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). 

How to Calculate PQI #2: Perforated Appendix Admission Rate

A perforated appendix is one of the complications of acute appendicitis. If appendicitis is left untreated, ischemic necrosis of a portion of appendiceal wall may occur, leading to perforation. An appendicolith is thought to be associated with a higher probability of perforation. Perforation of the appendix is more common among the elderly population due to an increased frequency of late and atypical presentation of appendicitis, delay in diagnosis, delayed decision for surgery and to the age-specific physiological changes.

Population Measured (Denominator)
Discharges, for patients ages 18 years and older, with any-listed ICD-CM diagnosis codes for appendicitis. Discharges are assigned to the denominator based on the metropolitan area or county of the patient residence, not the metropolitan area or county of the hospital where the discharge occurred.

How to Calculate PQI #1 Diabetes Short-Term Complications Admission Rate

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.

Beneficiaries are excluded from the population measured if they:
• were under the age of 18
• were enrolled in Medicare managed care (a Medicare Advantage plan) for any month during the performance period
• were enrolled in Medicare Part A only or Medicare Part B only for any month during the performance period
• resided outside of the United States, its territories, and its possessions for any month during the performance period
• Hospitalizations are excluded from the measure outcome if:
• the hospital admission is a transfer from a hospital, skilled nursing facility, intermediate care facility, or other health care facility
• the hospitalization is missing a principal diagnosis
• the discharge had any diagnosis code for sickle-cell anemia or HB-S disease, or any diagnosis or procedure code for immunocompromised state (bacterial pneumonia
component measure only)
• the discharge had any diagnosis code for kidney/urinary tract disorder or any diagnosis or procedure code for immunocompromised state (urinary tract infection component measure only)
• the discharge had any diagnosis code for chronic renal failure (dehydration component measure only)





NUMERATOR:
ICD-9-CM    Description
250.10    Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
250.11    Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
250.12    Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.13    Diabetes with ketoacidosis, type I [juvenile type], uncontrolled
250.20    Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21    Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
250.22    Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23    Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
250.30    Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
250.31    Diabetes with other coma, type I [juvenile type], not stated as uncontrolled
250.32    Diabetes with other coma, type II or unspecified type, uncontrolled
250.33    Diabetes with other coma, type I [juvenile type], uncontrolled

ICD-10-CM    Description
E10.10    Type 1 diabetes mellitus with ketoacidosis without coma
E10.11    Type 1 diabetes mellitus with ketoacidosis with coma
E10.641    Type 1 diabetes mellitus with hypoglycemia with coma
E10.65    Type 1 diabetes mellitus with hyperglycemia
E11.00    Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.01    Type 2 diabetes mellitus with hyperosmolarity with coma
E11.641    Type 2 diabetes mellitus with hypoglycemia with coma
E11.65    Type 2 diabetes mellitus with hyperglycemia
E13.00    Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E13.01    Other specified diabetes mellitus with hyperosmolarity with coma
E13.10    Other specified diabetes mellitus with ketoacidosis without coma
E13.11    Other specified diabetes mellitus with ketoacidosis with coma
E13.641    Other specified diabetes mellitus with hypoglycemia with coma

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)