Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Appendix A. Diagnosis and Procedure Codes to Identify Conditions of Focus

02/01/2009

Condition ICD-9 diagnosis codes How selected Source for dx codes
Acute myocardial infarction 410.xx (only first for second Dx on the claim At least 1 inpatient claim with DX code during 1 year period CMS Chronic Care Warehouse
Bacterial pneumonia 481.xx-483.xx (any Dx on claim) At least 1 inpatient, or 2 HOP or Carrier claims with DX codes during 1 year period Rello et al.
Breast cancer (limited to women) 174.xx, 233.0 (any Dx on claim) At least 1 inpatient, or 2 HOP or Carrier claims with DX codes during 1 year period CMS Chronic Care Warehouse
Cerebrovascular disease 433.xx; 434.xx (any Dx on claim) At least 1 inpatient, or 2 HOP or Carrier claims with DX codes during 1 year period Bravada (2003)
Chronic obstructive pulmonary disease- -   491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8,-  494.0, 494.1, 496 (any Dx on claim) At least 1 inpatient, SNF, HHA or 2 HOP or Carrier claims with DX codes during 1 year period CMS Chronic Care Warehouse
Congestive heart failure 398.91; 402.x1; 404.x1; 404.x3; 428.xx;-  (any DX on claim) At least 1 inpatient, HOP or Carrier claim with DX codes during 2 year period CMS Chronic Care Warehouse
Diabetes 250.xx, 357.2, 362.01, 362.02, 366.41 (any DX on the claim) At least 1 inpatient, SNF, HHA or 2 HOP or Carrier claims with DX codes during 2 year period CMS Chronic Care Warehouse
Hip fracture 808.0x 808.1x, 808.2x, 808.3x, 808.41, 808.42, 808.43, 808.49, 808.51, 808.52, 808.53, 808.59, 808.8x, 808.9x, 820.0x; 820.1x; 820.2x; 820.3x; 820.8x; 820.9x; (any Dx on claim) At least 1 inpatient claim with DX code during 1 year period CMS Chronic Care Warehouse
Low back 724.2x; 724.3x; 724.5x; 724.6x; 846.xx; 847.2x (any Dx on claim) At least 1 inpatient, or 2 HOP or Carrier claims with DX codes during 1 year period CMS Imaging 1 Measure for back pain

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