Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. III. Identification of Beneficiaries with Schizophrenia and Bipolar Disorder

04/09/2012

As recommended by the expert panel, we included beneficiaries with a primary diagnosis of schizophrenia or bipolar I disorder on at least one IP claim or on two outpatient claims on different dates (Simon and Unützer 1999; Unützer et al. 1998) (Table A.3). Following the recommendation of the expert panel, beneficiaries with a diagnosis of both bipolar disorder and schizophrenia were categorized according to the most frequent diagnosis during the calendar year, allowing IP claims to be weighted more heavily than outpatient claims if we observed an equal number of claims for the two diagnoses.

TABLE A.3. Proposed List of Diagnosis Codes for Identifying Individuals with Bipolar Disorder or Schizophrenia
 

  ICD-9-CM Code  

Description

Bipolar disorder   296.0 Bipolar I disorder, single manic episode
296.1 Manic disorder, recurrent episode
296.4 Bipolar I disorder, most recent episode (or current) manic
296.5 Bipolar I disorder, most recent episode (or current) depressed
296.6 Bipolar I disorder, most recent episode (or current) mixed
296.7 Bipolar I disorder, most recent episode (or current) unspecified  
Schizophrenia 295.0 Schizophrenia, simple type
295.1 Schizophrenia, disorganized type
295.2 Schizophrenia, catatonic type
295.3 Schizophrenia, paranoid type
295.4 Schizophreniform disorder
295.5 Latent schizophrenia
295.6 Schizophrenia, residual type
295.7 Schizoaffective disorder
295.8 Other specified types of schizophrenia
295.9 Unspecified schizophrenia

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