of selected 
ICD-9-CM codes for the numerator, denominator, and exclusion 
specifications. These clinical concepts are called `set names,' and 
they represent the basic foundation or building blocks in the 
construction of the AHRQ QIs. Every set name, whether diagnosis or 
procedure, must be mapped and reviewed for its clinical relationship to 
the clinical concept used within the current QI technical 
specification.
    Following consensus guidance from the National Quality Forum 
(http://www.qualityforum.org/Publications/2010/10/ICD-10-CM/PCS_Coding_Maintenance_Operational_Guidance.aspx), AHRQ's process for QI 
conversion in 2012 and 2013 included the following components:
    1. ``Convene Clinical and Coding Experts: * * *use a team approach 
that involves experts in the code sets and the appropriate clinical 
domain. The team should be used to identify specific areas where 
questions of clinical comparability exist, evaluate consistency of 
clinical concepts, and ensure appropriate conversion. Experts are 
needed in both the source and the target code set (e.g., ICD-9-CM and 
ICD-10-CM/PCS). Clinical expertise should be in the care setting 
represented by the clinical domain for the measure and may require 
specialized knowledge in some clinical areas.'' To this end, AHRQ 
contracted with clinical and coding experts at the University of 
California Davis and convened ten workgroups with a total of 27 
physicians, 22 nurses, 26 coding professionals, and 9 QI data users in 
the following domains: Cancer, Cardiac, Critical Care/Pulmonary, 
Infection, Internal Medicine, Neonatal/Pediatric, Neurology, Obstetrics 
and Gynecology, Orthopedic, General and Trauma Surgery. Work group 
members were trained on the ICD-10 code sets and supported by at least 
two American Health Information Management Association (AHIMA)-approved 
ICD-10-CM/PCS Trainers.
    2. ``Determine Intent: When converting a quality measure from ICD-
9-CM to ICD-10-CM/PCS, rather than doing a code-to-code conversion, a 
measure developer may choose to take advantage of the added granularity 
and specificity [that] ICD-10-CM/PCS offers, potentially making the 
updated measure inherently different* * * [T]he most ideal way to 
convert code sets for quality measures would be to examine the original 
intent of the measure and select codes directly from the target code 
set to define the concepts rather than relying on mapping alone* * * 
(1) The measure steward's goal was to convert this measure to a new 
code set, fully consistent with the intent of the original measure; (2) 
The measure steward's goal was to take advantage of the more specific 
code set to form a new version of the measure, but fully consistent 
with the original intent; (3) The measure steward has changed the 
intent of the measure.'' AHRQ adopted approaches (1) and (2) in the 
current conversion effort. Specifications consistent with (1) are 
called ``legacy specifications'' and are offered for historical 
analyses that require maximal comparability over time. Specifications 
consistent with (2) are called ``enhanced specifications'' and are 
offered for use in analyses of current health care quality, including 
public reporting and other accountability applications.
    3. ``Use Appropriate Conversion Tool: When converting from ICD-9-CM 
to ICD-10-CM/PCS, for example, maps such as General Equivalence Maps 
(GEMs) can be useful for narrowing the choice of target codes* * *'' 
GEM files were the foundation of AHRQ's code mapping effort.
    4. ``Assess for Material Change: Measure developers should 
determine during the process whether the measure has materially changed 
based on the intent of the updated measure and any testing that has 
been performed . . . This step is intended to address the comparability 
of the converted measure (using ICD-10-CM/PCS) to its predecessor 
(using ICD-9-CM) . . . Measure sponsors also should assess, if 
possible, whether the conversion results in rates that are similar 
within defined tolerances . . . '' This work will be undertaken over 
the next year as dual coded data becomes available for testing. AHRQ 
welcomes suggestions regarding dual-coded (ICD-9-CM and ICD-10-CM/PCS) 
data that may be available for testing purposes in early 2014.
    5. ``Solicit Stakeholder Comments: Conversion to new code sets 
requires involvement of many stakeholders; measure developers should 
solicit comments from a wide audience for additions and deletions, and 
with specific attention to new codes.'' This notice represents one 
component of AHRQ's comprehensive effort to solicit and respond to 
stakeholder comments.
    6. ``Version the Updated Measure: Measures with coding updates 
should be identified by version. Different versions of measures may be 
used longitudinally for various purposes but may not be exactly 
comparable.'' This final step will be implemented when the updated AHRQ 
QI specifications have been tested and are ready for public use, not 
later than October 2014.
    For additional information about the AHRQ QIs, please visit the 
AHRQ Web site at http://www.QUALITYindicators.AHRQ.gov.

Background

    The AHRQ Quality Indicators (AHRQ QIs) are a unique set of measures 
of health care quality that make use of readily available hospital 
inpatient administrative data. The AHRQ QIs are provider- and area-
level quality indicators and currently consist of four modules: The 
Prevention Quality Indicators (PQI), the Inpatient Quality Indicators, 
the Patient Safety Indicators (PSI), and the Pediatric Quality 
Indicators (PDIs). The AHRQ QIs serve multiple purposes, including 
research, needs assessments for planning at the local, state, and 
national levels, hospital quality improvement initiatives, performance 
assessment for public reporting to enable consumers to make more 
informed choices about their sites of care, public reporting to reward 
favorable outcomes and encourage changes in provider behavior, and 
information to be used by healthcare purchasers that link performance 
with payment. Users of the AHRQ QIs vary and include researchers, State 
data organizations, hospital systems and networks, hospital 
associations, State Medicaid agencies, Centers for Medicare & Medicaid 
Services (CMS), large private purchasers and public[hyphen]private 
purchaser coalitions, and consumer groups.
    AHRQ is committed to converting the AHRQ QIs from ICD-9-CM to ICD-
10-CM/PCS in an accurate and transparent manner, taking advantage of 
the additional specificity of ICD-10-CM/PCS to improve the validity and 
usefulness of the QIs from October 2014 onward.

    Dated: November 13, 2013.
Richard Kronick,
AHRQ Director.
[FR Doc. 2013-28282 Filed 11-25-13; 8:45 am]
BILLING CODE 4160-90-P
```