Performance Measurement in the Hospital Outpatient Setting. Appendix C: Diagnoses Associated with Visits to the Hospital Outpatient Setting and Emergency Departments by Medicare Beneficiaries, 2005

02/01/2008

In the following table, the key clinical categories listed are organized alphabetically and represent 100 percent of the primary diagnoses associated with Evaluation & Management (E&M) visits in the Hospital Outpatient Setting and Emergency Departments. Within each clinical category, we present more detailed diagnostic groups that account for at least 0.5 percent or more of the total diagnoses. Therefore, the sum of the percentages for diagnostics groups within a clinical category will not equal the percentage for the category.

 
Hospital Outpatient Setting
Emergency Department
Total Encounters
15,325,267
11,426,386
Percent Included In list
100%
100%
Clinical Category
Diagnostic Groups
Diagnostic Groups
Cardiothoracic Surgery 0.01%     0.01%    
Dentistry 0.10%     0.59%    
Dermatology 6.65%     4.21%    
  Other skin diseases 4.39%   Skin infections 1.93%
  Skin infections 0.81%   Symptoms 1.09%
  Inflammatory skin conditions 0.75%   Other skin diseases 0.63%
  Symptoms 0.60%   Inflammatory skin conditions 0.56%
Dysmorphology-Genetics 0.15%     0.02%    
Gynecology 0.79%     0.47%    
Head and Neck 1.09%     3.97%    
  Ear and mastoid 0.85%   Laceration/open wound 1.92%
        Ear and mastoid 1.00%
        Injury 0.67%
Medicine-Cardiology 6.68%     3.45%    
  Conduction/dysrhythmias 2.48%   Conduction/dysrhythmias 1.28%
  Ischemic heart 1.82%   Heart failure 0.86%
  Heart failure 1.33%   Symptoms 0.62%
        Ischemic heart 0.60%
Medicine-Endocrinology 7.03%     1.62%    

 

 
Hospital Outpatient Setting
Emergency Department
Total Encounters
15,325,267
11,426,386
Percent Included In list
100%
100%
Clinical Category
Diagnostic Groups
Diagnostic Groups
    Endocrine, metabolic 6.98%   Endocrine, metabolic 1.62%
Medicine-General 35.21%     43.40%    
  Hypertension 7.42%   Symptoms 20.35%
  Aftercare, specific procedures 6.40%   Injury 6.15%
  Symptoms 4.48%   COPD and related 3.49%
  Endocrine, metabolic 2.37%   Acute respiratory infection 2.78%
  Health system encounter 2.18%   Endocrine, metabolic 1.47%
  COPD and related 1.99%   Complications 1.41%
  Venous disease 1.97%   Hypertension 1.39%
  General exam 1.49%   Infectious and parasitic disease 1.23%
  Acute respiratory infection 1.34%   Aftercare, specific procedures 1.08%
  Complications 1.04%   Venous disease 0.72%
  Arterial disease 0.83%   Poisonings 0.55%
  Upper respiratory tract 0.56%   Toxic effects-external causes 0.50%
Medicine-GI 2.37%     6.26%    
  Upper GI 0.62%   Symptoms 1.78%
        Upper GI 1.17%
        Functional digestive 0.93%
        Inflammatory bowel 0.84%
Medicine-Infectious Disease 2.25%     1.27%    
  Infectious and parasitic disease 1.84%   Infectious and parasitic disease 1.21%
Medicine-Nephrology 0.92%     0.37%    
  Chronic renal failure 0.58%      
Medicine-Oncology/Neoplasia 13.10%     0.88%    
  Cancer 9.17%   Hematology 0.58%
  Hematology 2.35%      
  Neoplasm-uncertain behavior 0.54%      
Neurology 2.82%     2.45%    
  Cerebrovascular 0.64%   Migraine 0.87%
  Hereditary/degenerative 0.75%   Cerebrovascular 0.76%
  Peripheral nerve disorders 0.57%      
Neurology/Neurosurgery 0.13%     0.37%    
Obstetrics 0.13%     0.08%    
Ophthalmology 4.18%     0.83%    
           
  Glaucoma 1.14%      
  Cataract 0.95%      
  Retinal disorders 0.76%      
Orthopedics 10.39%     16.61%    
  Back disorders 3.92%   Back disorders 3.94%
  Arthropathies 1.95%   Sprains and strains 3.63%
  Rheumatism 1.73%   Fracture 2.75%
  Other joint disorders 1.31%   Rheumatism 2.59%
  Osteopathies, chondropathies 0.90%   Other joint disorders 2.02%
        Arthropathies 0.70%
Psychiatry 1.49%     3.59%    
  Psychoses 0.75%   Neuroses 2.11%
  Neuroses 0.70%   Psychoses 1.47%
Surgery-General 1.73%     2.49%    
  Laceration/open wound 1.10%   Laceration/open wound 2.49%
Trauma 0.17%     0.68%    
Urology 2.12%     5.32%    
  Symptoms 0.61%   Urinary tract infection 2.40%
  Urinary tract infection 0.53%   Symptoms 1.20%
        Calculus 0.52%

Table notes: The percentages associated with each diagnosis within a clinical category may not sum to the percentage for the clinical category given that we only list diagnoses at 0.5 percent or higher.

The data presented in Table 3 do not account for all hospital outpatient setting claims, as some hospital outpatient setting services may be entirely procedural and, therefore, not accompanied by a separately identifiable E&M code.

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