Listed below are the qualifications for Inpatient Measure Sets Initial Patient Population (IPP).
CMS Specifications:
Sepsis (SEP)
The population of the SEP measure set is identified using 5 data elements:
• ICD-10-CM Principal Diagnosis Code
• ICD-10-CM Other Diagnosis Codes
• Admission Date
• Birthdate
• Discharge Date
Patients admitted to the hospital for inpatient acute care with an ICD-10-CM Principal or Other Diagnosis Code for SEP as defined in Appendix A, Table 4.01, an ICD-10-CM Principal or Other Diagnosis Code not equal to U07.1 (COVID-19), a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years, and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the SEP Initial Patient
Population and are eligible to be sampled.
TJC Specifications:
Global (Includes ED, IMM, SUB, TOB)
The Global Initial Patient Population is defined by two data elements:
• Admission Date
• Discharge Date
All patients discharged from acute inpatient care with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the Global Initial Population and are eligible for sampling.
Hospital-Based Inpatient Psychiatric Services Discharges (HBIPS-DSC)
The general population of the HBIPS discharge measures can be identified by using four data elements that are common to the discharge performance measures in the HBIPS set:
• ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes
• Discharge Date
• Birthdate
• Psychiatric Care Setting
The HBIPS Discharge Topic Population is defined as patients discharged from the Psychiatric Care Setting with an ICD-10-CM Principal or Other Diagnosis Code for Mental Disorders as defined in Appendix A, Table 10.01 and a Patient Age at Discharge (Discharge Date minus Birthdate) >= 1 year.
Hospital-Based Inpatient Psychiatric Services Events (HBIPS-EVT)
The population of the HBIPS event measures can be identified by using two data elements that are common to the event performance measures in the HBIPS set:
• Event Date
• Psychiatric Care Setting
The HBIPS Event Topic Population (common to all HBIPS event measures) is defined as patients with an event (Event Date exists) while they are in the hospital with a Patient Age at Time of Event (Event Date minus Birthdate) >= 1 year and the patient was in a Psychiatric Care Setting (='Y') when the event occurred.
Perinatal Care (PC)
Mothers
The population of the PC-Mother measures (PC-01, and 02) are identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-PCS Principal or Other Procedure Code
Patients admitted to the hospital for inpatient acute care are included in the PC Mother Initial sampling group if they have: ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 11.01.1 Delivery, a Patient Age (Admission Date minus Birthdate) >= 8 years and < 65 and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Newborns
The population of the PC-Newborn measures (PC-05, PC-06) are identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM Principal or Other Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the PC Newborn Initial population if they have: A Patient Age (Admission Date minus Birthdate) <= 1 day and ICD-10-CM Principal or Other Diagnosis Codes as defined in Appendix A, Table 11.20.1 Single Liveborn Newborn.
Venous Thromboembolism (VTE)
The VTE sub-population utilizes four data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM Other Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the VTE ICD sub-populations if they have:
Other VTE Only sub-population – Patients with an ICD-10-CM Other Diagnosis Code as defined in Appendix A, Tables 7.03 and 7.04, a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years, and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days. The patients cannot have an ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Tables 7.03 and 7.04.
Acute Stroke Ready Inpatient (ASR-IP)
The population of the ASR-IP measure set is identified using 4 data elements:
• ICD-10-CM Principal Diagnosis Code
• Admission Date
• Birthdate
• Discharge Date
Patients admitted to the hospital for inpatient acute care with an ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1, a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the ASR-IP Initial Patient Population.
Comprehensive Stroke (CSTK)
Ischemic Stroke
The population of the CSTK 1-Ischemic Stroke measures (CSTK-01) are identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the Ischemic Stroke Without Procedure subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Ischemic Stroke With IV t-PA, IA t-PA, or MER
The population of the CSTK 2-Ischemic Stroke With IV t-PA, IA t-PA, or MER measures (CSTK-01, CSTK-02, CSTK-05, CSTK-07, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12) are identified using 5 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM Principal Diagnosis Code
• ICD-10-PCS Principal or Other Procedure Codes
Patients admitted to the hospital for inpatient acute care are included in the Ischemic Stroke With IV t-PA, IA t-PA, or MER subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1 AND ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 8.1a OR Table 8.1b, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Ischemic Stroke With IV t-PA, IA t-PA, or MER (NEW Begins 1/1/2024)
The population of the CSTK 2-Ischemic Stroke With IV t-PA, IA t-PA, or MER measures (CSTK-01, CSTK-02, CSTK-05, CSTK-08, CSTK-09, CSTK-10, CSTK-11, CSTK-12) are identified using 5 data elements:
- Admission Date
- Birthdate
- Discharge Date
- ICD-10-CM Principal Diagnosis Code
- ICD-10-PCS Principal or Other Procedure Codes
Patients admitted to the hospital for inpatient acute care are included in the CSTK-2 Ischemic Stroke With IV t-PA, IA t-PA, or MER subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1 AND ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 8.1a OR Table 8.1b OR Table 8.1c, a Patient Age (Admission Date – Birthdate) ≥ 18 years and a Length of Stay (Discharge Date - Admission Date) ≤ 120 days.
Hemorrhagic Stroke
The population of the Hemorrhagic Stroke measures (CSTK-03, CSTK-04, CSTK-06) are identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the CSTK 3-Hemorrhagic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.2, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Stroke (STK)
Ischemic Stroke
The population of the STK Ischemic Stroke is identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the Ischemic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Hemorrhagic Stroke
The population of the Hemorrhagic Stroke is identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the Hemorrhagic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.2, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Stroke Volume (STK-VOL)
Ischemic Stroke
The population of the STK Ischemic Stroke is identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the Ischemic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.1, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Hemorrhagic Stroke
The population of the Hemorrhagic Stroke is identified using 4 data elements:
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-CM-Principal Diagnosis Code
Patients admitted to the hospital for inpatient acute care are included in the Hemorrhagic Stroke subpopulation sampling group if they have: ICD-10-CM Principal Diagnosis Code as defined in Appendix A, Table 8.2, a Patient Age (Admission Date minus Birthdate) ≥ 18 years and a Length of Stay (Discharge Date minus Admission Date) ≤ 120 days.
Total Hip and Total Knee Replacement Inpatient (THKR-IP)
The population of the THKR measure set is identified using 6 data elements:
• ICD-10-PCS principal procedure code
• Admission Date
• Birthdate
• Discharge Date
• ICD-10-PCS Other procedure code
• ICD-10-CM Principal or Other Diagnosis Code
Patients admitted to the hospital for inpatient care are included in THKR-IP Measure set if they have:
An ICD-10-PCS Principal Procedure Code as defined in Appendix A, Table 14.01a, 14.02a , a Patient Age (Admission Date minus Birthdate) greater than or equal to 18 years and a Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days, ICD-10-PCS Other procedure codes are all missing or none on Table 14.05a, 14.06a, 14.07a, and no ICD-10-CM Principal or Other Diagnosis Codes on Table 14.08, 14.09.
And are eligible to be sampled for:
1 – Stratum 1 – If patients have an ICD-10-PCS Principal Procedure Code as defined in Appendix A, Table 14.01a are included in the THKR stratum-1 and are eligible to be sampled.
2 – Stratum 2 – If patients have an ICD-10-PCS Principal Procedure Code as defined in Appendix A, Table 14.02a are included in the THKR stratum-2 and are eligible to be sampled.
IPFQR Specifications
The initial selection of cases (i.e., patient medical records) intended for data abstraction
under the IPFQR Program must be all patients (i.e., Medicare and non-Medicare patients)
receiving care in a psychiatric hospital or certified psychiatric unit paid under IPF PPS.
The Transition Record with Specified Elements Received by Discharged Patients
measure will use the entire population (all IPF discharges) for the Initial Patient
Population.
The Screening for Metabolic Disorders measure Initial Patient Population is all
patients discharged from an IPF during the measurement period with a prescription
for one or more routinely scheduled antipsychotic medications.
For Code Tables, please see the relevant specifications for the time period in question.
TJC Specifications