How to Calculate PQI 07: Hypertension Admission Rate

The heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries). Blood returns in the veins leading to the heart, aided by gravity and muscle contraction.

It is known as the "silent killer" since it has no initial symptoms but can lead to long-term disease and complications.. High Blood Pressure a.k.a. Hypertension can be controlled by outpatient means by either medication or lifestyle change. When someone is admitted to a hospital due to complications from hypertension, then preventative measures could have failed. However, the cause of failure is not represented here, and that can include both patient and provider based causes.

Prevention is an important role for all healthcare providers. Hypertension is a controllable condition using outpatient care and drug therapy. Prevention Quality Indicators (PQIs) are a set of measures that help identify quality of care for outpatient and other non-hospital care.

How to Calculate PQI 07 Hypertension Admission Rate?
Measure Description: Admissions with a principal diagnosis of hypertension per 100,000 population, ages 18 years
and older. Excludes kidney disease combined with dialysis access procedure admissions, cardiac
procedure admissions, obstetric admissions, and transfers from other institutions.

Numerator: Discharges, for patients ages 18 years and older, with a principal ICD-CM diagnosis code for hypertension.  By definition, discharges with a principal diagnosis of hypertension are precluded from an assignment of MDC 14 by grouper software. Thus, obstetric discharges should not be considered in the PQI rate, though the AHRQ software does not explicitly exclude obstetric cases.

ICD-9-CM    Description
401.0    Malignant essential hypertension
401.9    Unspecified essential hypertension
402.00    Malignant hypertensive heart disease without heart failure
402.10    Benign hypertensive heart disease without heart failure
402.90    Unspecified hypertensive heart disease without heart failure
403.00    Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified
403.10    Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified
403.90    Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
404.00    Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.10    Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.90    Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
ICD-10-CM     Description
I10.    Essential (primary) hypertension
I11.9    Hypertensive heart disease without heart failure
I12.9    Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10    Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

NUMERATOR Exclude cases:
•transfer from a hospital (different facility) 
•transfer from a skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) 
•transfer from another health care facility
•MDC 14 (pregnancy, childbirth, and puerperium)
•with any-listed ICD-CM procedure codes for cardiac procedure
•with any-listed ICD-CM diagnosis codes of Stage I-IV kidney disease, only if accompanied by any-listed ICD-CM procedure codes for dialysis access
•with missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis(DX1=missing), or county (PSTCO=missing)

For Stage I-IV kidney disease diagnosis codes:
ICD-9-CM    Description
Stage I-IV kidney disease diagnosis codes  
ICD-9-CM    Description
403.00    Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified
403.10    Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified
403.90    Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
404.00    Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.10    Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
404.90    Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
I12.9    Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10    Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

Dialysis access procedure codes  
ICD-9-CM    Description
38.95    Venous catheterization for renal dialysis
39.27    Arteriovenostomy for renal dialysis
39.29    Other (peripheral) vascular shunt or bypass
39.42    Revision of arteriovenous shunt for renal dialysis
39.43    Removal of arteriovenous shunt for renal dialysis
39.93    Insertion of vessel-to-vessel cannula
39.94    Replacement of vessel-to-vessel cannula
ICD-10-PCS    Description
031209D    Bypass Innominate Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031209F    Bypass Innominate Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03120AD    Bypass Innominate Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03120AF    Bypass Innominate Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03120JD    Bypass Innominate Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03120JF    Bypass Innominate Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03120KD    Bypass Innominate Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03120KF    Bypass Innominate Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03120ZD    Bypass Innominate Artery to Upper Arm Vein, Open Approach
03120ZF    Bypass Innominate Artery to Lower Arm Vein, Open Approach
031309D    Bypass Right Subclavian Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031309F    Bypass Right Subclavian Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03130AD    Bypass Right Subclavian Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03130AF    Bypass Right Subclavian Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03130JD    Bypass Right Subclavian Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03130JF    Bypass Right Subclavian Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03130KD    Bypass Right Subclavian Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03130KF    Bypass Right Subclavian Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03130ZD    Bypass Right Subclavian Artery to Upper Arm Vein, Open Approach
03130ZF    Bypass Right Subclavian Artery to Lower Arm Vein, Open Approach
031409D    Bypass Left Subclavian Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031409F    Bypass Left Subclavian Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03140AD    Bypass Left Subclavian Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03140AF    Bypass Left Subclavian Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03140JD    Bypass Left Subclavian Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03140JF    Bypass Left Subclavian Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03140KD    Bypass Left Subclavian Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03140KF    Bypass Left Subclavian Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03140ZD    Bypass Left Subclavian Artery to Upper Arm Vein, Open Approach
03140ZF    Bypass Left Subclavian Artery to Lower Arm Vein, Open Approach
031509D    Bypass Right Axillary Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031509F    Bypass Right Axillary Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03150AD    Bypass Right Axillary Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03150AF    Bypass Right Axillary Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03150JD    Bypass Right Axillary Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03150JF    Bypass Right Axillary Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03150KD    Bypass Right Axillary Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03150KF    Bypass Right Axillary Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03150ZD    Bypass Right Axillary Artery to Upper Arm Vein, Open Approach
03150ZF    Bypass Right Axillary Artery to Lower Arm Vein, Open Approach
031609D    Bypass Left Axillary Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031609F    Bypass Left Axillary Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03160AD    Bypass Left Axillary Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03160AF    Bypass Left Axillary Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03160JD    Bypass Left Axillary Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03160JF    Bypass Left Axillary Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03160KD    Bypass Left Axillary Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03160KF    Bypass Left Axillary Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03160ZD    Bypass Left Axillary Artery to Upper Arm Vein, Open Approach
03160ZF    Bypass Left Axillary Artery to Lower Arm Vein, Open Approach
031709D    Bypass Right Brachial Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031709F    Bypass Right Brachial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03170AD    Bypass Right Brachial Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03170AF    Bypass Right Brachial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03170JD    Bypass Right Brachial Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03170JF    Bypass Right Brachial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03170KD    Bypass Right Brachial Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03170KF    Bypass Right Brachial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03170ZD    Bypass Right Brachial Artery to Upper Arm Vein, Open Approach
03170ZF    Bypass Right Brachial Artery to Lower Arm Vein, Open Approach
031809D    Bypass Left Brachial Artery to Upper Arm Vein with Autologous Venous Tissue, Open Approach
031809F    Bypass Left Brachial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03180AD    Bypass Left Brachial Artery to Upper Arm Vein with Autologous Arterial Tissue, Open Approach
03180AF    Bypass Left Brachial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03180JD    Bypass Left Brachial Artery to Upper Arm Vein with Synthetic Substitute, Open Approach
03180JF    Bypass Left Brachial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03180KD    Bypass Left Brachial Artery to Upper Arm Vein with Nonautologous Tissue Substitute, Open Approach
03180KF    Bypass Left Brachial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03180ZD    Bypass Left Brachial Artery to Upper Arm Vein, Open Approach
03180ZF    Bypass Left Brachial Artery to Lower Arm Vein, Open Approach
031909F    Bypass Right Ulnar Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
03190AF    Bypass Right Ulnar Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
03190JF    Bypass Right Ulnar Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
03190KF    Bypass Right Ulnar Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
03190ZF    Bypass Right Ulnar Artery to Lower Arm Vein, Open Approach
031A09F    Bypass Left Ulnar Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
031A0AF    Bypass Left Ulnar Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
031A0JF    Bypass Left Ulnar Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
031A0KF    Bypass Left Ulnar Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
031A0ZF    Bypass Left Ulnar Artery to Lower Arm Vein, Open Approach
031B09F    Bypass Right Radial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
031B0AF    Bypass Right Radial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
031B0JF    Bypass Right Radial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
031B0KF    Bypass Right Radial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
031B0ZF    Bypass Right Radial Artery to Lower Arm Vein, Open Approach
031C09F    Bypass Left Radial Artery to Lower Arm Vein with Autologous Venous Tissue, Open Approach
031C0AF    Bypass Left Radial Artery to Lower Arm Vein with Autologous Arterial Tissue, Open Approach
031C0JF    Bypass Left Radial Artery to Lower Arm Vein with Synthetic Substitute, Open Approach
031C0KF    Bypass Left Radial Artery to Lower Arm Vein with Nonautologous Tissue Substitute, Open Approach
031C0ZF    Bypass Left Radial Artery to Lower Arm Vein, Open Approach
03PY07Z    Removal of Autologous Tissue Substitute from Upper Artery, Open Approach
03PY0JZ    Removal of Synthetic Substitute from Upper Artery, Open Approach
03PY0KZ    Removal of Nonautologous Tissue Substitute from Upper Artery, Open Approach
03PY37Z    Removal of Autologous Tissue Substitute from Upper Artery, Percutaneous Approach
03PY3JZ    Removal of Synthetic Substitute from Upper Artery, Percutaneous Approach
03PY3KZ    Removal of Nonautologous Tissue Substitute from Upper Artery, Percutaneous Approach
03PY47Z    Removal of Autologous Tissue Substitute from Upper Artery, Percutaneous Endoscopic Approach
03PY4JZ    Removal of Synthetic Substitute from Upper Artery, Percutaneous Endoscopic Approach
03PY4KZ    Removal of Nonautologous Tissue Substitute from Upper Artery, Percutaneous Endoscopic Approach
03WY0JZ    Revision of Synthetic Substitute in Upper Artery, Open Approach
03WY3JZ    Revision of Synthetic Substitute in Upper Artery, Percutaneous Approach
03WY4JZ    Revision of Synthetic Substitute in Upper Artery, Percutaneous Endoscopic Approach
03WYXJZ    Revision of Synthetic Substitute in Upper Artery, External Approach
05HY33Z    Insertion of Infusion Device into Upper Vein, Percutaneous Approach
06HY33Z    Insertion of Infusion Device into Lower Vein, Percutaneous Approach

Population Measured (Denominator)
After applying the exclusions outlined in the next section, all inpatient utilization of the member were counted. Percentage can be counted based on the member count or by the IP admit count.