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HCUP Facts and Figures 2009
Statistics on Hospital-Based Care in the United States, 2009
TABLE OF CONTENTS

HIGHLIGHTS

INTRODUCTION

HCUP PARTNERS

1. OVERVIEW

2. DIAGNOSES

3. PROCEDURES

4. COSTS

5. WOMEN'S HEALTH

SOURCES/METHODS

DEFINITIONS

FOR MORE INFO

ACKNOWLEDGMENTS

CITATION

FACTS & FIGURES 2009 PDF
SOURCES AND METHODS

Unit of Analysis
The unit of analysis is the hospital stay rather than the patient. All stays have been weighted to produce national estimates.

Coding Diagnoses and Procedures
Diagnoses and procedures associated with an inpatient hospitalization can be defined using several different medical condition classification systems. The Clinical Classifications Software (CCS) was used predominantly within this report to identify specific diagnoses and procedures. CCS is based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), a uniform and standardized coding system containing over 13,600 diagnosis codes and 3,700 procedure codes. Each discharge record in the NIS is associated with one or more ICD-9-CM diagnosis code(s) and may contain one or more ICD-9-CM procedure code(s) if a procedure was performed during that hospitalization. Each hospital stay can have multiple CCS diagnoses and multiple CCS procedures.

In the CCS, ICD-9-CM codes are clustered into a smaller number of clinically meaningful categories that are sometimes more useful for presenting descriptive statistics than are individual ICD-9-CM codes. CCS codes are used extensively in this report to define groups of diagnoses and procedures for analysis. The CCS codes allow the reader to quickly and easily recognize patterns and trends in broad categories of hospital utilization. More information on CCS can be found online (http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp). Specific CCS conditions or diagnoses can also be summarized into CCS body system or condition categories, which are broad groups of CCS conditions, such as Neoplasms, Mental Disorders, and Diseases of the Circulatory System.

Exhibit Diagnoses and Procedures
Throughout this report, combinations of diagnostic and procedure codes are used to isolate specific conditions or procedures. These codes are defined below by exhibit number.

SECTION 2 — INPATIENT HOSPITAL STAYS BY DIAGNOSIS

EXHIBIT 2.1

Reasons for hospital stays are based on principal diagnosis defined by the following Major Diagnostic Categories (MDC):

MDC CATEGORY DESCRIPTION
0 Principal diagnosis cannot be assigned to MDC (invalid or pre-MDC)
1 Diseases and disorders of the nervous system
2 Diseases and disorders of the eye
3 Diseases and disorders of the ear, nose, mouth and throat
4 Diseases and disorders of the respiratory system
5 Diseases and disorders of the circulatory system
6 Diseases and disorders of the digestive system
7 Diseases and disorders of the hepatobiliary system and pancreas
8 Diseases and disorders of the musculoskeletal system and connective tissue
9 Diseases and disorders of the skin, subcutaneous tissue and breast
10 Endocrine, nutritional and metabolic diseases and disorders
11 Diseases and disorders of the kidney and urinary tract
12 Diseases and disorders of the male reproductive system
13 Diseases and disorders of the female reproductive system
14 Pregnancy, childbirth and the puerperium
15 Newborns and other neonates with conditions originating in the perinatal period
16 Diseases and disorders of blood, blood forming organs, immunological disorders
17 Myeloproliferative diseases and disorders, poorly differentiated neoplasm
18 Infectious and parasitic diseases, systemic or unspecified sites
19 Mental diseases and disorders
20 Alcohol/drug use and alcohol/drug induced organic mental disorders
21 Injuries, poisonings and toxic effects of drugs
22 Burns
23 Factors influencing health status and other contacts with health services
24 Multiple significant trauma
25 Human Immunodeficiency Virus infections

SECTION 4 — COSTS FOR INPATIENT HOSPITAL STAYS

EXHIBIT 4.5

See definition for MDCs under Exhibit 2.1.

SECTION 5 — WOMEN'S HEALTH

Maternal stays and stays for childbirth in this section occurred among females ages 15-44. Non-maternal female stays are hospital stays for females of all ages who are not pregnant or did not give birth.

EXHIBIT 5.1 and 5.6

Childbirth stays were defined using the following Diagnosis Related Groups (DRG) for 1997-2007:

DRG PROCEDURE DESCRIPTION
370 Cesarean section with complications and comorbidities
371 Cesarean section without complications and comorbidities
372 Vaginal delivery with complicating diagnoses
373 Vaginal delivery without complicating diagnoses
374 Vaginal delivery with sterilization and/or dilation and curettage
375 Vaginal delivery with operating room procedure except sterilization and/or dilation and curettage

Childbirth stays were defined using the following DRGs for 2008-2009:

DRG PROCEDURE DESCRIPTION
765 Cesarean section with complications and comorbidities/major complications and comorbidities
766 Cesarean section without complications and comorbidities/major complications and comorbidities
767 Vaginal delivery with sterilization and/or dilation and curettage
768 Vaginal delivery with operating room procedure except sterilization and/or dilation and curettage
774 Vaginal delivery with complicating diagnoses
775 Vaginal delivery without complicating diagnoses

Maternal stays were defined using the above listed DRG codes or the following CCS diagnosis codes:

CCS DIAGNOSIS DESCRIPTION
177 Spontaneous abortion
178 Induced abortion
179 Postabortion complications
180 Ectopic pregnancy
181 Other complications of pregnancy
182 Hemorrhage during pregnancy, abruptio placenta, placenta previa
183 Hypertension complicating pregnancy, childbirth and the puerperium
184 Early or threatened labor
185 Prolonged pregnancy
186 Diabetes or abnormal glucose tolerance complicating pregnancy, childbirth, or the puerperium
187 Malposition, malpresentation
188 Fetopelvic disproportion, obstruction
189 Previous C-section
190 Fetal distress and abnormal forces of labor
191 Polyhydramnios and other problems of amniotic cavity
192 Umbilical cord complication
193 OB-related trauma to perineum and vulva
194 Forceps delivery
195 Other complications of birth, puerperium affecting management of the mother

Average cost per day was calculated by taking the average of the cost per day for each stay.

EXHIBIT 5.2

See definition for MDCs under Exhibit 2.1.

EXHIBIT 5.6

Childbirth and maternal stays were defined by the DRGs and CCS codes for 1997-2009 listed under Exhibit 5.1.

Perineal lacerations

Stays for vaginal deliveries with perineal lacerations were defined using DRGs 372-375 for 1997-2007 and DRGs 767,768, 774, and 775 for 2008-2009, with the following ICD-9 diagnosis codes:

ICD-9-CM DIAGNOSIS DESCRIPTION
664.0 First-degree perineal laceration
664.1 Second-degree perineal laceration
664.2 Third-degree perineal laceration
664.3 Fourth-degree perineal laceration
664.4 Unspecified perineal laceration

Vaginal delivery with and without episiotomy

Stays for vaginal delivery with episiotomy were defined using DRGs 372-375 for 1997-2007 and DRGs 767,768, 774, and 775 for 2008-2009, with the following CCS procedure code:

CCS PROCEDURE DESCRIPTION
133 Episiotomy

Stays for vaginal delivery without episiotomy were defined using the above DRGs, but excluded CCS procedure code 133 (Episiotomy).

Vaginal delivery after induction of labor

Stays for vaginal delivery after induction of labor were defined using DRGs 372-375 for 1997-2007 and DRGs 767,768, 774, and 775 for 2008-2009, with the following ICD-9 procedure codes:

ICD-9-CM PROCEDURE DESCRIPTION
73.01 Induction of labor by artificial rupture of membranes
73.1 Other surgical induction of labor
73.4 Medical induction of labor

Cesarean section delivery after induction of labor

Stays for Cesarean section delivery after induction of labor were defined using DRGs 370 and 371 for 1997-2007 and DRGs 765 and 766 for 2008-2009, with the following ICD-9 procedure codes:

ICD-9-CM PROCEDURE DESCRIPTION
73.01 Induction of labor by artificial rupture of membranes
73.1 Other surgical induction of labor
73.4 Medical induction of labor

Vaginal delivery without a previous Cesarean section

Stays for vaginal delivery without a previous Cesarean section were defined using DRGs 372-375 for 1997-2007 and DRGs 767,768, 774, and 775 for 2008-2009, and excluded the following CCS diagnosis code:

CCS DIAGNOSIS DESCRIPTION
189 Previous C-section

First time Cesarean section

Stays for first time Cesarean section were defined using DRGs 370 and 371 for 1997-2007 and DRGs 765 and 766 for 2008-2009, or the following ICD-9 diagnosis codes:

ICD-9-CM DIAGNOSIS DESCRIPTION
669.70 Cesarean delivery, without mention of indication; unspecified as to episode of care or not applicable
669.71 Cesarean delivery, without mention of indication; delivered, with or without mention of antepartum condition
763.4 Cesarean delivery

And excluded the following ICD-9 diagnosis codes:

ICD-9-CM DIAGNOSIS DESCRIPTION
654.20 Previous cesarean delivery; unspecified as to episode of care or not applicable
654.21 Previous cesarean delivery; delivered, with or without mention of antepartum condition
654.23 Previous cesarean delivery; antepartum condition or complication

Repeat Cesarean section

Stays for repeat Cesarean section were defined using DRGs 370 and 371 for 1997-2007 and DRGs 765 and 766 for 2008-2009, with the following ICD-9 diagnosis codes:

ICD-9-CM DIAGNOSIS DESCRIPTION
654.20 Previous cesarean delivery; unspecified as to episode of care or not applicable
654.21 Previous cesarean delivery; delivered, with or without mention of antepartum condition
654.23 Previous cesarean delivery; antepartum condition or complication

Vaginal birth after Cesarean section

Stays for vaginal birth after Cesarean section were defined using DRGs 372-375 for 1997-2007 and DRGs 767,768, 774, and 775 for 2008-2009, with CCS diagnosis code 189 (Previous C-section).



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Internet Citation: Facts and Figures 2009 - Sources and Methods. Healthcare Cost and Utilization Project (HCUP). December 2011. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/factsandfigures/2009/sources_methods.jsp.
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