Patient Safety Indicators – What Are They?

Patient Safety Indicators (PSIs) are more than just quality metrics—they are a direct reflection of how accurately coding and documentation capture patient care. Developed by AHRQ, PSIs identify potentially preventable complications and are used to compare hospital performance, influence public reporting, and impact reimbursement. Understanding how PSIs are triggered, including the role of ICD-10-CM code assignment and present on admission indicators, is essential for coding professionals and healthcare leaders alike. Even small coding or documentation gaps can alter PSI outcomes, affecting PSI 90 composite scores and ultimately shaping how an organization is evaluated across national benchmarking programs.

Patient safety indicators (PSI) were developed by the Agency for Healthcare Research and Quality (AHRQ) to serve as a standardized method of identifying and reporting patient safety issues. Indicators are associated with certain adverse events occurring after a surgery, procedure or childbirth during a hospital inpatient admission that are considered potentially avoidable.

The indicators are used to compare and track organizations’ performance on safety measures. These are the 17 current patient safety indicators.

There are also 10 appendices containing data used in conjunction with safety indicator criteria to identify circumstances where patient safety indicators are applicable.

PSI 90

Organizations pay special attention to PSI 90 Patient Safety and Adverse Events Composite. This is a composite measure that combines an organization’s performance on multiple safety indicators into a single score. This score can be used for several purposes:

• Help hospitals assess their performance in relation to preventable complications
• Supports financial penalties or incentives tied to quality care
• Provides a publicly available hospital “score card” used to rank hospitals

Not all PSIs are used in the calculation of PSI 90 scores. Currently, PSI 90 composite scores are calculated from performance on the PSIs listed here.

Click here for all the details about composite measures, including what they are and how they are created.

What Triggers Assignment of a Patient Safety Indicator?

PSI reporting is based on ICD-10-CM code assignment along with meeting certain inclusionary and exclusionary criteria called technical specifications.

Example: PSI 03 Pressure Ulcer Rate

PSI 03 Pressure Ulcer Rate is triggered for patients meeting the following technical specifications.

• Assignment of a code for a *stage 3, *stage 4 or *unstageable pressure ulcer as a secondary diagnosis
• Patient is a *medical or *surgical patients 18 years or older 

Note: *Pertinent ICD-10-CM pressure ulcer codes are included in the technical specifications information for PSI 03 and medical and surgical MS-DRGs are outlined in PSI Appendix C Medical Discharge MS-DRGs and PSI Appendix E Surgical Discharge MS-DRGs.

With the exception of certain categories of discharges which are excluded from triggering PSI 03 even when the technical specifications are met.

Excluded – Discharges With:

• Length of stay of less than 3 days
• Principal ICD-10-CM diagnosis code for site-specific pressure ulcer stage 3 or 4 (or unstageable) or deep tissue injury at the same anatomic site
• Any ICD-10-CM diagnosis code for *severe burns (≥20% body surface area)
• Any ICD-10-CM diagnosis code for *exfoliative disorders of the skin (≥20% body surface area)
• Principal ICD-10-CM diagnosis code assigned to *MDC 14 Pregnancy, Childbirth & the Puerperium
• Principal ICD-10-CM diagnosis code assigned to *MDC 15 Newborns & Other Neonates with Conditions Originating in Perinatal Period
• An ungroupable DRG (DRG=999)
• Missing
  • Sex
  • Age
  • Quarter
  • Year
  • Principal diagnosis
  • MDC when the user indicates that MDC is provided
• A secondary diagnosis code for deep tissue injury or unstageable pressure ulcer present on admission at ALL anatomic sites

Note: * The applicable ICD-10-CM codes for severe burns and exfoliative skin disorders are included in the technical specifications information for PSI 03, and the principal diagnosis codes that map to MDCs 14 and 15 are found in PSI Appendix O.

Present on Admission

Assignment of a PSI is also influenced by the POA status of the diagnoses that are being tracked in relation to patient safety measures. For example, when these diagnoses are reported with a POA indicator of “Y”, indicating that they were present on admission, they are excluded from patient safety indicator determinations. There are other exclusions that apply as well.

The Impact of ICD-10-CM Coding

Although PSI determinations are made behind the scenes through the use of software, their assignment is based in part on reporting and sequencing of diagnosis codes and assignment of POA indicators. This means the accuracy of the work of coding professionals is directly related to how their organization fares on quality measures, which has a downstream impact on an organization’s revenue cycle.

A full list of patient safety indicators with links to their individual technical specifications, as well as a list of all other AHRQ quality indicators can be found at AHRQ QI: Patient Safety Indicators Overview | AHRQ Quality Indicators.

Take Aways

• Patient Safety Indicators serve as a standardized method of identifying and reporting patient safety issues.
• An organization’s score on PSI 90 is an important metric highlighting areas needing improvement in patient safety and influencing revenue through quality scores
• Certain circumstances as defined by technical specifications must be met before patent safety indicators are triggered.
• The accuracy of ICD-10-CM coding is a key factor in PSI determinations, giving it a direct influence on an organization’s revenue.

References

• https://qualityindicators.ahrq.gov/measures/PSI_TechSpec
• https://followinghealthcare.com/psi-90/

FAQ

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.