Gastro-Esophageal Reflux Disease(GERD) ECR Summary Description

Version: 5.4.005

Gastro-esophageal reflux disease (GERD) is a chronic condition open from 30 days prior to the date of the trigger service until the end of the study period, or until the patient's date of death. The trigger service can be an inpatient service with a GERD-specific principal diagnosis code or an outpatient or professional E&M service with a GERD-specific diagnosis code in any position. The professional trigger also requires a confirming inpatient, outpatient or professional diabetes-related E&M service at least 7 days later. Services with diagnosis codes for signs and symptoms related to GERD such as dyspepsia or heartburn have been defined as typical care for GERD, and conditions such as admission for aspiration pneumonia and fluid and electrolyte disturbances have been labeled as complications.

In addition, patients who undergo an Upper GI Endoscopy (EGD) are included in a separate procedural episode but are linked back to the GERD episode to understand the frequency and consequently the appropriateness of these procedures in GERD patients. Furthermore, other concurrent episodes of Pneumonia are linked back at the patient level to GERD episodes as complications.

Episode Components

Trigger CodesCodes that, when meeting the trigger criteria, indicate an episode exists (See Table A)
SubTypesEpisodes often have sub-types or variants, which are useful to adjust for the severity of that episode, and reduce the need to have multiple episodes of the same type.
Relevant DiagnosesThese are diagnosis codes that could serve as a proxy to the trigger diagnosis codes in order to steer services to an episode. There are two types of relevant diagnosis: 1) those that are for routine and typical care for an episode and include codes that represent signs and symptoms related to the episode, diagnosis codes for similar conditions, status codes, family history codes or for aftercare (See Table B); and 2) those that indicate the occurrence of a PAC (potentially avoidable complication) during the episode time window (See Table C)
Relevant ProceduresThese include all services that are relevant to a given episode but would only be included in the episode if they have a relevant diagnosis code on the claim (See Tables D and E)
Relevant PharmacyThese include all pharmacy codes that are relevant to a given episode. Pharmacy codes are grouped into Prometheus Drug Groups for inclusion in the episode (See Table H). All relevant pharmacy codes in this episode are classified as typical.

SubTypes

SubType GroupsAchalasia, Esophageal Spasm, Dysphagia, Acute esophagitis, acute gastritis, duodenitis, Alcoholic Gastritis, Allergic, Dietetic, Eosinophilic Gastroenteritis, Barrett's Esophagus, Congenital GI Problems in NB, Current Tobacco / Cigarette Smoker, Diaphragmatic Hernia, Dysphagia, Esophageal Complications, Esophageal Reflux and Other Esophagitis, Opportunistic Infections, Orthostatic Hypotension / Dizziness, Other bacterial infections, Other Esophageal conditions, Preventive Medicine, Care Coordination

Code Tables

In accordance with WHO and AMA respective licenses, the specific codes for ICD-10, HCPCS, and CPT have been redacted as “***” below. The specific ICD-10, HCPCS, and CPT code definitions for each episode-of-care are available to authorized users of the TrustHub platform.

Table A: Trigger Codes

Trigger TypeCodes
ICD-9-CM (DX) Triggers***
ICD-10-CM (DX) Triggers***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

Trigger Codes will be used to identify patients with this episode.

Table B: ICD-9 Relevant Typical Diagnosis Codes:

Group IDGroup NameICD-9-CM (DX)
DX03119Resp - laryngitis - chronic***
DX03129Resp - voice disturbance***
DX04100Resp - painful breathing***
DX04155laryngeal problems***
DX0496Resp - cough***
DX0498Resp - wheezing***
DX05282Unstable angina***
DX05345Orthostatic Hypotension / Dizziness***
DX06206GI - abdominal pain***
DX06207GI - flatulence / gas pain***
DX06208GI - symptoms - nec / nos***
DX06214GI - abdominal tenderness***
DX06218GI - abnormal abdominal imaging study***
DX06219GI - abnormal gi imaging study***
DX06221GI - personal hx of GI disease***
DX06267Nausea, vomiting***
DX06275Abdominal hernia***
DX06285Previous bowel surgery, ostomy status***
DX06313Esophageal Complications***
DX06316Achalasia, Esophageal Spasm, Dysphagia***
DX06317Acute esophagitis, acute gastritis, duodenitis***
DX06319Barrett's Esophagus***
DX06325Diaphragmatic Hernia***
DX06331Other Esophageal conditions***
DX06332Dysphagia***
DX06347Alcoholic Gastritis***
DX06364Heartburn***
DX06365Abdominal pain***
DX06366Abdominal mass***
DX06367Abdominal tenderness***
DX06369Esophageal Reflux and Other Esophagitis***
DX10109Protein Calorie Malnutrition***
DX1062Endo - vitamin a deficiency***
DX1063Endo - thiamin deficiency***
DX1064Endo - vitamin b deficiency***
DX1066Endo - other nutrl deficiencies***
DX1846Opportunistic Infections***
DX1923BH - other ds***
DX1963Anxiety Disorders***
DX2369Abnormal weight loss***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

 

Table B: ICD-10 Relevant Typical Diagnosis Codes:

Group IDGroup NameICD-10-CM (DX)
DXX01392Delirium, Encephalopathy***
DXX03119Resp - laryngitis - chronic***
DXX03129Resp - voice disturbance***
DXX04100Resp - painful breathing***
DXX04127empyema, lung abscess***
DXX04155laryngeal problems***
DXX0496Resp - cough***
DXX0498Resp - wheezing***
DXX05282Unstable angina***
DXX05345Orthostatic Hypotension / Dizziness***
DXX0608ID - other viral - nec / nos***
DXX06206GI - abdominal pain***
DXX06207GI - flatulence / gas pain***
DXX06214GI - abdominal tenderness***
DXX06218GI - abnormal abdominal imaging study***
DXX06219GI - abnormal gi imaging study***
DXX06221GI - personal hx of GI disease***
DXX06267Nausea, vomiting***
DXX06285Previous bowel surgery, ostomy status***
DXX06313Esophageal Complications***
DXX06316Achalasia, Esophageal Spasm, Dysphagia***
DXX06317Acute esophagitis, acute gastritis, duodenitis***
DXX06319Barrett's Esophagus***
DXX06325Diaphragmatic Hernia***
DXX06331Other Esophageal conditions***
DXX06332Dysphagia***
DXX06347Alcoholic Gastritis***
DXX06364Heartburn***
DXX06365Abdominal pain***
DXX06367Abdominal tenderness***
DXX06369Esophageal Reflux and Other Esophagitis***
DXX06375Allergic, Dietetic, Eosinophilic Gastroenteritis***
DXX06380Abdominal Hernia w/out Gangrene/Obstruction***
DXX0671GI - esophagitis***
DXX10109Protein Calorie Malnutrition***
DXX1062Endo - vitamin a deficiency***
DXX1063Endo - thiamin deficiency***
DXX1064Endo - vitamin b deficiency***
DXX1066Endo - other nutrl deficiencies***
DXX1846Opportunistic Infections***
DXX1923BH - other ds***
DXX1963Anxiety Disorders***
DXX2369Abnormal weight loss***
DXX2377Personal history of blood, endocrine, nutritional disorders***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

 

Diagnosis Codes which will be used in combination with Procedure codes to identify relevant typical services.

Table C: ICD-9 Relevant Potentially Avoidable Complication Codes:

Group IDGroup NameICD-9-CM (DX)
DX01391Meningitis / Encephalitis***
DX04126other lung complications***
DX04130Aspiration Pneumonia***
DX04142Respiratory Failure***
DX04154Respiratory Insufficiency***
DX04170Ventilator Associated Pnuemonia***
DX04177Ventilator Dependence***
DX04187Other lung problems***
DX05272dic, coagulation, hemorrhagic disorders***
DX05274transfusion, infusion related complications***
DX05275phlebitis, deep vein thrombosis (dvt)***
DX05298Fluid Electrolyte Acid Base Problems***
DX05299Shock / Cardiac Arrest***
DX05311Other Phlebitis, Lymphangitis, varices***
DX06268Complicated Hiatal Hernia***
DX06305C-Difficile Infection***
DX06306GI Bleed***
DX06307Intestinal Obstruction***
DX06313Esophageal Complications***
DX06338Complications of colostomy, enterostomy***
DX06347Alcoholic Gastritis***
DX09187wound infections***
DX09192Dermatitis, Urticaria***
DX10110Severe Protein Calorie Malnutrition***
DX11145Urinary Complications***
DX16296Hemorrhage***
DX1846Opportunistic Infections***
DX1849Other bacterial infections***
DX1850MRSA, Drug Resistant Infections***
DX1852Severe Sepsis***
DX1853Bacteremia, SIRS, no organ dysfunction***
DX2171Adverse effects of drugs***
DX2172Overdose, Poisonings***
DX2360Complication of Implanted device, graft***
DX2361complications of surgical procedures***
DX2362complications of medical care***
DX2370Fever & Chills***
DX9909HAC: Foreign Body Retained After Surgery***
DX9910HAC 02: Air Embolism***
DX9911HAC: Blood Incompatibility***
DX9915HAC: Catheter Associated UTIs***
DX9916HAC: Infection due to central venous catheter***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

Table C: ICD-10 Relevant Potentially Avoidable Complication Codes:

Group IDGroup NameICD-10-CM (DX)
DXX01391Meningitis / Encephalitis***
DXX01392Delirium, Encephalopathy***
DXX01403Complication of nervous system device***
DXX02147Complications after eye surgery***
DXX04126other lung complications***
DXX04127empyema, lung abscess***
DXX04130Aspiration Pneumonia***
DXX04142Respiratory Failure***
DXX04154Respiratory Insufficiency***
DXX04170Ventilator Associated Pnuemonia***
DXX04177Ventilator Dependence***
DXX04187Other lung problems***
DXX04188Other Bacterial Pneumonia***
DXX05272dic, coagulation, hemorrhagic disorders***
DXX05274transfusion, infusion related complications***
DXX05275phlebitis, deep vein thrombosis (dvt)***
DXX05298Fluid Electrolyte Acid Base Problems***
DXX05299Shock / Cardiac Arrest***
DXX05311Other Phlebitis, Lymphangitis, varices***
DXX05317Complications after heart procedures***
DXX06268Complicated Hiatal Hernia***
DXX06305C-Difficile Infection***
DXX06306GI Bleed***
DXX06307Intestinal Obstruction***
DXX06313Esophageal Complications***
DXX06338Complications of colostomy, enterostomy***
DXX06347Alcoholic Gastritis***
DXX09192Dermatitis, Urticaria***
DXX11145Urinary Complications***
DXX16296Hemorrhage***
DXX1846Opportunistic Infections***
DXX1849Other bacterial infections***
DXX1850MRSA, Drug Resistant Infections***
DXX1851Sepsis***
DXX1852Severe Sepsis***
DXX1853Bacteremia, SIRS, no organ dysfunction***
DXX1948Suicide or Self-inflicted Injury***
DXX2156adverse effects of drugs, correct use***
DXX2171Adverse effects of drugs***
DXX2360Complication of Implanted device, graft***
DXX2361complications of surgical procedures***
DXX2362complications of medical care***
DXX9909HAC: Foreign Body Retained After Surgery***
DXX9910HAC 02: Air Embolism***
DXX9911HAC: Blood Incompatibility***
DXX9916HAC: Infection due to central venous catheter***
XX0000Ungrouped Codes***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

PAC Codes which will be used in combination with Procedure codes to identify relevant PAC services.

Table D: ICD-9 Relevant Procedure Codes

Group IDGroup NameICD-9-PCS (PX)
PX03229Nonoperative removal of foreign body - 229***
PX06179CT scan abdomen - 179***
PX06185Upper gastrointestinal X-ray - 185***
PX06186Lower gastrointestinal X-ray - 186***
PX06194Diagnostic ultrasound of gastrointestinal tract - 194***
PX06196Diagnostic ultrasound of abdomen or retroperitoneum - 196***
PX0668Injection or ligation of esophageal varices - 068***
PX0669Esophageal dilatation - 069***
PX0693Other non-OR upper GI therapeutic procedures - 093***
PX0694Other OR upper GI therapeutic procedures - 094***
PX0697Other gastrointestinal diagnostic procedures - 097***
PX0698Other non-OR gastrointestinal therapeutic procedures - 098***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

Table D: ICD-10 Relevant Procedure Codes

Group IDGroup NameICD-10-PCS (PX)
PXX03229Nonoperative removal of foreign body - 229***
PXX03231Other therapeutic procedures - 231***
PXX04178CT scan chest - 178***
PXX0441Other non-OR therapeutic procedures on respiratory system - 041***
PXX0442Other OR therapeutic procedures on respiratory system - 042***
PXX05226Other diagnostic radiology and related techniques - 226***
PXX0561Other OR procedures on vessels other than head and neck - 061***
PXX06179CT scan abdomen - 179***
PXX06185Upper gastrointestinal X-ray - 185***
PXX06186Lower gastrointestinal X-ray - 186***
PXX06194Diagnostic ultrasound of gastrointestinal tract - 194***
PXX06196Diagnostic ultrasound of abdomen or retroperitoneum - 196***
PXX06239Bariatric Surgery: Open Other***
PXX0668Injection or ligation of esophageal varices - 068***
PXX0669Esophageal dilatation - 069***
PXX0686Other hernia repair - 086***
PXX0693Other non-OR upper GI therapeutic procedures - 093***
PXX0694Other OR upper GI therapeutic procedures - 094***
PXX0697Other gastrointestinal diagnostic procedures - 097***
PXX0698Other non-OR gastrointestinal therapeutic procedures - 098***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

Procedure Codes which will be used in combination with diagnosis codes to identify relevant services.

Table E: Relevant Procedure Codes CPT/HCPCS

Group IDGroup NameCPT / HCPCS
CT0025Preventive Medicine, Care Coordination***
CT0026Medication Assisted Management (MAT)***
CT0080Imaging Abdomen***
CT0082Opioid Administration / Dispensing (OTP)***
CT0088Hepatitis B vaccine ***
CT0089Metabolic Renal Hepatic Chemistry Panel***
CT0090Physical Therapy / Rehab***
CT0091Physician Services - Outpatient ***
CT0092Physician Services - Inpatient***
CT0093Routine Immunizations***
CT0133Rx - central nervous system - symnpatholytic rx***
CT0136Rx - central nervous system - antidepressants***
CT0137Rx - central nervous system - tranq/antipsychotics***
CT01394Medications (Injections, infusions and other forms)***
CT01395DME and supplies***
CT0140Rx - central nervous system - barbiturates***
CT0141Rx - central nervous system - benzodiazepines***
CT0142Rx - central nervous system - anxiolytic/sedative/hypnot nec***
CT0160Tests - neuro - eeg***
CT0161Tests - neuro - muscle testing***
CT0162Tests - neuro - ncv / emg***
CT0163Tests - neuro - evoked potentials***
CT0165Tests - neuro - other***
CT0324Procedure - nasopharyngoscopy - dx***
CT0335Procedure - laryngoscopy - dx***
CT0336Procedure - laryngoscopy w / biopsy***
CT0337Procedure - laryngoscopy w dilation***
CT0338Procedure - laryngoscopy w foreign body removal***
CT0342Procedure - laryngoscopy - other***
CT0354Rx - eent - topical - eye/ear/nose/throat misc***
CT0378Tests - ent - swallowing evaluation***
CT0380Tests - ent - other dx***
CT0401Procedure - laryngoscopy - dx***
CT0424Rx - respiratory - beta agonists***
CT0425Rx - respiratory - phenylephrine***
CT0426Rx - respiratory - mucolytics/cold comb***
CT0427Rx - respiratory - methylxanthines***
CT04280Lung Function Tests***
CT04281Blood Gases, Pulse Oximetry***
CT04282Chest X-Ray***
CT0433Other care - respiratory - ventillator management***
CT0434Other care - respiratory - oxygen / oxygen concentrator***
CT0438Other care - respiratory - equipment / supplies - nebulizer***
CT0439Other care - respiratory - equipment / supplies - peak flow meter***
CT0440Other care - respiratory - equipment / supplies - spirometer***
CT0441Other care - respiratory - equipment / supplies - apnea monitor***
CT0442Other care - respiratory - equipment / supplies***
CT0443Other care - respiratory - other***
CT0444Other care - prevention - smoking cessation***
CT0446Imaging - cta - chest***
CT0447Imaging - mri - chest***
CT0448Imaging - mra - chest***
CT0453Tests - pulmonary - peak flow***
CT0463Tests - pulmonary - other***
CT05194Rx - cardiovascular system - cardiac glycosides***
CT05196Rx - cardiovascular system - beta blockers***
CT05199Rx - cardiovascular system - vasodilating rx***
CT05204Rx - diuretics, thiazides / related***
CT05205Rx - diuretics - diuretic, carb anhydrase inhib***
CT05233Tests - cardiac - ecg - ecg - 12 lead***
CT05258Tests - vascular - venous***
CT05260Tests - cardiovascular - other***
CT0610Procedure - dilation - esophagus***
CT06104Imaging - nuclear - shilling test***
CT06105Imaging - nuclear - shilling test - radiopharmaceutical***
CT06106Imaging - nuclear - gi blood loss***
CT06107Imaging - nuclear - other gi***
CT0611Procedure - injection / ligation - esophageal varices***
CT06110Imaging - x-ray - upper gi - esophagus - contrast***
CT06112Imaging - x-ray - upper gi - small bowel - contrast***
CT06113Imaging - x-ray - upper gi - duodenogram***
CT06114Imaging - x-ray - upper gi - other***
CT06118Tests - gi - esophageal balloon distension test***
CT06119Tests - gi - gastric motility study***
CT0612Procedure - esophageal / gastric intubation***
CT06120Tests - gi - duodeneal motility study***
CT06121Tests - gi - other dx***
CT06122Lab - gi - fat absorption***
CT0617Procedure - other procedures - esophagus***
CT0619Procedure - gastrostomy***
CT06304Esophageal Motility and Diagnostic Workup***
CT0653Procedure - laparoscopy - gi - other***
CT0659Procedure - other lower gi procedures - other non - or rx***
CT0690Procedure - anesthesia***
CT0692Therapy - neurostimulator - nausea / vomiting***
CT0693Rx - gi - antichol/antispasmodics***
CT0694Rx - gi - antiemetics***
CT0695Rx - gi - h2 antagonists***
CT0696Rx - gi drug misc,nec***
CT0697Rx - gi - ppis***
CT0698Rx - diagnostic rx - gastric function***
CT0733Imaging - x-ray - biliary tract - cholangiogram - intraoperative***
CT08113DME - heat/cold application***
CT08116DME - rehabilitation***
CT0857Rx - muscle relaxants - muscle relax, skeletal central***
CT0858Rx - muscle relaxants - muscle relax, skeletal, misc***
CT0859Rx - muscle relaxants - muscle relax, neuromusc block***
CT0959Procedure - other non - or rx - other non - or skin procedures***
CT0963Rx - skin / mucous membrane - antiinflam s/mm agnts / comb nec***
CT0964Rx - skin / mucous membrane - s/mm miscellaneous***
CT0965Other care - wound care***
CT0969Other care - chronic edema - surgical stockings***
CT1017Rx - vitamins - vitamin b / b complex***
CT1021Rx - vitamins - multivit prep***
CT1023Rx - diagnostic rx, misc***
CT1026Other care - diabetes care - glucose monitoring - lancet***
CT1027Other care - diabetes care - glucose monitoring***
CT10296Low dose steroids***
CT10297High dose steroids***
CT1036Other care - nutrition - assessment***
CT1038Other care - nutrition - enteral***
CT1039Other care - nutrition - enteral - tubing***
CT1040Other care - nutrition - enteral - formula***
CT1041Other care - nutrition - enteral - pump***
CT1042Other care - nutrition - parenteral - nutrition solution***
CT1043Other care - nutrition - parenteral***
CT1044Other care - nutrition - parenteral - pump***
CT1046Other care - nutrition - education***
CT1048Other care - nutrition - counseling - dietician***
CT1049Other care - other - weight management***
CT1146Therapy - dialysis - supplies***
CT1166Lab - urinalysis***
CT1167Lab - specimen collection - urine***
CT1620Therapy - phlebotomy***
CT1628Rx - hematopoietic system - iron / related***
CT1629Rx - hematopoietic system - hematopoietic growth factors***
CT16296Lipid Level Monitoring***
CT16297Blood Count***
CT16298NewBorn Blood Tests***
CT16299Bleeding Status***
CT1630Rx - coagulation system - anticoagulants***
CT1632Rx - coagulation system - hemostatics***
CT1633Rx - coagulation system - thrombolytic rx***
CT1635Rx - serums, toxoids, vaccines - serums***
CT1636Rx - serums, toxoids, vaccines - toxins***
CT1638Rx - administration - injection***
CT1639Rx - administration - infusion***
CT1647Lab - hematology - blood count***
CT1648Lab - hematology - blood count - eosinophil count***
CT1649Lab - other hematology***
CT1651Lab - immunology***
CT1806Rx - antibiotics - aminoglycosides***
CT1807Rx - antibiotics - cephalosporins***
CT1808Rx - b-lactam antibiotics***
CT1809Rx - antibiotics - chloramphenicol / comb***
CT1810Rx - antibiotics - macrolides***
CT1813Rx - antibiotics, misc***
CT1814Rx - antibiotics - quinolones***
CT1815Rx - antibiotics - sulfonamides / comb***
CT1821Lab - infectious agent antigen***
CT1823Lab - infectious agent dna***
CT1824Lab - microbiology - other***
CT1825Lab - microbiology - c & s***
CT1826Lab - microbiology - microscopic exam***
CT1827Lab - microbiology - viral culture***
CT1828Lab - microbiology***
CT1901Therapy - behavior - evaluation and therapy***
CT1903Therapy - behavior - medication management***
CT1905Therapy - behavior - partial hospilization***
CT1907Tests - neuro - sleep studies***
CT19304Psychiatry Services***
CT19378Laboratory - Chemistry and Hematology***
CT19381Smoking / Tobacco Cessation***
CT19384Peer Services***
CT2009Alcohol / Drug Use Screening***
CT20376Other Laboratory***
CT2301Therapy - allergy treatment***
CT2302Therapy - behavior - other***
CT2304Therapy - pt - exercises / activities***
CT2305Therapy - pt - modalities***
CT2309Therapy - activity therapy***
CT2314Therapy - vaccination - hepatitis a vaccine***
CT2315Therapy - vaccination - hepatitis b***
CT2320Therapy - vaccination - vaccine administration***
CT2329Other care - bladder / bowel care - other supplies - diaper / related***
CT2330Other care - bladder / bowel care - other supplies - skin barrier***
CT23307Vaccine for flu or Pneumonia***
CT23309Markers for Inflammation***
CT2331Other care - observation***
CT23311Current Tobacco / Cigarette Smoker***
CT2338Other care - other - education***
CT2339Other care - other - geriatric care***
CT23393Prophylactic vaccinations and inoculations***
CT23398Ancillary Services***
CT2341Other care - other - exercise classes***
CT2342Tests - allergy tests - percutaneous***
CT2343Tests - allergy tests - intradermal***
CT2344Tests - allergy tests - patch***
CT2345Tests - allergy tests - other***
CT2352DME - mobility aids***
CT2353DME - patient lifts***
CT9902E & M - consultation***
CT9903E & M - hospital***
CT9904E & M - emergency care***
CT9905E & M - home visit***
CT9906E & M - nursing home***
CT9907E & M - prevention***
CT9908E & M - other***
CT99102Other care - other***
CT99103Imaging - ct - follow - up***
CT99104Imaging - ct - other***
CT99106Imaging - cta - other***
CT99107Imaging - mri - other***
CT99109Imaging - mri - contrast agent***
CT9911Procedure - sedation***
CT99113Imaging - us - guide - biopsy***
CT99114Imaging - us - guide - other***
CT99115Imaging - us - other***
CT99127Imaging - nuclear - other - automated data add - on***
CT99129Imaging - nuclear - radiopharmaceutical - radiopharmaceutical - other***
CT99133Imaging - other imaging - fluoroscopy***
CT99136Imaging - other imaging***
CT99139Imaging - supplies - contrast agent - low osmolar***
CT99141Imaging - supplies - ultrasound related***
CT99142Lab - pathology consultation***
CT99143Lab - chemistry***
CT99148Lab - surgical pathology***
CT99149Lab - other clinical lab***
CT99169Lab - specimen collection - blood - venous - venipuncture***
CT99173Lab - specimen collection - specimen handling***
CT99174Lab - microscopic - wet mount***
CT99175Lab - microscopic - koh prep***
CT9918Procedure - related supplies - ablation - catheter***
CT99182Transportation - paramedic***
CT99183Transportation - other transportation***
CT99184DME - other***
CT99185DME - bath / toilet aids***
CT99186DME - beds / accessories***
CT99190DME - repair / maintenance***
CT99191Supplies***
CT99197Other - non - covered***
CT9922Procedure - related supplies - drainage***
CT9928Therapy - accupuncture***
CT99309Physician Services***
CT9931Therapy - rehabilitation - other***
CT99311Urine Protein***
CT99316Physician Services - Inpatient***
CT9937Therapy - neurostimulator - tens - leads***
CT9938Therapy - neurostimulator - tens - supplies***
CT9939Therapy - neurostimulator - other***
CT99392Other diagnostic procedures (interview, evaluation, consultation)***
CT9940Therapy - other***
CT9941Rx - allergy - antihistamines / comb***
CT9942Rx - gi - antichol/antispasmodics***
CT9943Rx - autonomic rx - parasympathomimetics***
CT9944Rx - autonomic rx - sympathomimetic rx***
CT9946Rx - analg/antipy/nsaids - nsaids***
CT9947Rx - analg/antipy/nsaids - narcotics***
CT9949Rx - electrolytic, caloric, water - calcium supplements***
CT9950Rx - electrolytic, caloric, water - potassium supp***
CT9951Rx - electrolytic, caloric, water - multi-mineral prep***
CT9952Rx - electrolytic, caloric, water - sodium chlor preps***
CT9953Rx - electrolytic, caloric, water - replacement preparations, misc***
CT9955Rx - electrolytic, caloric, water - caloric rx dextrose / rel***
CT9956Rx - electrolytic, caloric, water - hydration - unspecfied***
CT9957Rx - miscellaneous rx***
CT9958Rx - miscellaneous rx - enzymes***
CT9960Rx - miscellaneous rx - anesthetics, local***
CT9961Rx - diagnostic rx - roentgenography***
CT9962Rx - other***
CT9963Rx - pharmacy fee***
CT9964Other care - home care - specialized visit***
CT9965Other care - home care - physician supervision***
CT9966Other care - home care - nursing care***
CT9967Other care - home care - nursing care - rn***
CT9969Other care - home care - nursing care - np***
CT9970Other care - home care - rehabilitation - physical therapy***
CT9971Other care - home care - rehabilitation - occupational therapy***
CT9972Other care - home care - rehabilitation - speech therapy***
CT9973Other care - home care - social worker***
CT9974Other care - home care - home health aide***
CT9986Other care - hospice***
CT9990Other care - other - ancillary services***
CT9995Other care - other - irrigation***
CT9996Other care - other - lodging***
CT9997Other care - other - meals***
XX0000Ungrouped Codes***

*** Specific ICD/HCPCS/CPT codes will be shared upon execution of a license agreement

CPT / HCPCS / ICD-9-PCS (PX) Codes which will be used in combination with ICD-9 diagnosis codes to identify relevant services.

Table H: Relevant Typical Drug Groups

Group IDGroup Name
RX001contrast media
RX002diagnostic agents
RX017hypnotics and sedatives
RX0320cough and cold preparations
RX0321decongestants and other nasal preparations for topical use
RX0322other otologicals
RX0324throat preparations
RX0425antihistamines for systemic use
RX0426Bronchodilators: adrenergics for systemic use
RX0427drugs for obstructive airway diseases - inhalants
RX0429other systemic drugs for obstructive airway diseases
RX0531Agents for hypertensive emergencies
RX0536calcium channel blockers
RX0538diuretics
RX0539i.v. solutions & additives
RX0540Nitrates and other antianginals
RX0541other antihypertensives
RX0546Antiplatelet Agents Thrombin Inhibitors
RX0645antacids
RX0646antidiarrheals intestinal adsorbents
RX0647antiemetics and antinauseants
RX0648digestives incl. enzymes
RX0649drugs for constipation
RX0650drugs for functional gastrointestinal disorders
RX0651drugs for peptic ulcer and gerd
RX0652intestinal antiinfectives
RX0653intestinal antiinflammatory agents
RX0654stomatological preparations
RX0755bile and liver therapy
RX0857antiinflammatory and antirheumatic products
RX0861opioids
RX0862other analgesics and antipyretics
RX0970antipruritics incl. antihistamines anesthetics etc.
RX1082antiobesity preparations excl. diet products
RX1086corticosteroids for systemic use
RX1087drugs affecting bone structure and mineralization
RX1088drugs for inborn errors of metabolism
RX16106iron preparations
RX16109vitamin b12 and folic acid
RX16112Blood Stimulating Agents Erythropoietin
RX18114agents against amoebiasis and other protozoal diseases
RX18115agents against leishmaniasis and trypanosomiasis
RX18116anthelmintics
RX18117antibacterials for systemic use
RX18119antiinfectives
RX19125anxiolytics
RX19126drugs used in addictive disorders
RX23129immune sera and immunoglobulins
RX23131mineral supplements
RX23133other nutrients
RX23134vaccines
RX23135vitamins
RX99137anesthetics local
RX99139Other Therapeutic Drugs