Appendix D. Methodology Enhancements for 2007 Ratings Models
© Copyright 2007 Health Grades, Inc. All rights reserved.
Hospital Report CardsTM Methodology 40
May not be reprinted or reproduced without permission from Health Grades, Inc.
Orthopedics
Cohorts Affected
2007 Ratings' Model Change
Rationale for Changes
Total Knee, Total Hip,
Back and Neck
Surgery, Spinal fusion
Consider Renal Failure, AMI, and
Pneumonia as complications
without a corresponding
postoperative 900 complication
code
In using administrative data, some codes that appear
may be a complication but they can also be risks. In
order to differentiate complications in the analysis,
HealthGrades assigns codes as complications only if
there is a corresponding 900 postoperative
complication code. This year in the elective joint
procedures, if codes for renal failure, AMI, or
pneumonia appear, they are automatically assigned
as complications. The rationale for this is that it is
highly unlikely these conditions are risk factors in this
population.
Total Knee and Total
Hip Replacements
Exclude patients with mechanical
complication of prosthetic joint
device codes when primary
diagnosis (9964)
Some patients receiving a joint replacement have had
previous orthopedic surgery on that joint and are now
experiencing complications on that same joint.
Because this situation is infrequent, when it occurs,
inadequate risk adjustment may occur due to the low
volume of this patient population (and not reaching
the statistical significance required to remain in the
final prediction model), thus necessitating exclusion
from the patient population evaluated.
Hip Fracture Repair
Partial Hip
Replacement
Exclude Removal of implanted
devices from bone (78.65-78.67)
and removal of hip and knee
prostheses (80.05-80.06)
Some patients who have hip fracture repair surgery or
partial hip replacements have had previous
orthopedic surgery and require removal of fixation
devices or limb lengthening devices. Patients who
present with previous orthopedic devices that must be
removed are sometimes coded as having a
mechanical complication. In these cases, the
complication appears to be post-operative in the
administrative data. Thus these patients are removed.
