Guest post: Reviewing PSIs to ensure patient safety, ICD-10-CM/PCS compliance

by James S. Kennedy, MD, CCS, CDIP, CCDS

Physicians are ethically engaged in keeping patients safe and doing no harm. Unfortunately, medical and surgical care is complicated, especially in patients with high-risk comorbidities; thus, unintended negative results do occur.

In advocating patient safety, CMS implemented financial incentives and penalties based on hospital performance with the HHS Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) 90 through fiscal year (FY) 2018 and the Patient Safety and Adverse Events (Composite) (PSAEC) measure beginning in FY 2023.

As discussed in last year’s IPPS 2018 final rule, the PSAEC consists of the following AHRQ PSIs:

• PSI 03, Pressure Ulcer Rate
• PSI 06, Iatrogenic Pneumothorax Rate
• PSI 08, In-Hospital Fall with Hip Fracture Rate
• PSI 09, Perioperative Hemorrhage or Hematoma Rate
• PSI 10, Postoperative Acute Kidney Injury Requiring Dialysis Rate
• PSI 11, Postoperative Respiratory Failure Rate
• PSI 12, Perioperative Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) Rate
• PSI 13, Postoperative Sepsis Rate
• PSI 14, Postoperative Wound Dehiscence Rate
• PSI 15, Unrecognized Abdominopelvic Accidental Puncture/Laceration Rate

CMS is also using PSI 04 (Death Rate among Surgical Inpatients with Serious Treatable Conditions) in its value-based purchasing programs.

These PSIs were developed by AHRQ after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses. They are a set of indicators that provide information on the potential of hospital complications and adverse events following surgeries, procedures, and childbirth. ICD-10-CM validation is still in progress.

Unlike most clinical databases (e.g., Society of Thoracic Surgeons’ for thoracic surgery) that are abstracted by trained clinicians, PSIs are based only on ICD-10-CM/PCS claims submitted by inpatient facilities, and those claims are based solely on physician documentation using the somewhat quirky language and coding guidelines governing ICD-10-CM/PCS code assignment. Mastering PSIs means physicians must document according to AHRQ’s:

• Inclusion criteria
• Exclusion criteria
• Risk-adjustment methodology

PSI version 7.0, using ICD-10-CM/PCS codes, is profiled on the AHRQ website. View your hospital’s performance on the CMS website.

Editor’s note: This article originally appeared in JustCoding. Dr. Kennedy is a general internist and certified coder, specializing in clinical effectiveness, medical informatics, and clinical documentation and coding improvement strategies. Contact him at 615-479-7021 or at jkennedy@cdimd.com. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.