CLINICAL EPISODE DEFINITIONS

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Transurethral resection prostate (TURP)

Services and costs associated with a procedure of Transurethral Resection Prostate (TURP) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure...

Tonsillectomy (TONSIL)

Services and costs associated with a procedure of Tonsillectomy (TONSIL) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those with a...

Stroke (STR)

While Stroke (STR) is primarily an acute condition, the successful management of stroke patients involves the need for longer-term treatment and secondary prevention. Therefore, the Stroke episode looks into the index hospitalization to measure variation in costs at the hospital level and then follows the patient for 30 days post-discharge to capture variability associated...

Shoulder Replacement (SHLDRP)

Services and costs associated with a procedure of Shoulder Replacement (SHLDRP) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure code...

Prostatectomy (PRSCMY)

Services and costs associated with a procedure of Prostatectomy (PRSCMY) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those with a...

Pneumonia (PNE)

Pneumonia (PNE) is an acute episode with 30-day look forward window. Within the Pneumonia population, there are patients that have the index trigger event in an inpatient setting and others who are diagnosed and initially, or completely, managed in an outpatient setting. Even though Pneumonia by itself is associated as a complication with our...

Pacemaker / Defibrillator (PCMDFR)

Services and costs associated with a procedure of Pacemaker/Defibrillator (PCMDFR) are grouped together to include the index stay during which the procedure was performed, a 7-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 30-day post-discharge period to capture post-operative care. Patients are identified as those with a...

Mastectomy (MSTCMY)

Services and costs associated with a procedure of Mastectomy (MSTCMY) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure code of...

Lumbar Spine Fusion (FUSION)

Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them. Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bonelike material within the space between two spinal vertebrae. Metal plates, screws and...

Lumbar Laminectomy (LBRLAM)

Services and costs associated with a procedure of Lumbar Laminectomy (LBRLAM) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure code...

Knee Arthroscopy (KNARTH)

Services and costs associated with a procedure of Knee Arthroscopy (KNARTH) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure code...

Hysterectomy (HYST)

Services and costs associated with a procedure of Hysterectomy (HYST) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure code of...

Hip/Pelvic Fracture (HIPLFR)

The Hip/Pelvic Fracture (HIPLFR) episode is an acute episode, which looks into the index hospitalization to measure variation in costs at the hospital level and then follows the patient for 30 days post-discharge to capture variability associated with readmissions and the use of post-acute care. Services with diagnosis codes for signs and symptoms related...

Gall Bladder Surgery (GBSURG)

Services and costs associated with a procedure of Gall Bladder Surgery (GBSURG) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period. Patients are identified as those with a primary procedure...

Coronary Angioplasty (PCI)

Services and costs associated with a procedure of percutaneous coronary intervention (PCI) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those...

Colorectal Resection (COLON)

Services and costs associated with a procedure of Colon Resection (COLON) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those with...

Colonoscopy (COLOS)

Most colonoscopies are currently done in an outpatient setting, either in a doctor’s office or in an ambulatory surgery center, so these are the ones intended to be captured in the COLOS episode. The COLOS episode focuses on screening, surveillance and diagnostic colonoscopies. Services and costs associated with a procedure of colonoscopy (COLOS) are...

Cataract Surgery (CTRTSU)

Most cataract surgery procedures are done in an outpatient setting, so these are the ones intended to be captured in the CTRTSU episode. Services and costs associated with a procedure of Cataract Surgery (CTRTSU) are grouped together to include the index event during which the procedure was performed, a 30-day look back period to...

CABG and/or Valve Procedures (CXCABG)

Services and costs associated with a procedure of coronary artery bypass grafting, with or without valve surgery, arrhythmia surgery, or other related open-heart procedures, are grouped together into a complex coronary artery bypass graft (CxCABG) episode. The episode includes the index stay during which the procedure was performed, a 30-day look back period to...

Breast Biopsy (BSTBIO)

Most breast biopsy procedures are done in an outpatient setting, so these are the ones intended to be captured in the BSTBIO episode. Services and costs associated with a procedure of Breast Biopsy (BSTBIO) are grouped together to include the index event during which the procedure was performed, a 7-day look back period to...

Bariatric Surgery (BARI)

Services and costs associated with a procedure of Bariatric Surgery (BARI) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those with...

Acute Myocardial Infarction (AMI)

While AMI is primarily an acute condition, the successful management of AMI patients involves the need for longer-term treatment and secondary prevention. Therefore, the AMI episode looks into the index hospitalization to measure variation in costs at the hospital level and then follows the patient for 30 days post-discharge to capture variability associated with...