Hypertension(HTN) ECR Summary Description

Version: 5.4.005

Hypertension (HTN) 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 hypertension-specific principal diagnosis code or an outpatient or professional E&M service with a hypertension-specific diagnosis code in any position. The professional trigger also requires a confirming inpatient, outpatient or professional hypertension-related E&M service at least 30 days later. Services with diagnosis codes for signs and symptoms related to HTN have been defined as typical care, and conditions such as fluid and electrolyte disturbances have been labeled as complications.

In addition, other concurrent episodes of AMI, Pneumonia and Stroke are linked back at the patient level to Hypertension 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 GroupsCurrent Tobacco / Cigarette Smoker, Hypertensive Heart Disease, Orthostatic Hypotension / Dizziness, Preventive Medicine, Care Coordination, Renovascular and other secondary hypertension

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)
DX01108NS - migraine***
DX01109NS - headache - tension***
DX01110NS - headache - other syndromes***
DX01111NS - headache - symptom***
DX01186NS - chronic pain - other***
DX01405Personal history of TIA***
DX01412Carotid Artery Stenosis***
DX0179NS - other cerebvasc ds***
DX02124Retinal Complications***
DX02135Pain, swelling, redness of eye***
DX02176Visual field defects***
DX04105Resp - hyperventillation***
DX0458Resp - resp failure***
DX0493Resp - other resp ds***
DX0497Resp - shortness of breath***
DX0510CV - essential ht***
DX05104CV - atherosclerosis - aorta***
DX05105CV - aneurysm - thoracic aorta - w/o rupture***
DX05108CV - aneurysm - thrc-abd aorta - w/o rupture***
DX05111CV - aneurysm - abdominal aorta - w/o rupture***
DX05114CV - aneurysm - aorta - nos - w/o rupture***
DX05120CV - other ascvd***
DX05152CV - screening - ischemic heart ds***
DX05153CV - screening - hypertension***
DX05154CV - screening - cv ds - nec***
DX05156CV - sxs nec nos***
DX05158CV - edema***
DX0516CV - elevated BP***
DX05161CV - abnl cv test nec nos***
DX05164CV - s/p cv ds nec nos***
DX05188CV - family hx***
DX0524CV - cardiac murmurs***
DX05327Hypertensive Heart Disease***
DX05332Pacemaker, Defibrillator in place***
DX05334Renovascular and other secondary hypertension***
DX05344Chronic Heart Failure, Degeneration***
DX05345Orthostatic Hypotension / Dizziness***
DX05346Premature Beats***
DX0554CV - av block - 1st degree***
DX0559CV - right bundle branch block***
DX0588CV - other heart ds***
DX0592CV - peripheral vascular ds***
DX0593CV - peripheral vascular ds - w/ claudication***
DX0595CV - peripheral vascular ds - w/ ulceration***
DX0597CV - peripheral vascular ds - nec / nos***
DX06203GI - anorexia***
DX06311Vascular Insufficiency of intestine***
DX06363Irritable Bowel and other functional GI disor***
DX06365Abdominal pain***
DX07114Hepatotoxicity***
DX08949MS - muscle - nos - muscle weakness***
DX1007Overweight***
DX10106hyperlipidemia***
DX10107Obesity***
DX10108Sleep Apnea***
DX10109Protein Calorie Malnutrition***
DX10112Severe Morbid Obesity***
DX10113Obstructive sleep apnea***
DX1019Morbid Obesity***
DX1040Endo - obesity***
DX1069Endo - abnl weight gain***
DX1071Endo - other***
DX1094Sxs - abnormal findings - lab or exam***
DX1132CV - ht w/ renal ds***
DX1134CV - renal artery ds***
DX1155GU - proteninuria***
DX16257Blood - abnormal coagulation test***
DX16271Blood - lymphadenitis***
DX16275Blood - other blood ds***
DX16293Iron deficiency and other anemias***
DX1930NS - hypersomnia***
DX1931NS - insomnia***
DX1932NS - other sleep ds***
DX1963Anxiety Disorders***
DX2008Tobacco Use***
DX2103NS - other sleep ds***
DX2127Othr - other***
DX2329Sxs - chronic fatique syndrome***
DX2330Sxs - general symptoms / debility / morbidity - nec***
DX2332Sxs - symptoms -other***
DX2335Sxs - abnormal findings - lab or exam***
DX2337Prvn - routine medical exam***
DX2342Prvn - encounter for lab test***
DX2346Othr - rehabilitation***
DX2352Othr - other***
DX2355Othr - follow-up exam - nec***
DX2356Othr - long-term use other medication***
DX2357Othr - longterm anticoaguation***
DX2359Othr - other aftercare***
DX2369Abnormal weight loss***
DX2377Personal history of blood, endocrine, nutritional disorders***

*** 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)
DXX01108NS - migraine***
DXX01109NS - headache - tension***
DXX01110NS - headache - other syndromes***
DXX01111NS - headache - symptom***
DXX01186NS - chronic pain - other***
DXX01405Personal history of TIA***
DXX01412Carotid Artery Stenosis***
DXX0179NS - other cerebvasc ds***
DXX02124Retinal Complications***
DXX02135Pain, swelling, redness of eye***
DXX02176Visual field defects***
DXX04105Resp - hyperventillation***
DXX04112Resp - abnormal chest sounds***
DXX0458Resp - resp failure***
DXX0497Resp - shortness of breath***
DXX0510CV - essential ht***
DXX05104CV - atherosclerosis - aorta***
DXX05105CV - aneurysm - thoracic aorta - w/o rupture***
DXX05108CV - aneurysm - thrc-abd aorta - w/o rupture***
DXX05111CV - aneurysm - abdominal aorta - w/o rupture***
DXX05114CV - aneurysm - aorta - nos - w/o rupture***
DXX05120CV - other ascvd***
DXX05158CV - edema***
DXX0516CV - elevated BP***
DXX05161CV - abnl cv test nec nos***
DXX05164CV - s/p cv ds nec nos***
DXX0524CV - cardiac murmurs***
DXX05294Malignant Hypertension with CKD***
DXX05327Hypertensive Heart Disease***
DXX05332Pacemaker, Defibrillator in place***
DXX05334Renovascular and other secondary hypertension***
DXX05344Chronic Heart Failure, Degeneration***
DXX05345Orthostatic Hypotension / Dizziness***
DXX05346Premature Beats***
DXX05355PVD w Ulcer***
DXX05359Family history of CV disease***
DXX0554CV - av block - 1st degree***
DXX0559CV - right bundle branch block***
DXX0588CV - other heart ds***
DXX0592CV - peripheral vascular ds***
DXX0593CV - peripheral vascular ds - w/ claudication***
DXX0597CV - peripheral vascular ds - nec / nos***
DXX06203GI - anorexia***
DXX06277Irritable Bowel and other functional GI disor***
DXX06311Vascular Insufficiency of intestine***
DXX06365Abdominal pain***
DXX07114Hepatotoxicity***
DXX08949MS - muscle - nos - muscle weakness***
DXX1007Overweight***
DXX10106hyperlipidemia***
DXX10107Obesity***
DXX10108Sleep Apnea***
DXX10109Protein Calorie Malnutrition***
DXX10112Severe Morbid Obesity***
DXX10113Obstructive sleep apnea***
DXX1019Morbid Obesity***
DXX1040Endo - obesity***
DXX1069Endo - abnl weight gain***
DXX1071Endo - other***
DXX1094Sxs - abnormal findings - lab or exam***
DXX1134CV - renal artery ds***
DXX1155GU - proteninuria***
DXX16257Blood - abnormal coagulation test***
DXX16271Blood - lymphadenitis***
DXX16293Iron deficiency and other anemias***
DXX1930NS - hypersomnia***
DXX1931NS - insomnia***
DXX1932NS - other sleep ds***
DXX1963Anxiety Disorders***
DXX2008Tobacco Use***
DXX2103NS - other sleep ds***
DXX2328Sxs - malaise / fatigue***
DXX2329Sxs - chronic fatique syndrome***
DXX2332Sxs - symptoms -other***
DXX2335Sxs - abnormal findings - lab or exam***
DXX2337Prvn - routine medical exam***
DXX2352Othr - other***
DXX2356Othr - long-term use other medication***
DXX2357Othr - longterm anticoaguation***
DXX2359Othr - other aftercare***
DXX2369Abnormal weight loss***
DXX2379Observation/Examination***
DXX2380Follow up after cancer treatment***
DXX2381Aftercare***
DXX2382Preventive Screening***

*** 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)
DX01384Hemorrhagic Stroke***
DX01385Thromboembolic Stroke***
DX01388Transient cerebral ischemia, TIA***
DX01390Coma, persistent vegetative state***
DX01391Meningitis / Encephalitis***
DX01392Delirium, Encephalopathy***
DX01400Persistent Cognitive and Gait Abnormalities***
DX01409Dissection of extracerebral arteries***
DX02135Pain, swelling, redness of eye***
DX02141Blurred vision / Diplopia***
DX02175Other visual impairment***
DX04157Hemoptysis***
DX05264arterial thromboembolism***
DX05272dic, coagulation, hemorrhagic disorders***
DX05274transfusion, infusion related complications***
DX05275phlebitis, deep vein thrombosis (dvt)***
DX05281STEMI ***
DX05289Subendocardial infarct***
DX05294Malignant Hypertension with CKD***
DX05297Hypotension / Syncope***
DX05298Fluid Electrolyte Acid Base Problems***
DX05299Shock / Cardiac Arrest***
DX05302Malignant Hypertension***
DX05303Acute CHF / pulm edema***
DX05308Pulmonary Embolism***
DX05309IVC & other intra-abd venous thrombosis***
DX05311Other Phlebitis, Lymphangitis, varices***
DX05342Acute cor pulmonale***
DX05347Dissection of Aorta***
DX06305C-Difficile Infection***
DX06306GI Bleed***
DX06317Acute esophagitis, acute gastritis, duodenitis***
DX09191Decubitus Ulcer***
DX09192Dermatitis, Urticaria***
DX1030Diabetes, poor control***
DX11137rhabdomyolysis***
DX11142Acute Renal Failure***
DX16296Hemorrhage***
DX1849Other bacterial infections***
DX1850MRSA, Drug Resistant Infections***
DX1851Sepsis***
DX1852Severe Sepsis***
DX1853Bacteremia, SIRS, no organ dysfunction***
DX2164Accidental Falls***
DX2171Adverse effects of drugs***
DX2172Overdose, Poisonings***
DX2361complications of surgical procedures***
DX2362complications of medical care***
DX9910HAC 02: Air Embolism***
DX9911HAC: Blood Incompatibility***
DX9912HAC 04: Stage III and IV Pressure Ulcers***
DX9914HAC 09: Manifestations of Poor Glycemic Control***
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)
DXX01384Hemorrhagic Stroke***
DXX01385Thromboembolic Stroke***
DXX01388Transient cerebral ischemia, TIA***
DXX01390Coma, persistent vegetative state***
DXX01391Meningitis / Encephalitis***
DXX01392Delirium, Encephalopathy***
DXX01409Dissection of extracerebral arteries***
DXX02135Pain, swelling, redness of eye***
DXX02141Blurred vision / Diplopia***
DXX02175Other visual impairment***
DXX04157Hemoptysis***
DXX04187Other lung problems***
DXX05264arterial thromboembolism***
DXX05272dic, coagulation, hemorrhagic disorders***
DXX05274transfusion, infusion related complications***
DXX05275phlebitis, deep vein thrombosis (dvt)***
DXX05281STEMI ***
DXX05289Subendocardial infarct***
DXX05291Recent AMI***
DXX05297Hypotension / Syncope***
DXX05298Fluid Electrolyte Acid Base Problems***
DXX05299Shock / Cardiac Arrest***
DXX05303Acute CHF / pulm edema***
DXX05308Pulmonary Embolism***
DXX05309IVC & other intra-abd venous thrombosis***
DXX05311Other Phlebitis, Lymphangitis, varices***
DXX05342Acute cor pulmonale***
DXX05347Dissection of Aorta***
DXX06305C-Difficile Infection***
DXX06306GI Bleed***
DXX06317Acute esophagitis, acute gastritis, duodenitis***
DXX09191Decubitus Ulcer***
DXX09192Dermatitis, Urticaria***
DXX10111Diabetes, other manifestation***
DXX1030Diabetes, poor control***
DXX11137rhabdomyolysis***
DXX11142Acute Renal Failure***
DXX16296Hemorrhage***
DXX1849Other bacterial infections***
DXX1850MRSA, Drug Resistant Infections***
DXX1851Sepsis***
DXX1852Severe Sepsis***
DXX1853Bacteremia, SIRS, no organ dysfunction***
DXX19103Altered mental status***
DXX2156adverse effects of drugs, correct use***
DXX2164Accidental Falls***
DXX2171Adverse effects of drugs***
DXX2361complications of surgical procedures***
DXX2362complications of medical care***
DXX9910HAC 02: Air Embolism***
DXX9911HAC: Blood Incompatibility***
DXX9912HAC 04: Stage III and IV Pressure Ulcers***
DXX9914HAC 09: Manifestations of Poor Glycemic Control***
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)
PX01177Computerized axial tomography (CT) scan head - 177***
PX01199Electroencephalogram (EEG) - 199***
PX03215Other physical therapy and rehabilitation - 215***
PX03231Other therapeutic procedures - 231***
PX04178CT scan chest - 178***
PX04217Other respiratory therapy - 217***
PX05189Contrast aortogram - 189***
PX05190Contrast arteriogram of femoral and lower extremity arteries - 190***
PX05193Diagnostic ultrasound of heart (echocardiogram) - 193***
PX05197Other diagnostic ultrasound - 197***
PX05201Cardiac stress tests - 201***
PX05205Arterial blood gases - 205***
PX05225Conversion of cardiac rhythm - 225***
PX0554Other vascular catheterization, not heart - 054***
PX06223Enteral and parenteral nutrition - 223***
PX08213Physical therapy exercises, manipulation, and other procedures - 213***
PX11108Indwelling catheter - 108***

*** 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)
PXX01177Computerized axial tomography (CT) scan head - 177***
PXX01199Electroencephalogram (EEG) - 199***
PXX03215Other physical therapy and rehabilitation - 215***
PXX03231Other therapeutic procedures - 231***
PXX04178CT scan chest - 178***
PXX04217Other respiratory therapy - 217***
PXX05189Contrast aortogram - 189***
PXX05190Contrast arteriogram of femoral and lower extremity arteries - 190***
PXX05193Diagnostic ultrasound of heart (echocardiogram) - 193***
PXX05197Other diagnostic ultrasound - 197***
PXX05201Cardiac stress tests - 201***
PXX05205Arterial blood gases - 205***
PXX05225Conversion of cardiac rhythm - 225***
PXX0554Other vascular catheterization, not heart - 054***
PXX06223Enteral and parenteral nutrition - 223***
PXX08213Physical therapy exercises, manipulation, and other procedures - 213***
PXX11108Indwelling catheter - 108***

*** 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***
CT0080Imaging Abdomen***
CT0082Opioid Administration / Dispensing (OTP)***
CT0083Blood Type, Coomb's test***
CT0087Hearing Test***
CT0088Hepatitis B vaccine ***
CT0089Metabolic Renal Hepatic Chemistry Panel***
CT0090Physical Therapy / Rehab***
CT0091Physician Services - Outpatient ***
CT0092Physician Services - Inpatient***
CT0093Routine Immunizations***
CT0094Screen for amino acid disorders***
CT0119Procedure - block - nerve***
CT01395DME and supplies***
CT0141Rx - central nervous system - benzodiazepines***
CT0144Imaging - ct - head / brain***
CT0148Imaging - cta - head / neck***
CT0149Imaging - mri - brain***
CT0152Imaging - nuclear - csf - scan***
CT0159Tests - vascular - cerebrovascular***
CT0160Tests - neuro - eeg***
CT0161Tests - neuro - muscle testing***
CT0162Tests - neuro - ncv / emg***
CT0163Tests - neuro - evoked potentials***
CT0165Tests - neuro - other***
CT0238Imaging - us - eye***
CT0251Tests - eye - dx - other***
CT0361Imaging - mra - head***
CT0380Tests - ent - other dx***
CT04280Lung Function Tests***
CT04281Blood Gases, Pulse Oximetry***
CT04282Chest X-Ray***
CT0429Other care - respiratory therapy***
CT0430Other care - respiratory - tracheostomy care***
CT0433Other care - respiratory - ventillator management***
CT0434Other care - respiratory - oxygen / oxygen concentrator***
CT0435Other care - respiratory - equipment / supplies - ventilator***
CT0436Other care - respiratory - equipment / supplies - cpap***
CT0437Other care - respiratory - equipment / supplies - ippb***
CT0438Other care - respiratory - equipment / supplies - nebulizer***
CT0442Other care - respiratory - equipment / supplies***
CT0443Other care - respiratory - other***
CT0445Imaging - ct - chest***
CT0446Imaging - cta - chest***
CT0447Imaging - mri - chest***
CT0448Imaging - mra - chest***
CT0463Tests - pulmonary - other***
CT05112Procedure - artery - extremity - angioplasty - transluminal / percutaneous***
CT05113Procedure - artery - extremity - atherectomy - transluminal / percutaneous***
CT05118Procedure - artery - nos - angioplasty / stenting***
CT05124Procedure - artery - nos - thrombolysis***
CT0513Procedure - pacemaker / defibrillator - transcutaneous pacing***
CT05133Procedure - artery / vein - nos - closure / closure device***
CT05135Procedure - artery / vein - nos - other***
CT05150Procedure - vein - vena cava - filter***
CT05159Procedure - vein - nos - angioplasty***
CT05163Procedure - vascular - occlusion / embolization - transcatheter***
CT05165Procedure - vascular - related supplies - atherectomy***
CT05171Procedure - central venous catheter - insertion***
CT05172Procedure - central venous catheter - fluoroscopy - guidance***
CT05174Procedure - central venous catheter - repair / maintenance***
CT05175Procedure - central venous catheter - removal***
CT05176Procedure - peripheral venous catheter***
CT05178Procedure - catheter - venous - other - other***
CT05181Procedure - catheter - arterial - selective branch catheter***
CT05194Rx - cardiovascular system - cardiac glycosides***
CT05195Rx - cardiovascular system - antiarrhythmic rx***
CT05202Rx - diuretics, loop diuretics***
CT05215Imaging - cta - aorta***
CT05216Imaging - us - intravascular***
CT05217Imaging - nuclear - venous thrombosis - scan***
CT05220Imaging - arteriography - other***
CT0523Procedure - cardioversion***
CT05230Tests - cardiac stress tests - cardiac stress tests - other***
CT05231Tests - other cardiac scans - infarct scan***
CT05232Tests - other cardiac scans***
CT05234Tests - cardiac - ecg - other***
CT05241Tests - cardiac - doppler***
CT05250Tests - cardiac - electrophysiology - other***
CT05252Tests - cardiac - swan ganz***
CT05256Tests - cardiac - radiopharmaceuticals***
CT05257Tests - vascular - arterial - extremity***
CT05258Tests - vascular - venous***
CT05259Tests - vascular - other***
CT05260Tests - cardiovascular - other***
CT05306Heart Echo / Ultrasound***
CT05307Electrocardiogram - EKG monitoring***
CT05308Cardiac Stress Test***
CT05309Cardiac cath & Angiogram***
CT0573Procedure - artery - abdomen - angioplasty - transluminal / open***
CT0574Procedure - artery - abdomen - angioplasty - transluminal / percutaneous***
CT0575Procedure - artery - abdomen - atherectomy - transluminal / open***
CT0576Procedure - artery - abdomen - atherectomy - transluminal / percutaneous***
CT06112Imaging - x-ray - upper gi - small bowel - contrast***
CT06114Imaging - x-ray - upper gi - other***
CT0612Procedure - esophageal / gastric intubation***
CT06120Tests - gi - duodeneal motility study***
CT06121Tests - gi - other dx***
CT0619Procedure - gastrostomy***
CT0667Procedure - other anal / rectal procedures - other procedures - rectum / anus***
CT0694Rx - gi - antiemetics***
CT08106Imaging - x-ray - other - joint survey***
CT0872Imaging - mri - lower extremity***
CT0877Imaging - us - extremity***
CT0959Procedure - other non - or rx - other non - or skin procedures***
CT0965Other care - wound care***
CT1017Rx - vitamins - vitamin b / b complex***
CT1026Other care - diabetes care - glucose monitoring - lancet***
CT10295Thyroid Function Tests***
CT10296Low dose steroids***
CT10297High dose steroids***
CT1036Other care - nutrition - assessment***
CT1055Imaging - venography - other***
CT1061Lab - endocrine response test***
CT1122Procedure - gu - other non - or rx***
CT1150Imaging - nuclear - kidney - scan***
CT1151Imaging - nuclear - bladder / ureter***
CT1155Imaging - x-ray - urinary tract - cystography / voiding cystourethrogram ***
CT1156Imaging - x-ray - urinary tract - other***
CT1158Imaging - venography - other***
CT1159Tests - gu - post void residual / bladder capacity***
CT1164Tests - gu - urodynamics - voiding pressure***
CT1166Lab - urinalysis***
CT14388Magnetic resonance imaging***
CT1615Therapy - transfusion - administration***
CT1616Therapy - transfusion - blood***
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***
CT1634Rx - coagulation system - antiplatelet rx***
CT1635Rx - serums, toxoids, vaccines - serums***
CT1638Rx - administration - injection***
CT1639Rx - administration - infusion***
CT1640Imaging - nuclear - red cell survival***
CT1642Imaging - nuclear - platelet kinetics***
CT1643Imaging - nuclear - other blood / related***
CT1645Lab - blood gases***
CT1646Lab - hematology - coagulation***
CT1647Lab - hematology - blood count***
CT1649Lab - other hematology***
CT1651Lab - immunology***
CT1652Lab - transfusion medicine***
CT1807Rx - antibiotics - cephalosporins***
CT1813Rx - antibiotics, misc***
CT1817Rx - antivirals***
CT1821Lab - infectious agent antigen***
CT1822Lab - infectious agent antibody***
CT1823Lab - infectious agent dna***
CT1824Lab - microbiology - other***
CT1825Lab - microbiology - c & s***
CT1826Lab - microbiology - microscopic exam***
CT1827Lab - microbiology - viral culture***
CT1901Therapy - behavior - evaluation and therapy***
CT1902Therapy - behavior - electroconvulsive therapy***
CT1903Therapy - behavior - medication management***
CT1907Tests - neuro - sleep studies***
CT19303Psychiatry Evaluations***
CT19304Psychiatry Services***
CT19378Laboratory - Chemistry and Hematology***
CT19381Smoking / Tobacco Cessation***
CT2004Lab - chemistry***
CT2009Alcohol / Drug Use Screening***
CT2101Lab - therapeutic drug assay***
CT2301Therapy - allergy treatment***
CT2302Therapy - behavior - other***
CT2304Therapy - pt - exercises / activities***
CT2308Therapy - biofeedback***
CT2311Therapy - vaccination - mmr / related***
CT2312Therapy - vaccination - dtp / related***
CT2313Therapy - vaccination - hib vaccine***
CT2314Therapy - vaccination - hepatitis a vaccine***
CT2315Therapy - vaccination - hepatitis b***
CT2316Therapy - vaccination - poliovirus vaccine***
CT2317Therapy - vaccination - chicken pox***
CT2319Therapy - vaccination - other vaccine***
CT2320Therapy - vaccination - vaccine administration***
CT2321Therapy - vaccination - hpv vaccine***
CT23307Vaccine for flu or Pneumonia***
CT23309Markers for Inflammation***
CT2331Other care - observation***
CT23311Current Tobacco / Cigarette Smoker***
CT23393Prophylactic vaccinations and inoculations***
CT2342Tests - allergy tests - percutaneous***
CT2343Tests - allergy tests - intradermal***
CT2344Tests - allergy tests - patch***
CT2345Tests - allergy tests - other***
CT9902E & M - consultation***
CT9903E & M - hospital***
CT9904E & M - emergency care***
CT9905E & M - home visit***
CT9906E & M - nursing home***
CT9907E & M - prevention***
CT9908E & M - other***
CT9909Procedure - maintenance - cns / spinal pump / port***
CT9910Procedure - anesthesia***
CT99103Imaging - ct - follow - up***
CT99104Imaging - ct - other***
CT99105Imaging - ct - guidance***
CT99107Imaging - mri - other***
CT99108Imaging - mri - guidance***
CT99109Imaging - mri - contrast agent***
CT9911Procedure - sedation***
CT99110Imaging - us - head / neck***
CT99111Imaging - us - retroperitoneum***
CT99113Imaging - us - guide - biopsy***
CT99114Imaging - us - guide - other***
CT99115Imaging - us - other***
CT99117Imaging - nuclear - bone scan - radiopharmaceutical***
CT99118Imaging - nuclear - blood / plasma volume - scan***
CT9912Procedure - anesthesia - related supplies***
CT99120Imaging - nuclear - lymphatics***
CT99125Imaging - nuclear - localization of inflammation***
CT99127Imaging - nuclear - other - automated data add - on***
CT99128Imaging - nuclear - other***
CT99131Imaging - venography - other***
CT99133Imaging - other imaging - fluoroscopy***
CT99134Imaging - other imaging - fluoroscopy - guidance***
CT99136Imaging - other imaging***
CT99137Imaging - therapeutic procedure - abscess drainage***
CT99138Imaging - therapeutic procedure - other therapeutic procedure***
CT99139Imaging - supplies - contrast agent - low osmolar***
CT99142Lab - pathology consultation***
CT99143Lab - chemistry***
CT99144Lab - tissue typing***
CT99146Lab - cytology***
CT99147Lab - cytogenetics***
CT99148Lab - surgical pathology***
CT99149Lab - other clinical lab***
CT99169Lab - specimen collection - blood - venous - venipuncture***
CT99171Lab - specimen collection - blood - venous - venous port***
CT99172Lab - specimen collection - blood - arterial - arterial puncture***
CT99173Lab - specimen collection - specimen handling***
CT99183Transportation - other transportation***
CT99191Supplies***
CT9928Therapy - accupuncture***
CT99309Physician Services***
CT99311Urine Protein***
CT99316Physician Services - Inpatient***
CT9935Therapy - hyperbaric oxygen***
CT99392Other diagnostic procedures (interview, evaluation, consultation)***
CT9940Therapy - other***
CT9944Rx - autonomic rx - sympathomimetic rx***
CT9947Rx - analg/antipy/nsaids - narcotics***
CT9952Rx - electrolytic, caloric, water - sodium chlor preps***
CT9956Rx - electrolytic, caloric, water - hydration - unspecfied***
CT9957Rx - miscellaneous rx***
CT9960Rx - miscellaneous rx - anesthetics, local***
CT9964Other care - home care - specialized visit***
CT9965Other care - home care - physician supervision***
CT9967Other care - home care - nursing care - rn***
CT9970Other care - home care - rehabilitation - physical therapy***
CT9971Other care - home care - rehabilitation - occupational therapy***
CT9973Other care - home care - social worker***
CT9974Other care - home care - home health aide***
CT9986Other care - hospice***
CT9990Other care - other - ancillary services***
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
RX015antiepileptics
RX016antimigraine preparations
RX017hypnotics and sedatives
RX0425antihistamines for systemic use
RX0427drugs for obstructive airway diseases - inhalants
RX0530agents acting on the renin-angiotensin system
RX0531Agents for hypertensive emergencies
RX0534Anticoagulants
RX0535beta blocking agents
RX0536calcium channel blockers
RX0537cardiac glycosides and cardiac stimulants
RX0538diuretics
RX0539i.v. solutions & additives
RX0540Nitrates and other antianginals
RX0541other antihypertensives
RX0542other cardiac preparations
RX0543peripheral vasodilators
RX0544statins and lipid modifying agents
RX0546Antiplatelet Agents Thrombin Inhibitors
RX0645antacids
RX0647antiemetics and antinauseants
RX0648digestives incl. enzymes
RX0649drugs for constipation
RX0861opioids
RX0862other analgesics and antipyretics
RX13101other gynecologicals
RX16106iron preparations
RX16109vitamin b12 and folic acid
RX16110vitamin k and other hemostatics
RX16111Agents to stop bleeding
RX19125anxiolytics
RX23131mineral supplements
RX23133other nutrients
RX23135vitamins