From: Methods for identifying 30 chronic conditions: application to administrative data
Number and nature of claims required to substantiate the diagnosis | |||||||||
---|---|---|---|---|---|---|---|---|---|
Morbidity | Algorithm | Hospitalizations | Claims | ACCS | Years | ICD-9 CM | ICD-10 | Permanent | Citation |
Alcohol misuse^ | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 265.2, 291.1–291.3, 291.5–291.9, 303.0, 303.9, 305.0, 357.5, 425.5, 535.3, 571.0–571.3, 980, V11.3 | E52, F10, G62.1, I42.6,K29.2, K70.0, K70.3, K70.9, T51, Z50.2, Z71.4, Z72.1 | Y | |
Asthma | 1 hospitalization or 3 ACCS in 2 years or less | 1 | . | 3 | 2 | 493 | J45 | Y | Gershon 2009 [37] |
Atrial fibrillation | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 427.3& | I48.0 | Y | Alonso 2009 [38] |
Cancer, lymphoma | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 200–202, 203.0, 238.6 | C81–C85, C88, C90.0, C90.2, C96 | N 5 y | |
Cancer, metastatic | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 196–199 | C77–C80 | N 5 y | |
Cancer, non-metastatic (breast, cervical, colorectal, lung, prostate) | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 153-154, 162-163, 174, 180, 185, 230.3-230.6, 231.2, 233.0-233.1, 233.4 | C18-C21, C33-C34, C38.4, C45.0, C46.71, C50, C53, C61, D01.0-D01.3, D02.2, D05-D06, D07.5 | N 5 y | Penberthy 2003 [39] |
Chronic heart failure$^ | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425.4–425.9, 428 | I09.9, I25.5, I42.0, I42.5–I42.9, I43, I50 | Y | |
Chronic kidney disease | Mean eGFR <60 mL/min*1.73 m2 or mean albuminuria >30 mg/g over 12 months | . | . | . | . | . | . | Stevens 2013 [16] | |
or 1 hospitalization or 3 claims in 1 year | 1 | 3 | . | 1 | 583, 584, 585, 586, 592, 593.9 | N00-N23 | Y | Ronksley 2012 [15] | |
Chronic pain | 2 hospitalizations or 2 claims or 2 ACCS in 30 days or less | 2 | 2 | 2 | 30 d | 307.80, 307.89, 338.0, 338.2, 338.4, 719.41, 719.45 - 719.47, 719.49, 720.0, 720.2, 720.9, 721.0 - 721.4, 721.6, 721.8, 721.9, 722, 723.0, 723.1, 723.3 - 723.9, 724.0 - 724.6, 724.70, 724.79, 724.8, 724.9, 729.0 - 729.2, 729.4, 729.5 | F45.4, M08.1, M25.50, M25.51, M25.55 - M25.57, M43.2 - M43.6, M45, M46.1, M46.3, M46.4, M46.9, M47, M48.0, M48.1, M48.8, M48.9, M50.8, M50.9, M51, M53.1 - M53.3, M53.8, M53.9, M54, M60.8, M60.9, M63.3, M79.0 - M79.2, M79.6, M79.7, M96.1 | N 2 y | Tian 2013 [18] |
Chronic pulmonary disease% | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 416.8, 416.9, 490–492, 494-505, 506.4, 508.1, 508.8 | I27.8, I27.9, J40–J44, J46-J47, J60–J67, J68.4, J70.1, J70.3 | Y | |
Chronic viral hepatitis B | 2 hospitalizations or 2 claims or 2 ACCS | 2 | 2 | 2 | 6 mo | 70.2-70.3 | B16, B18.0-B18.1 | Y | Mahajan 2013 [40] |
Cirrhosis^ | 1 hospitalization or 1 claim or 1 ACCS | 1 | 1 | 1 | . | 571.2, 571.5, 571.6 | K70.3, K74.3, K74.4, K74.5, K74.6 | Y | Goldberg 2012 [41] |
and hepatic decompensation 1 hospitalization or 1 claim or 1 ACCS | 1 | 1 | 1 | . | 456.0, 456.1, 456.20, 456.21, 567.0, 567.2,* 567.21, 567.29, 567.8, 567.9, 572.2, 572.4, 789.5 | I85.0, I85.9, I98.2, I98.3, K65.0, K65.8, K65.9, K67.0, K67.1, K67.2, K67.3, K67.8, K76.7, K93.0, R18 | |||
Exclude 567.81, 567.82, 789.51 | |||||||||
Dementia^ | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 290, 294.1, 331.2 | F00–F03, F05.1, G30, G31.1 | Y | |
Depression^ | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 296.2, 296.3, 296.5, 300.4, 309, 311 | F20.4, F31.3–F31.5, F32, F33, F34.1, F41.2, F43.2 | N 2 y | |
Diabetes | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 250 | E10-E14 | Y | Hux 2005 [42] |
Epilepsy | 1 most responsible hospitalization or 2 claims in 2 years or less or 1 most responsible ACCS | 1 | 2 | 1 | 2 | 345 | G40-G41 | Y | Jette 2010 [43] |
Hypertension^ | 1 hospitalization or 2 claim in 2 years or less | 1 | 2 | . | 2 | 401-405 | I10-I13, I15 | Y | Quan 2009 [44] |
Hypothyroidism | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 240.9, 243, 244, 246.1, 246.8 | E00–E03, E89.0 | Y | |
Inflammatory bowel disease | 2 hospitalizations or 2 GAST or GP claims in 3 years or less | 2 | 2 | . | 3 | 555, 556 | K50, K51 | Y | Liu 2009 [19] |
Irritable bowel syndrome | 1 hospitalization without surgery or 2 claims in 2 years or less | 1 | 2 | . | 2 | 564.1 | K58 | Y | Sands 2006 [21] |
Exclude 153-154, 157, 183.0, 197.5, 198.6, 235.2, 239.0, 555-556, 571.2, 571.5, 577.1, 579 | Exclude C18-C21, C25, C56, C78.5, C79.6, D01.7, D01.9, D37.1-D37.5, K50-K51, K70.2-K70.3, K74.0, K74.2, K74.6, K86.0-K86.1, K90, K91.2 | ||||||||
Multiple sclerosis | 2 hospitalizations or 2 claims in 3 years or less | 2 | 2 | . | 3 | 323, 340, 341.0, 341.9, 377.3 | G35, G36, G37, H46 | Y | Marrie 2013 [20] |
Myocardial infarction | 1 hospitalization | 1 | . | . | . | 410 | I21-I22 | Y | Austin 2002 [45] |
Parkinson’s disease | 1 hospitalizations or 1 claim | 1 | 1 | . | . | 332 | G20, G21, G22 | Y | Noyes 2007 [46] |
Peptic ulcer disease | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 531.7, 531.9, 532.7, 532.9, 533.7, 533.9, 534.7, 534.9 | K25.7, K25.9, K26.7, K26.9, K27.7, K27.9, K28.7, K28.9 | N 2 y | |
Peripheral vascular disease | 1 hospitalization or 1 claim or 1 ACCS | 1 | 1 | 1 | . | 440.2 | I70.2 | Y | Fan 2013 [47] |
Psoriasis | 1 hospitalization or 1 DERM claim | 1 | 1 | . | . | 696.1 | L40.0 - L40.4, L40.8, L40.9 | Y | Asgari 2013 [48] |
Rheumatoid arthritis | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 446.5, 710.0–710.4, 714.0–714.2, 714.8, 725 | M05, M06, M31.5, M32–M34, M35.1, M35.3, M36.0 | Y | |
Schizophrenia^ | 1 hospitalization or 2 claims in 2 years or less | 1 | 2 | . | 2 | 295 | F20, F21, F23.2, F25 | Y | |
Severe constipation | 1 hospitalization without surgery or 2 claims in 2 years or less | 1 | 2 | . | 2 | 560.1, 560.30, 560.39, 560.9, 564.0, 569.83, 569.89 | K55.8, K56.0, K56.4, K56.7, K59.0, K63.1, K63.4, K63.81, K63.88, K92.80, K92.88 | N 2 y | Sands 2006 [21] |
Exclude 152-154, 158, 179-189, 197.5-197.6, 235.2, 239.0, 555-556, 568.0, 614.6, (560.9 if 789.01, 789.02, 789.06), and any CCPx surgery# listed in claims | |||||||||
Exclude C17-C21, C45.1, C48, C51-C58, C60-C68, C78.5-C78.6, D01.7, D01.9, D37.1-D37.5, K50-K51, K66.0, N73.6, N99.4 (K56.6 if R10.1), and any CCPx surgery# listed in claims | |||||||||
Stroke or TIA | 1 most responsible or post-admittance hospitalization or 1 claim or 1 most responsible ED ACCS | 1 | 1 | 1 | . | 362.3, 430, 431, 433.x1, 434.x1, 435, 436 | G45.0-G45.3, G45.8-G45.9, H34.1, I60, I61, I63, I64 | Y | Kokotailo 2005 [51] |