with any code indicating thoracic surgery, lung or pleural biopsy, or cardiac surgery PSI 7. Central Venous Bloodstream Infections of ICD-9-CM codes 99662 or 9993 or 99931 per 1,000 discharges. Discharges with selected infections defined by specific ICD-9-CM codes any secondary diagnosis field among cases meeting the All surgical and medical discharges, 18 years and older or MDC 14 (pregnancy, childbirth, and puerperium), defined by specific DRGs or MS-DRGs. Exclude cases:
inclusion and exclusion rules for the denominator. For discharges prior to October 1, 2007: ICD-9-CM Infection diagnosis codes: with principal diagnosis of selected infections or secondary diagnosis present on admission with length of stay less than 2 days with any diagnosis or procedure code for immunocompromised state with any diagnosis of cancer
PSI 8. Postoperative Hip Fracture Cases of in-hospital hip fracture per 1,000 surgical discharges with an operating room procedure. Discharges with code for hip fracture in any secondary diagnosis of field among cases meeting the inclusion and exclusion All surgical discharges age 18 and defined by specific DRGs or MS-DRGs and an ICD-9-CM code for an operating room procedure. Exclude cases:
PSI 9. Postoperative Hemorrhage or Hematoma Cases of hematoma or hemorrhage requiring a procedure per 1,000 surgical discharges with an operating room procedure. Discharges among cases meeting the inclusion and exclusion rules for the denominator with the following: ICD-9-CM code for postoperative hemorrhage or All surgical discharges 18 years and older defined by specific DRGs or MS-DRGs and an ICD-9-CM code for an operating room procedure. Exclude cases: with principal diagnosis of postoperative hemorrhage or
postoperative hematoma in any secondary diagnosis field AND ICD-9-CM code for postoperative postoperative hematoma or secondary diagnosis present on admission where the only operating room procedure is postoperative control of hemorrhage or drainage of hematoma. where a procedure for postoperative control of hemorrhage or drainage of hematoma occurs before the first operating room procedure.
with an operating room procedure. in any secondary diagnosis field. Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by Exclude cases: with preexisting condition (principal diagnosis or secondary diagnosis present on admission) of physiologic and metabolic derangements or chronic renal failure with acute renal failure (see Numerator) where a procedure for
with an operating room procedure. ICD-9-CM codes for acute respiratory failure in any secondary diagnosis field. OR Discharges among cases meeting the inclusion *Elective-Admission type # is recorded as elective (Admission Type = 3). Exclude cases: with principal diagnosis of acute respiratory failure or secondary diagnosis present on admission
and exclusion rules for the denominator with ICD-9-CM codes in any secondary procedure field as follows: Mechanical Ventilation for 96 consecutive hours or with ICD-9-CM diagnosis code of neuromuscular disorder where a procedure for tracheostomy is the only operating room procedure where a procedure for tracheostomy occurs before the first operating room procedure. Note: If day of procedure is not available in the input data file, the rate
more - zero or more days after the major operating room procedure code Mechanical Ventilation for less than 96 consecutive hours or undetermined - two may be slightly lower than if the information was available. with craniofacial anomalies with 1) a procedure code for laryngeal or pharyngeal surgery or 2) a procedure on face and a diagnosis code of craniofacial abnormalities MDC 14 (pregnancy, childbirth, and puerperium)
PSI 12. Postoperative Pulmonary Embolism or Deep Vein Thrombosis Cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 1,000 surgical discharges with an Discharges cases meeting the inclusion and exclusion rules for the denominator.with ICD-9-CM codes for deep vein thrombosis or pulmonary embolism in All surgical discharges age 18 and older defined by specific DRGs or MS-DRGs and an ICD-9-CM code for an operating room procedure. Exclude cases: with principal diagnosis of deep vein thrombosis or pulmonary embolism or secondary diagnosis present on admission
may be slightly lower than if the information was available. MDC 14 (pregnancy, childbirth, and puerperium) PSI 13. Postoperative Sepsis Cases of sepsis per 1,000 elective surgery patients with an operating Discharges among cases meeting the inclusion and exclusion rules for the denominator. with ICD-9-CM All elective* surgical discharges age 18 and older defined by specific DRGs or and an ICD-9CM code for an operating room procedure.
Wound Dehiscence 1,000 cases of abdominopelvic surgery. ICD-9-CM code for reclosure of postoperative disruption of abdominal wall in any procedure field. Exclude cases: where a procedure for reclosure of postoperative disruption of abdominal wall occurs before or on the same day as the first abdominopelvic surgery procedure Note: If day of procedure is not available in the input data file, the
PSI 15. Accidental Puncture or Laceration Cases of technical difficulty (e.g., accidental cut or laceration during procedure) per 1,000 discharges. Discharges among cases meeting the inclusion and exclusion rules for the denominator with ICD-9-CM code denoting accidental cut, puncture, perforation or laceration during a All surgical and medical discharges age 18 years and older defined by specific DRGs or MS-DRGs. Exclude cases: with principal diagnosis denoting technical difficulty (e.g., accidental cut, puncture, perforation, or
procedure in any secondary diagnosis field. laceration) or secondary diagnosis present on admission MDC 14 (pregnancy, childbirth, and puerperium). with ICD-9-CM code for spine surgery Note: For Version 4.1.a (used in this paper), the only change from Version 4.1 was an update in exclusion codes for PSI#8, Postoperative Hip Fracture. The following diagnosis codes were removed from the exclusion set: 96561