Review of Proposed Changes with ICD-10-CM/PCS; Conversion of Quality IndicatorsTM, 70558-70559 [2013-28282]

Download as PDF 70558 Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices template of important elements for such lending.27 The FDIC encourages banks to continue to offer these products, in a manner consistent with safety and soundness and other supervisory considerations, and encourages other banks to consider offering such products. Properly managed smalldollar loan products offered with reasonable terms and at a reasonable cost do not pose the same level of supervisory risk as deposit advance products. The FDIC encourages banks to develop new or innovative programs to effectively meet the need for smalldollar credit that do not exhibit the risks associated with deposit advance products and payday loans. Dated at Washington, DC, this 21st day of November, 2013. Federal Deposit Insurance Corporation. Robert E. Feldman, Executive Secretary. [FR Doc. 2013–28306 Filed 11–25–13; 8:45 am] BILLING CODE 6714–01–P FEDERAL DEPOSIT INSURANCE CORPORATION FDIC Systemic Resolution Advisory Committee; Notice of Meeting Federal Deposit Insurance Corporation. ACTION: Notice of open meeting. AGENCY: In accordance with the Federal Advisory Committee Act, 5 U.S.C. App. 2, notice is hereby given of a meeting of the FDIC Systemic Resolution Advisory Committee (the ‘‘SR Advisory Committee’’), which will be held in Washington, DC. The SR Advisory Committee will provide advice and recommendations on a broad range of issues regarding the resolution of systemically important financial companies pursuant to Title II of the Dodd-Frank Wall Street Reform and Consumer Protection Act, Public Law 111–203 (July 21, 2010), 12 U.S.C. 5301 et seq. (the ‘‘Dodd-Frank Act’’). 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VerDate Mar<15>2010 18:04 Nov 25, 2013 Jkt 232001 PO 00000 Frm 00031 Fmt 4703 Sfmt 4703 DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Review of Proposed Changes with ICD–10–CM/PCS; Conversion of Quality IndicatorsTM (QIs) Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of request for public comments. AGENCY: The Agency for Healthcare Research and Quality (AHRQ) seeks comments on the proposed conversion of the AHRQ Quality IndicatorsTM to ‘‘International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System’’ (ICD–10–CM and ICD–10–PCS) codes. These changes would be applicable to hospital discharges occurring on or after October 1, 2014. The proposed ICD–10– CM/PCS codes are posted on the AHRQ QI Web site for review at: http:// www.qualityindicators.ahrq.gov/icd10/ default.aspx DATES: Comments on this notice must be received no later than 5 p.m. EDT of December 26, 2013. ADDRESSES: Comments can be filed via email or on paper. Write ‘‘AHRQ QI ICD–10 Conversion’’ on the comments. Postal mail addressed to AHRQ is subject to delay due to security screening. As a result, AHRQ encourages submission of comments via email. Please submit email comments to: QIComment@AHRQ.hhs.gov. If comments are filed on paper, write ‘‘AHRQ QI ICD–10 Conversion’’ on such comments and on the envelope, and mail them to the following address: Pam Owens, Scientific Lead, AHRQ QI Program, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. AHRQ will remove all identifying information from the comments and will not provide individual responses. AHRQ will provide a summary of comments and actions taken as a result of those comments. The summary document will be posted on the AHRQ QI Web site no later than the end of January 2014. FOR FURTHER INFORMATION CONTACT: Pam Owens, Agency for Healthcare Research and Quality, Center for Delivery, Organization and Markets, 540 Gaither Road, Rockville, MD 20850, Email: pam.owens@AHRQ.hhs.gov, Phone: (301) 427–1412. SUPPLEMENTARY INFORMATION: A structured approach was adopted for SUMMARY: E:\FR\FM\26NON1.SGM 26NON1 emcdonald on DSK67QTVN1PROD with NOTICES Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices converting the existing AHRQ QI specifications from ICD–9–CM to ICD– 10–CM/PCS, incorporating coding expertise, clinical expertise, and health services research/quality measurement expertise. This process is summarized in a document available for review at: http://www.qualityindicators.ahrq.gov/ Downloads/Resources/Publications/ 2013/ICD-10%20Report%2007-152013.pdf Each current AHRQ QI technical specification with ICD–9–CM codes must be converted to ICD–10–CM/PCS codes. In each AHRQ QI technical specification, there can be one or more clinical concepts of selected ICD–9–CM codes for the numerator, denominator, and exclusion specifications. These clinical concepts are called ‘set names,’ and they represent the basic foundation or building blocks in the construction of the AHRQ QIs. Every set name, whether diagnosis or procedure, must be mapped and reviewed for its clinical relationship to the clinical concept used within the current QI technical specification. Following consensus guidance from the National Quality Forum (http:// www.qualityforum.org/Publications/ 2010/10/ICD-10-CM/PCS_Coding_ Maintenance_Operational_ Guidance.aspx), AHRQ’s process for QI conversion in 2012 and 2013 included the following components: 1. ‘‘Convene Clinical and Coding Experts: * * *use a team approach that involves experts in the code sets and the appropriate clinical domain. The team should be used to identify specific areas where questions of clinical comparability exist, evaluate consistency of clinical concepts, and ensure appropriate conversion. Experts are needed in both the source and the target code set (e.g., ICD–9–CM and ICD–10–CM/PCS). Clinical expertise should be in the care setting represented by the clinical domain for the measure and may require specialized knowledge in some clinical areas.’’ To this end, AHRQ contracted with clinical and coding experts at the University of California Davis and convened ten workgroups with a total of 27 physicians, 22 nurses, 26 coding professionals, and 9 QI data users in the following domains: Cancer, Cardiac, Critical Care/Pulmonary, Infection, Internal Medicine, Neonatal/Pediatric, Neurology, Obstetrics and Gynecology, Orthopedic, General and Trauma Surgery. Work group members were trained on the ICD–10 code sets and supported by at least two American Health Information Management Association (AHIMA)-approved ICD– 10–CM/PCS Trainers. VerDate Mar<15>2010 18:04 Nov 25, 2013 Jkt 232001 2. ‘‘Determine Intent: When converting a quality measure from ICD– 9–CM to ICD–10–CM/PCS, rather than doing a code-to-code conversion, a measure developer may choose to take advantage of the added granularity and specificity [that] ICD–10–CM/PCS offers, potentially making the updated measure inherently different* * * [T]he most ideal way to convert code sets for quality measures would be to examine the original intent of the measure and select codes directly from the target code set to define the concepts rather than relying on mapping alone* * * (1) The measure steward’s goal was to convert this measure to a new code set, fully consistent with the intent of the original measure; (2) The measure steward’s goal was to take advantage of the more specific code set to form a new version of the measure, but fully consistent with the original intent; (3) The measure steward has changed the intent of the measure.’’ AHRQ adopted approaches (1) and (2) in the current conversion effort. Specifications consistent with (1) are called ‘‘legacy specifications’’ and are offered for historical analyses that require maximal comparability over time. Specifications consistent with (2) are called ‘‘enhanced specifications’’ and are offered for use in analyses of current health care quality, including public reporting and other accountability applications. 3. ‘‘Use Appropriate Conversion Tool: When converting from ICD–9–CM to ICD–10–CM/PCS, for example, maps such as General Equivalence Maps (GEMs) can be useful for narrowing the choice of target codes* * *’’ GEM files were the foundation of AHRQ’s code mapping effort. 4. ‘‘Assess for Material Change: Measure developers should determine during the process whether the measure has materially changed based on the intent of the updated measure and any testing that has been performed . . . This step is intended to address the comparability of the converted measure (using ICD–10–CM/PCS) to its predecessor (using ICD–9–CM) . . . Measure sponsors also should assess, if possible, whether the conversion results in rates that are similar within defined tolerances . . . ’’ This work will be undertaken over the next year as dual coded data becomes available for testing. AHRQ welcomes suggestions regarding dual-coded (ICD–9–CM and ICD–10–CM/PCS) data that may be available for testing purposes in early 2014. 5. ‘‘Solicit Stakeholder Comments: Conversion to new code sets requires involvement of many stakeholders; measure developers should solicit PO 00000 Frm 00032 Fmt 4703 Sfmt 9990 70559 comments from a wide audience for additions and deletions, and with specific attention to new codes.’’ This notice represents one component of AHRQ’s comprehensive effort to solicit and respond to stakeholder comments. 6. ‘‘Version the Updated Measure: Measures with coding updates should be identified by version. Different versions of measures may be used longitudinally for various purposes but may not be exactly comparable.’’ This final step will be implemented when the updated AHRQ QI specifications have been tested and are ready for public use, not later than October 2014. For additional information about the AHRQ QIs, please visit the AHRQ Web site at http:// www.QUALITYindicators.AHRQ.gov. Background The AHRQ Quality Indicators (AHRQ QIs) are a unique set of measures of health care quality that make use of readily available hospital inpatient administrative data. The AHRQ QIs are provider- and area-level quality indicators and currently consist of four modules: The Prevention Quality Indicators (PQI), the Inpatient Quality Indicators, the Patient Safety Indicators (PSI), and the Pediatric Quality Indicators (PDIs). The AHRQ QIs serve multiple purposes, including research, needs assessments for planning at the local, state, and national levels, hospital quality improvement initiatives, performance assessment for public reporting to enable consumers to make more informed choices about their sites of care, public reporting to reward favorable outcomes and encourage changes in provider behavior, and information to be used by healthcare purchasers that link performance with payment. Users of the AHRQ QIs vary and include researchers, State data organizations, hospital systems and networks, hospital associations, State Medicaid agencies, Centers for Medicare & Medicaid Services (CMS), large private purchasers and public-private purchaser coalitions, and consumer groups. AHRQ is committed to converting the AHRQ QIs from ICD–9–CM to ICD–10– CM/PCS in an accurate and transparent manner, taking advantage of the additional specificity of ICD–10–CM/ PCS to improve the validity and usefulness of the QIs from October 2014 onward. Dated: November 13, 2013. Richard Kronick, AHRQ Director. [FR Doc. 2013–28282 Filed 11–25–13; 8:45 am] BILLING CODE 4160–90–P E:\FR\FM\26NON1.SGM 26NON1

Agencies

[Federal Register Volume 78, Number 228 (Tuesday, November 26, 2013)]
[Notices]
[Pages 70558-70559]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-28282]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Review of Proposed Changes with ICD-10-CM/PCS; Conversion of 
Quality IndicatorsTM (QIs)

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of request for public comments.

-----------------------------------------------------------------------

SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) seeks 
comments on the proposed conversion of the AHRQ Quality 
IndicatorsTM to ``International Classification of Diseases, 
10th Edition, Clinical Modification/Procedure Coding System'' (ICD-10-
CM and ICD-10-PCS) codes. These changes would be applicable to hospital 
discharges occurring on or after October 1, 2014. The proposed ICD-10-
CM/PCS codes are posted on the AHRQ QI Web site for review at: http://www.qualityindicators.ahrq.gov/icd10/default.aspx

DATES: Comments on this notice must be received no later than 5 p.m. 
EDT of December 26, 2013.

ADDRESSES: Comments can be filed via email or on paper. Write ``AHRQ QI 
ICD-10 Conversion'' on the comments.
    Postal mail addressed to AHRQ is subject to delay due to security 
screening. As a result, AHRQ encourages submission of comments via 
email. Please submit email comments to: QIComment@AHRQ.hhs.gov.
    If comments are filed on paper, write ``AHRQ QI ICD-10 Conversion'' 
on such comments and on the envelope, and mail them to the following 
address: Pam Owens, Scientific Lead, AHRQ QI Program, Center for 
Delivery, Organization and Markets, Agency for Healthcare Research and 
Quality, 540 Gaither Road, Rockville, MD 20850.
    AHRQ will remove all identifying information from the comments and 
will not provide individual responses. AHRQ will provide a summary of 
comments and actions taken as a result of those comments. The summary 
document will be posted on the AHRQ QI Web site no later than the end 
of January 2014.

FOR FURTHER INFORMATION CONTACT: Pam Owens, Agency for Healthcare 
Research and Quality, Center for Delivery, Organization and Markets, 
540 Gaither Road, Rockville, MD 20850, Email: pam.owens@AHRQ.hhs.gov, 
Phone: (301) 427-1412.

SUPPLEMENTARY INFORMATION: A structured approach was adopted for

[[Page 70559]]

converting the existing AHRQ QI specifications from ICD-9-CM to ICD-10-
CM/PCS, incorporating coding expertise, clinical expertise, and health 
services research/quality measurement expertise. This process is 
summarized in a document available for review at: http://www.qualityindicators.ahrq.gov/Downloads/Resources/Publications/2013/ICD-10%20Report%2007-15-2013.pdf
    Each current AHRQ QI technical specification with ICD-9-CM codes 
must be converted to ICD-10-CM/PCS codes. In each AHRQ QI technical 
specification, there can be one or more clinical concepts of selected 
ICD-9-CM codes for the numerator, denominator, and exclusion 
specifications. These clinical concepts are called `set names,' and 
they represent the basic foundation or building blocks in the 
construction of the AHRQ QIs. Every set name, whether diagnosis or 
procedure, must be mapped and reviewed for its clinical relationship to 
the clinical concept used within the current QI technical 
specification.
    Following consensus guidance from the National Quality Forum 
(http://www.qualityforum.org/Publications/2010/10/ICD-10-CM/PCS_Coding_Maintenance_Operational_Guidance.aspx), AHRQ's process for QI 
conversion in 2012 and 2013 included the following components:
    1. ``Convene Clinical and Coding Experts: * * *use a team approach 
that involves experts in the code sets and the appropriate clinical 
domain. The team should be used to identify specific areas where 
questions of clinical comparability exist, evaluate consistency of 
clinical concepts, and ensure appropriate conversion. Experts are 
needed in both the source and the target code set (e.g., ICD-9-CM and 
ICD-10-CM/PCS). Clinical expertise should be in the care setting 
represented by the clinical domain for the measure and may require 
specialized knowledge in some clinical areas.'' To this end, AHRQ 
contracted with clinical and coding experts at the University of 
California Davis and convened ten workgroups with a total of 27 
physicians, 22 nurses, 26 coding professionals, and 9 QI data users in 
the following domains: Cancer, Cardiac, Critical Care/Pulmonary, 
Infection, Internal Medicine, Neonatal/Pediatric, Neurology, Obstetrics 
and Gynecology, Orthopedic, General and Trauma Surgery. Work group 
members were trained on the ICD-10 code sets and supported by at least 
two American Health Information Management Association (AHIMA)-approved 
ICD-10-CM/PCS Trainers.
    2. ``Determine Intent: When converting a quality measure from ICD-
9-CM to ICD-10-CM/PCS, rather than doing a code-to-code conversion, a 
measure developer may choose to take advantage of the added granularity 
and specificity [that] ICD-10-CM/PCS offers, potentially making the 
updated measure inherently different* * * [T]he most ideal way to 
convert code sets for quality measures would be to examine the original 
intent of the measure and select codes directly from the target code 
set to define the concepts rather than relying on mapping alone* * * 
(1) The measure steward's goal was to convert this measure to a new 
code set, fully consistent with the intent of the original measure; (2) 
The measure steward's goal was to take advantage of the more specific 
code set to form a new version of the measure, but fully consistent 
with the original intent; (3) The measure steward has changed the 
intent of the measure.'' AHRQ adopted approaches (1) and (2) in the 
current conversion effort. Specifications consistent with (1) are 
called ``legacy specifications'' and are offered for historical 
analyses that require maximal comparability over time. Specifications 
consistent with (2) are called ``enhanced specifications'' and are 
offered for use in analyses of current health care quality, including 
public reporting and other accountability applications.
    3. ``Use Appropriate Conversion Tool: When converting from ICD-9-CM 
to ICD-10-CM/PCS, for example, maps such as General Equivalence Maps 
(GEMs) can be useful for narrowing the choice of target codes* * *'' 
GEM files were the foundation of AHRQ's code mapping effort.
    4. ``Assess for Material Change: Measure developers should 
determine during the process whether the measure has materially changed 
based on the intent of the updated measure and any testing that has 
been performed . . . This step is intended to address the comparability 
of the converted measure (using ICD-10-CM/PCS) to its predecessor 
(using ICD-9-CM) . . . Measure sponsors also should assess, if 
possible, whether the conversion results in rates that are similar 
within defined tolerances . . . '' This work will be undertaken over 
the next year as dual coded data becomes available for testing. AHRQ 
welcomes suggestions regarding dual-coded (ICD-9-CM and ICD-10-CM/PCS) 
data that may be available for testing purposes in early 2014.
    5. ``Solicit Stakeholder Comments: Conversion to new code sets 
requires involvement of many stakeholders; measure developers should 
solicit comments from a wide audience for additions and deletions, and 
with specific attention to new codes.'' This notice represents one 
component of AHRQ's comprehensive effort to solicit and respond to 
stakeholder comments.
    6. ``Version the Updated Measure: Measures with coding updates 
should be identified by version. Different versions of measures may be 
used longitudinally for various purposes but may not be exactly 
comparable.'' This final step will be implemented when the updated AHRQ 
QI specifications have been tested and are ready for public use, not 
later than October 2014.
    For additional information about the AHRQ QIs, please visit the 
AHRQ Web site at http://www.QUALITYindicators.AHRQ.gov.

Background

    The AHRQ Quality Indicators (AHRQ QIs) are a unique set of measures 
of health care quality that make use of readily available hospital 
inpatient administrative data. The AHRQ QIs are provider- and area-
level quality indicators and currently consist of four modules: The 
Prevention Quality Indicators (PQI), the Inpatient Quality Indicators, 
the Patient Safety Indicators (PSI), and the Pediatric Quality 
Indicators (PDIs). The AHRQ QIs serve multiple purposes, including 
research, needs assessments for planning at the local, state, and 
national levels, hospital quality improvement initiatives, performance 
assessment for public reporting to enable consumers to make more 
informed choices about their sites of care, public reporting to reward 
favorable outcomes and encourage changes in provider behavior, and 
information to be used by healthcare purchasers that link performance 
with payment. Users of the AHRQ QIs vary and include researchers, State 
data organizations, hospital systems and networks, hospital 
associations, State Medicaid agencies, Centers for Medicare & Medicaid 
Services (CMS), large private purchasers and public[hyphen]private 
purchaser coalitions, and consumer groups.
    AHRQ is committed to converting the AHRQ QIs from ICD-9-CM to ICD-
10-CM/PCS in an accurate and transparent manner, taking advantage of 
the additional specificity of ICD-10-CM/PCS to improve the validity and 
usefulness of the QIs from October 2014 onward.

    Dated: November 13, 2013.
Richard Kronick,
AHRQ Director.
[FR Doc. 2013-28282 Filed 11-25-13; 8:45 am]
BILLING CODE 4160-90-P