Coding & Quality Measures Tip PQI 07: Hypertension Admission Rate
Our Coding & Quality Measures Series discusses how coding may adversely affect your quality statistics and bottom line. For this weeks tip, our Executive Director of Education, Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC explores what happens to your Hypertension Admission Rate quality metric when a coder erroneously reports hypertension. Patricia also provides key takeaways and best practices.
PQI 07: Hypertension Admission Rate
Did you know that by coding hypertension with associated CKD correctly along with any surgical dialysis access creation on patients admitted with hypertension, will keep the case out of the AHRQ PQI #07: Hypertension Admission Rate quality measure?
The Prevention Quality Indicators (PQIs) are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for “ambulatory care sensitive conditions.” These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. With high-quality, community-based primary care, hospitalization for these illnesses often can be avoided. Because the PQIs are calculated using readily available hospital administrative data, they are an easy-to-use and inexpensive screening tool.
PQI 07 states: “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.”
Let’s say a coder erroneously reports I10, Hypertension NOS, for hypertension with CKD stage IV instead of I12.9, Hypertensive CKD with stage I-IV and N18.4, CKD stage 4. The coder also forgets to assign or correctly code creation of an AV fistula such as 03180ZD, Bypass Left Brachial Artery to Upper Arm Vein, Open Approach, in anticipation of future dialysis on this case. This can cause the case to hit the PQI #07 quality measure! Also, if the diagnoses codes are coded correctly, however the AV fistula creation code is incorrect, the case may also hit the PQI #07 quality measure.
There is also a list of cardiac procedures that can exclude the case from this measure.
There are other exclusions to this measure such as an incorrect UB04 admission source (2-other hospital and 3-another facility, including long-term care excludes the case) or point of origin code (POO) 4-transfer from a hospital, 5-transfer from an SNF or ICF, and 6-Trans from another health care facility, which exclude the case. Please see the references below for more information.
The Code Hard Truth: Every Code Counts!
AHRQ Prevention Quality Indicators Technical Specifications and Appendices
ICD-10-CM Official Guidelines for Coding and Reporting FY 2018
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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