How to Calculate PQI #3: Diabetes Long-term Complications Admission Rate

Diabetes is a complicated disease. But don’t confuse this thought with the term “diabetes complications”! Complications generally occur after years of high blood glucose. The blood vessels become damaged unless you can keep your glucose levels in a healthy range most of the time. The range of complications span from being simply annoying to actually life threatening. The lesser conditions include dry and itchy skin, mild gum disease, a tendency to be more susceptible to colds and flu, and in women, yeast infections. The more serious complications - some life-changing or life-threatening - include eye disease, kidney disease, nerve disease and heart disease.

Numerator
All discharges age 18 years and older with ICD-9-CM principal diagnosis code for diabeteslong-term complications (renal, eye, neurological, circulatory, or complications not otherwise specified). 

ICD-9-CM    Description
250.40    Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
250.41    Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled
250.42    Diabetes with renal manifestations, type II or unspecified type, uncontrolled
250.43    Diabetes with renal manifestations, type I [juvenile type], uncontrolled
250.50    Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled
250.51    Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled
250.52    Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled
250.53    Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled
250.60    Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
250.61    Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled
250.62    Diabetes with neurological manifestations, type II or unspecified type, uncontrolled
250.63    Diabetes with neurological manifestations, type I [juvenile type], uncontrolled
250.70    Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled
250.71    Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled
250.72    Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled
250.73    Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled
250.80    Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled
250.81    Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled
250.82    Diabetes with other specified manifestations, type II or unspecified type, uncontrolled
250.83    Diabetes with other specified manifestations, type I [juvenile type], uncontrolled
250.90    Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled
250.91    Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled
250.92    Diabetes with unspecified complication, type II or unspecified type, uncontrolled
250.93    Diabetes with unspecified complication, type I [juvenile type], uncontrolled



ICD-10-CM     Description
E10.21    Type 1 diabetes mellitus with diabetic nephropathy
E10.22    Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.29    Type 1 diabetes mellitus with other diabetic kidney complication
E10.311    Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319    Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.321    Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E10.329    Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E10.331    Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E10.339    Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E10.341    Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E10.349    Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E10.351    Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E10.359    Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E10.36    Type 1 diabetes mellitus with diabetic cataract
E10.39    Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.40    Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41    Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42    Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43    Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44    Type 1 diabetes mellitus with diabetic amyotrophy
E10.49    Type 1 diabetes mellitus with other diabetic neurological complication
E10.51    Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52    Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.59    Type 1 diabetes mellitus with other circulatory complications
E10.610    Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E10.618    Type 1 diabetes mellitus with other diabetic arthropathy
E10.620    Type 1 diabetes mellitus with diabetic dermatitis
E10.621    Type 1 diabetes mellitus with foot ulcer
E10.622    Type 1 diabetes mellitus with other skin ulcer
E10.628    Type 1 diabetes mellitus with other skin complications
E10.630    Type 1 diabetes mellitus with periodontal disease
E10.638    Type 1 diabetes mellitus with other oral complications
E10.69    Type 1 diabetes mellitus with other specified complication
E10.8    Type 1 diabetes mellitus with unspecified complications
E11.21    Type 2 diabetes mellitus with diabetic nephropathy
E11.22    Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.29    Type 2 diabetes mellitus with other diabetic kidney complication
E11.311    Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319    Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.321    Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.329    Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E11.331    Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E11.339    Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E11.341    Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E11.349    Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E11.351    Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E11.359    Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E11.36    Type 2 diabetes mellitus with diabetic cataract
E11.39    Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.40    Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.41    Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42    Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43    Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44    Type 2 diabetes mellitus with diabetic amyotrophy
E11.49    Type 2 diabetes mellitus with other diabetic neurological complication
E11.51    Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52    Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59    Type 2 diabetes mellitus with other circulatory complications
E11.610    Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E11.618    Type 2 diabetes mellitus with other diabetic arthropathy
E11.620    Type 2 diabetes mellitus with diabetic dermatitis
E11.621    Type 2 diabetes mellitus with foot ulcer
E11.622    Type 2 diabetes mellitus with other skin ulcer
E11.628    Type 2 diabetes mellitus with other skin complications
E11.630    Type 2 diabetes mellitus with periodontal disease
E11.638    Type 2 diabetes mellitus with other oral complications
E11.69    Type 2 diabetes mellitus with other specified complication
E11.8    Type 2 diabetes mellitus with unspecified complications
E13.21    Other specified diabetes mellitus with diabetic nephropathy
E13.22    Other specified diabetes mellitus with diabetic chronic kidney disease
E13.29    Other specified diabetes mellitus with other diabetic kidney complication
E13.311    Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
E13.319    Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema
E13.321    Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E13.329    Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E13.331    Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E13.339    Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E13.341    Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E13.349    Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E13.351    Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
E13.359    Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema
E13.36    Other specified diabetes mellitus with diabetic cataract
E13.39    Other specified diabetes mellitus with other diabetic ophthalmic complication
E13.40    Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41    Other specified diabetes mellitus with diabetic mononeuropathy
E13.42    Other specified diabetes mellitus with diabetic polyneuropathy
E13.43    Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44    Other specified diabetes mellitus with diabetic amyotrophy
E13.49    Other specified diabetes mellitus with other diabetic neurological complication
E13.51    Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52    Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.59    Other specified diabetes mellitus with other circulatory complications
E13.610    Other specified diabetes mellitus with diabetic neuropathic arthropathy
E13.618    Other specified diabetes mellitus with other diabetic arthropathy
E13.620    Other specified diabetes mellitus with diabetic dermatitis
E13.621    Other specified diabetes mellitus with foot ulcer
E13.622    Other specified diabetes mellitus with other skin ulcer
E13.628    Other specified diabetes mellitus with other skin complications
E13.630    Other specified diabetes mellitus with periodontal disease
E13.638    Other specified diabetes mellitus with other oral complications
E13.649    Other specified diabetes mellitus with hypoglycemia without coma
E13.65    Other specified diabetes mellitus with hyperglycemia
E13.69    Other specified diabetes mellitus with other specified complication
E13.8    Other specified diabetes mellitus with unspecified complications
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
•with missing gender (SEX=missing), age (AGE=missing), quarter (DQTR=missing), year (YEAR=missing), principal diagnosis (DX1=missing), or county (PSTCO=missing)  

Denominator
Discharges in the numerator are assigned to the denominator based on the Metro Area or county of the patient residence, not the Metro Area or county where the hospital discharge occurred.