Low Back Pain(LBP) ECR Summary Description

Version: 5.4.005

Low Back Pain 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 low back pain-specific principal diagnosis code or an outpatient or professional E&M service with a low back pain-specific diagnosis code in any position. The professional trigger also requires a confirming inpatient, outpatient or professional low back pain-related E&M service at least 30 days later. Services with diagnosis codes for signs and symptoms related to Low Back Pain such as lumbago or sciatica have been defined as typical care for Low Back Pain, and conditions such as electrolyte disturbances or GI bleed due to use of pain medicines without proper protection have been labeled as complications.

Patients who undergo a Lumbar Laminectomy (LBRLAM) are included in a separate procedural episode but are linked back to the Low Back Pain episode to understand the frequency and consequently the appropriateness of these procedures in Low Back Pain patients. In addition, the Low Back Pain episode is related back to the underlying Osteoarthritis episode (if one exists) as typical care at the patient level, and is compared to similar Low Back Pain episodes as part of the risk adjustment methodology.

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 GroupsInflammatory spondylopathies, Low Back Pain, Radiculopathy, Low Back Pain, Radiculopathy, Myelopathy, Obstructive sleep apnea, Orthostatic Hypotension / Dizziness, Other arthropathies, Other Back Pain, Radiculopathy, Myelopathy, Other bone infections, Other Spine Problems, Sleep Apnea, Spina Bifida, Stiff Spine

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)
DX0102ID - syphilis***
DX0104ID - other herpes zoster***
DX01130NS - autonomic ns ds***
DX01146NS - hereditary polyneuropathy***
DX01147NS - idiopathic polyneuropathy***
DX01183NS - acute pain - other***
DX01186NS - chronic pain - other***
DX01208MS - soft tissue - nos- symptoms / findings***
DX01343Inj - cauda equina***
DX01398Mild - Moderate Neurological Deficit***
DX01399Major Neurological Deficit***
DX05345Orthostatic Hypotension / Dizziness***
DX06335Retroperitoneal Abscess***
DX081038Post Laminectomy Syndrome***
DX081045Deformities, lower limb***
DX081048Hip / Pelvis deformities***
DX081050Inflammatory Arthropathies***
DX081051Inflammatory spondylopathies***
DX081054Low Back Pain, Radiculopathy***
DX081055Low Back Pain, Radiculopathy, Myelopathy***
DX081062Other arthropathies***
DX081063Other Back Pain, Radiculopathy, Myelopathy***
DX081092Backache***
DX081093Sprain Lower Back***
DX081094Sprains and Strains***
DX081095Stiff Spine***
DX081096Other Spine Problems***
DX08195MS - spine - ccyx - hypermobility***
DX08196MS - spine - ccyx - ds of ccyx***
DX08218MS - spine - fx - w/o cord injury - closed***
DX08219MS - spine - fx - w/o cord injury - open***
DX08220MS - spine - fx - w/ cord injury - closed***
DX08221MS - spine - fx - w/ cord injury - open***
DX08224MS - spine - deformity***
DX08225MS - spine - anomaly***
DX0853Immune sys - screening for rheumatoid arthritis***
DX0873MS - head / neck - ossification of ligament***
DX08892MS - joint nos - arthropathy - nos***
DX08931MS - soft tissue - nos- nec / nos***
DX08948MS - muscle - nos - spasm of muscle***
DX08949MS - muscle - nos - muscle weakness***
DX08950MS - muscle - nos - myalgia***
DX08960MS - nos - aftercare***
DX1765NS - chronic pain - cancer***
DX1923BH - other ds***
DX1963Anxiety Disorders***
DX2159Toxic Effects of Radiation***
DX2307NS - acute pain - other***
DX2337Prvn - routine medical exam***
DX2338Prvn - routine exam - other***
DX2339Prvn - admin exam / visit***
DX2341Prvn - encounter for x-ray***
DX2342Prvn - encounter for lab test***
DX2345Othr - fitting - other device***
DX2346Othr - rehabilitation***
DX2352Othr - other***

*** 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)
DXX0012Other injuries and conditions due to external***
DXX0102ID - syphilis***
DXX0104ID - other herpes zoster***
DXX01130NS - autonomic ns ds***
DXX01146NS - hereditary polyneuropathy***
DXX01147NS - idiopathic polyneuropathy***
DXX01152NS - polyneuropathy - other diseases***
DXX01183NS - acute pain - other***
DXX01186NS - chronic pain - other***
DXX01208MS - soft tissue - nos- symptoms / findings***
DXX01343Inj - cauda equina***
DXX01399Major Neurological Deficit***
DXX05345Orthostatic Hypotension / Dizziness***
DXX06335Retroperitoneal Abscess***
DXX081038Post Laminectomy Syndrome***
DXX081045Deformities, lower limb***
DXX081048Hip / Pelvis deformities***
DXX081050Inflammatory Arthropathies***
DXX081051Inflammatory spondylopathies***
DXX081054Low Back Pain, Radiculopathy***
DXX081055Low Back Pain, Radiculopathy, Myelopathy***
DXX081062Other arthropathies***
DXX081063Other Back Pain, Radiculopathy, Myelopathy***
DXX08107MS - pelvis - sprn/strn***
DXX081070Other bone infections***
DXX081092Backache***
DXX081093Sprain Lower Back***
DXX081094Sprains and Strains***
DXX081095Stiff Spine***
DXX081096Other Spine Problems***
DXX081104Other injuries to spine***
DXX081105Spinal cord injury***
DXX08186MS - spine - scrm / ccyx - fx - w/o cord injury - closed***
DXX08187MS - spine - scrm / ccyx - fx - w/o cord injury - open***
DXX08224MS - spine - deformity***
DXX0873MS - head / neck - ossification of ligament***
DXX08897MS - joint nos - jnt derangmnt - other***
DXX08931MS - soft tissue - nos- nec / nos***
DXX08948MS - muscle - nos - spasm of muscle***
DXX08949MS - muscle - nos - muscle weakness***
DXX08950MS - muscle - nos - myalgia***
DXX08960MS - nos - aftercare***
DXX0990MS - head / neck - infection***
DXX1554Spina Bifida***
DXX1765NS - chronic pain - cancer***
DXX1923BH - other ds***
DXX1963Anxiety Disorders***
DXX2159Toxic Effects of Radiation***
DXX2337Prvn - routine medical exam***
DXX2338Prvn - routine exam - other***
DXX2339Prvn - admin exam / visit***
DXX2345Othr - fitting - other device***
DXX2352Othr - other***
DXX2378Pain, unspecified***
DXX2379Observation/Examination***
DXX2381Aftercare***
DXX2382Preventive Screening***
XX0000Ungrouped Codes***

*** 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***
DX04142Respiratory Failure***
DX05274transfusion, infusion related complications***
DX05275phlebitis, deep vein thrombosis (dvt)***
DX05297Hypotension / Syncope***
DX05298Fluid Electrolyte Acid Base Problems***
DX05308Pulmonary Embolism***
DX05309IVC & other intra-abd venous thrombosis***
DX05311Other Phlebitis, Lymphangitis, varices***
DX05342Acute cor pulmonale***
DX06306GI Bleed***
DX06307Intestinal Obstruction***
DX06314Digestive system complications***
DX06317Acute esophagitis, acute gastritis, duodenitis***
DX081039Intraspinal abscess***
DX081082Compl of joint prosthesis, orthopedic proced***
DX09191Decubitus Ulcer***
DX09192Dermatitis, Urticaria***
DX09193Cellulitis, Skin Infection***
DX11143Urinary Tract Infection***
DX11147Complication of genitourinary device***
DX11150Bladder Dysfunction, hemorrhage***
DX11153Urinary Incontinence***
DX2164Accidental Falls***
DX2171Adverse effects of drugs***
DX2172Overdose, Poisonings***
DX2360Complication of Implanted device, graft***
DX2361complications of surgical procedures***
DX2362complications of medical care***
DX9910HAC 02: Air Embolism***
DX9912HAC 04: Stage III and IV Pressure Ulcers***
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)
DXX01392Delirium, Encephalopathy***
DXX01403Complication of nervous system device***
DXX02119Cmplctns - eye - graft/implant***
DXX02147Complications after eye surgery***
DXX04142Respiratory Failure***
DXX05274transfusion, infusion related complications***
DXX05275phlebitis, deep vein thrombosis (dvt)***
DXX05297Hypotension / Syncope***
DXX05298Fluid Electrolyte Acid Base Problems***
DXX05308Pulmonary Embolism***
DXX05309IVC & other intra-abd venous thrombosis***
DXX05311Other Phlebitis, Lymphangitis, varices***
DXX05342Acute cor pulmonale***
DXX06306GI Bleed***
DXX06307Intestinal Obstruction***
DXX06314Digestive system complications***
DXX06317Acute esophagitis, acute gastritis, duodenitis***
DXX06372Ulc Colitis w Obstruction***
DXX081039Intraspinal abscess***
DXX081082Compl of joint prosthesis, orthopedic proced***
DXX09191Decubitus Ulcer***
DXX09192Dermatitis, Urticaria***
DXX09193Cellulitis, Skin Infection***
DXX11143Urinary Tract Infection***
DXX11147Complication of genitourinary device***
DXX11150Bladder Dysfunction, hemorrhage***
DXX11153Urinary Incontinence***
DXX1948Suicide or Self-inflicted Injury***
DXX2156adverse effects of drugs, correct use***
DXX2164Accidental Falls***
DXX2171Adverse effects of drugs***
DXX2360Complication of Implanted device, graft***
DXX2361complications of surgical procedures***
DXX2362complications of medical care***
DXX2367Malfunction / Complication of Heart Device, H***
DXX9910HAC 02: Air Embolism***
DXX9912HAC 04: Stage III and IV Pressure Ulcers***
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)
PX01198Magnetic resonance imaging - 198***
PX03215Other physical therapy and rehabilitation - 215***
PX03231Other therapeutic procedures - 231***
PX05197Other diagnostic ultrasound - 197***
PX05226Other diagnostic radiology and related techniques - 226***
PX05227Other diagnostic procedures (interview, evaluation, consultation) - 227***
PX08156Injections and aspirations of muscles, tendons, bursa, joints and soft tis - 156***
PX08159Other diagnostic procedures on musculoskeletal system - 159***
PX08162Other OR therapeutic procedures on joints - 162***
PX08163Other non-OR therapeutic procedures on musculoskeletal system - 163***
PX08181Myelogram - 181***
PX08207Radioisotope bone scan - 207***
PX08212Diagnostic physical therapy - 212***
PX08213Physical therapy exercises, manipulation, and other procedures - 213***
PX08214Traction, splints, and other wound care - 214***
PX08217Biologic Infusions***
PX08227Spinal Instrumentation / Stabilization***
PX09168Incision and drainage, skin and subcutaneous tissue - 168***
PX09169Debridement of wound, infection or burn - 169***
PX09171Suture of skin and subcutaneous tissue - 171***
PX11180Other CT scan - 180***

*** 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)
PXX0101Incision and excision of CNS - 001***
PXX0105Insertion of catheter or spinal stimulator and injection into spinal canal - 005***
PXX0108Other non-OR or closed therapeutic nervous system procedures - 008***
PXX01198Magnetic resonance imaging - 198***
PXX0219Other therapeutic procedures on eyelids, conjunctiva, cornea - 019***
PXX02220Ophthalmologic and otologic diagnosis and treatment - 220***
PXX03215Other physical therapy and rehabilitation - 215***
PXX03231Other therapeutic procedures - 231***
PXX04183Routine chest X-ray - 183***
PXX0441Other non-OR therapeutic procedures on respiratory system - 041***
PXX05197Other diagnostic ultrasound - 197***
PXX05226Other diagnostic radiology and related techniques - 226***
PXX05227Other diagnostic procedures (interview, evaluation, consultation) - 227***
PXX0686Other hernia repair - 086***
PXX0696Other OR lower GI therapeutic procedures - 096***
PXX0697Other gastrointestinal diagnostic procedures - 097***
PXX08149Arthroscopy - 149***
PXX08156Injections and aspirations of muscles, tendons, bursa, joints and soft tis - 156***
PXX08159Other diagnostic procedures on musculoskeletal system - 159***
PXX08160Other therapeutic procedures on muscles and tendons - 160***
PXX08162Other OR therapeutic procedures on joints - 162***
PXX08163Other non-OR therapeutic procedures on musculoskeletal system - 163***
PXX08164Other OR therapeutic procedures on musculoskeletal system - 164***
PXX08181Myelogram - 181***
PXX08207Radioisotope bone scan - 207***
PXX08212Diagnostic physical therapy - 212***
PXX08213Physical therapy exercises, manipulation, and other procedures - 213***
PXX08214Traction, splints, and other wound care - 214***
PXX08217Biologic Infusions***
PXX08227Spinal Instrumentation / Stabilization***
PXX08239Removal From Hip Joint***
PXX09168Incision and drainage, skin and subcutaneous tissue - 168***
PXX09171Suture of skin and subcutaneous tissue - 171***
PXX11180Other CT scan - 180***
PXX17225CHEMOTHERAPY***

*** 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
CT0007X-Ray Thoracolumbar Spine / Pelvis***
CT0025Preventive Medicine, Care Coordination***
CT0078Prosthetic Implant***
CT0080Imaging Abdomen***
CT0082Opioid Administration / Dispensing (OTP)***
CT0089Metabolic Renal Hepatic Chemistry Panel***
CT0090Physical Therapy / Rehab***
CT0091Physician Services - Outpatient ***
CT0092Physician Services - Inpatient***
CT0111Procedure - spinal neurostimulator***
CT0112Procedure - spinal canal - injection into spinal canal***
CT0113Procedure - spinal canal - other***
CT0118Procedure - peripheral nerve - decompression - other***
CT0119Procedure - block - nerve***
CT0120Procedure - destruction - nerve***
CT0124Procedure - other or rx - peripheral neurostimulator procedures***
CT0125Procedure - neuro - other or rx***
CT0126Procedure - neuro - other non - or rx***
CT0131Procedure - anesthesia***
CT01395DME and supplies***
CT0158Imaging - other imaging - epidurography***
CT0161Tests - neuro - muscle testing***
CT0162Tests - neuro - ncv / emg***
CT0163Tests - neuro - evoked potentials***
CT0165Tests - neuro - other***
CT03396Other OR therapeutic procedures on nose, mouth and pharynx***
CT0442Other care - respiratory - equipment / supplies***
CT0444Other care - prevention - smoking cessation***
CT0446Imaging - cta - chest***
CT0453Tests - pulmonary - peak flow***
CT05141Procedure - graft***
CT05171Procedure - central venous catheter - insertion***
CT05176Procedure - peripheral venous catheter***
CT05184Procedure - vascular access - port / pump - insertion***
CT05191Procedure - related supplies - other***
CT05202Rx - diuretics, loop diuretics***
CT05210Other care - other - pvd - compressor***
CT05257Tests - vascular - arterial - extremity***
CT05258Tests - vascular - venous***
CT0692Therapy - neurostimulator - nausea / vomiting***
CT0694Rx - gi - antiemetics***
CT0697Rx - gi - ppis***
CT0809Procedure - other spine - rx / dx - injection***
CT08111Imaging - other imaging - bone density - dexa***
CT08113DME - heat/cold application***
CT08114DME - traction***
CT08115DME - trapeze / other orthopedic device***
CT08118Prosthetics - lower extremity***
CT08120Prosthetics - external power***
CT08121Orthotics - spine***
CT08122Orthotics - upper extremity***
CT08123Orthotics - lower extremity***
CT08124Orthotics - orthopedic shoes***
CT08125Orthotics - other***
CT0831Procedure - removal of pins or fixation***
CT0833Procedure - casting / splinting - application***
CT0834Procedure - casting / splinting - supplies***
CT0835Procedure - injection - tendons / joints / etc.***
CT0840Procedure - other dx on musculoskeletal system***
CT0841Procedure - other rx on muscles and tendons***
CT0849Procedure - anesthesia***
CT0851Therapy - chiropractic / osteopathic manipulation***
CT0855Therapy - neurostimulator - muscle training***
CT0857Rx - muscle relaxants - muscle relax, skeletal central***
CT0860Imaging - ct - abdomen - pelvis***
CT0863Imaging - ct - lumbar spine***
CT0866Imaging - ct - study***
CT0867Imaging - mri - pelvis***
CT0870Imaging - mri - lumbar spine***
CT0873Imaging - mra - spinal canal ***
CT0874Imaging - mra - pelvis***
CT0878Imaging - nuclear - other musculoskeletal***
CT0887Imaging - x-ray - si joints - arthrogram***
CT0889Imaging - x-ray - discography***
CT0890Imaging - x-ray - myelogram***
CT0920Procedure - injection of skin lesion***
CT0929Procedure - excision - skin - shave skin lesion***
CT0969Other care - chronic edema - surgical stockings***
CT0970Other care - chronic edema - appliance - limb compression***
CT0971Other care - chronic edema - appliance - non - segmental***
CT0972Other care - chronic edema - appliance - segmental***
CT0973Other care - chronic edema - compression stocking***
CT0974Other care - chronic edema - compressor - non - segmental***
CT0975Other care - chronic edema - compressor - segmental***
CT0976Other care - chronic edema - compressor***
CT0977Other care - chronic edema - sleeve***
CT0978Other care - chronic edema - glove***
CT0979Other care - chronic edema - gauntlet***
CT0980Other care - chronic edema - exterior wrap***
CT0981Other care - chronic edema - complex therapy***
CT0991Tests - skin***
CT1021Rx - vitamins - multivit prep***
CT1026Other care - diabetes care - glucose monitoring - lancet***
CT10296Low dose steroids***
CT1036Other care - nutrition - assessment***
CT1044Other care - nutrition - parenteral - pump***
CT1045Other care - nutrition - parenteral - all - inclusive***
CT1046Other care - nutrition - education***
CT1047Other care - nutrition - medical food***
CT1048Other care - nutrition - counseling - dietician***
CT1049Other care - other - weight management***
CT14389Other Laboratory***
CT1620Therapy - phlebotomy***
CT16296Lipid Level Monitoring***
CT16297Blood Count***
CT16298NewBorn Blood Tests***
CT16299Bleeding Status***
CT1638Rx - administration - injection***
CT1639Rx - administration - infusion***
CT1646Lab - hematology - coagulation***
CT1647Lab - hematology - blood count***
CT18300Microscopic examination (bacterial smear, culture, toxicology)***
CT1901Therapy - behavior - evaluation and therapy***
CT1903Therapy - behavior - medication management***
CT1905Therapy - behavior - partial hospilization***
CT1907Tests - neuro - sleep studies***
CT19303Psychiatry Evaluations***
CT19304Psychiatry Services***
CT19378Laboratory - Chemistry and Hematology***
CT19381Smoking / Tobacco Cessation***
CT2009Alcohol / Drug Use Screening***
CT20376Other Laboratory***
CT2302Therapy - behavior - other***
CT2304Therapy - pt - exercises / activities***
CT2305Therapy - pt - modalities***
CT2308Therapy - biofeedback***
CT2309Therapy - activity therapy***
CT2325Other care - ostomy - supplies***
CT2326Other care - bladder / bowel care - other supplies***
CT2327Other care - bladder / bowel care - catheter***
CT2328Other care - bladder / bowel care - drainage bag***
CT2329Other care - bladder / bowel care - other supplies - diaper / related***
CT2330Other care - bladder / bowel care - other supplies - skin barrier***
CT2331Other care - observation***
CT2332Other care - child care - foster care***
CT2333Other care - child care - education***
CT2336Other care - case / disease management - case management***
CT2339Other care - other - geriatric care***
CT23398Ancillary Services***
CT2341Other care - other - exercise classes***
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***
CT9909Procedure - maintenance - cns / spinal pump / port***
CT9910Procedure - anesthesia***
CT99100Other care - other - personal care services***
CT99101Other care - other - lead assessment***
CT99102Other care - other***
CT99103Imaging - ct - follow - up***
CT99104Imaging - ct - other***
CT99105Imaging - ct - guidance***
CT99106Imaging - cta - other***
CT99107Imaging - mri - other***
CT99108Imaging - mri - guidance***
CT99109Imaging - mri - contrast agent***
CT9911Procedure - sedation***
CT99113Imaging - us - guide - biopsy***
CT99114Imaging - us - guide - other***
CT99115Imaging - us - other***
CT99116Imaging - nuclear - bone scan***
CT99125Imaging - nuclear - localization of inflammation***
CT99133Imaging - other imaging - fluoroscopy***
CT99134Imaging - other imaging - fluoroscopy - guidance***
CT99136Imaging - other imaging***
CT99139Imaging - supplies - contrast agent - low osmolar***
CT99140Imaging - supplies - contrast agent - high osmolar***
CT99142Lab - pathology consultation***
CT99143Lab - chemistry***
CT99148Lab - surgical pathology***
CT9915Procedure - microsurgery***
CT99169Lab - specimen collection - blood - venous - venipuncture***
CT9917Procedure - related supplies - access catheter***
CT99171Lab - specimen collection - blood - venous - venous port***
CT99172Lab - specimen collection - blood - arterial - arterial puncture***
CT99173Lab - specimen collection - specimen handling***
CT99176Lab - stat request***
CT9918Procedure - related supplies - ablation - catheter***
CT99182Transportation - paramedic***
CT99183Transportation - other transportation***
CT99184DME - other***
CT99185DME - bath / toilet aids***
CT99186DME - beds / accessories***
CT99187DME - safety equipment***
CT99188DME - restraints***
CT99189DME - whirlpool - equipment***
CT99190DME - repair / maintenance***
CT99191Supplies***
CT99192Prosthetics - implant***
CT99195Prosthetics - other***
CT99196Prosthetics - repair***
CT99197Other - non - covered***
CT99198PQRI***
CT9927Procedure - related supplies - other***
CT9928Therapy - accupuncture***
CT9930Therapy - habilitation***
CT99309Physician Services***
CT99316Physician Services - Inpatient***
CT9935Therapy - hyperbaric oxygen***
CT9936Therapy - neurostimulator - tens - device***
CT9937Therapy - neurostimulator - tens - leads***
CT9938Therapy - neurostimulator - tens - supplies***
CT99392Other diagnostic procedures (interview, evaluation, consultation)***
CT9940Therapy - other***
CT9947Rx - analg/antipy/nsaids - narcotics***
CT9950Rx - electrolytic, caloric, water - potassium supp***
CT9951Rx - electrolytic, caloric, water - multi-mineral prep***
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***
CT9968Other care - home care - nursing care - lpn***
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***
CT9975Other care - home care - other care - day care***
CT9976Other care - home care - other care - chore care***
CT9977Other care - home care - other care - attendant care***
CT9978Other care - home care - other care - homemaker***
CT9979Other care - home care - other care - companion care***
CT9980Other care - home care - other care - respite care***
CT9981Other care - home care - other care***
CT9982Other care - home care - training***
CT9983Other care - home care - emergency response system***
CT9984Other care - home care - meals***
CT9985Other care - pain management - pca / related***
CT9986Other care - hospice***
CT9987Other care - long term care - residential care***
CT9988Other care - long term care - assisted living***
CT9990Other care - other - ancillary services***
CT9993Other care - other - therapeutic riding***
CT9994Other care - other - back care***
CT9996Other care - other - lodging***
CT9997Other care - other - meals***
CT9998Other care - other - medical records***
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
RX018other nervous system drugs
RX0543peripheral vasodilators
RX0544statins and lipid modifying agents
RX0546Antiplatelet Agents Thrombin Inhibitors
RX0645antacids
RX0647antiemetics and antinauseants
RX0648digestives incl. enzymes
RX0649drugs for constipation
RX0650drugs for functional gastrointestinal disorders
RX0651drugs for peptic ulcer and gerd
RX0856antigout preparations
RX0857antiinflammatory and antirheumatic products
RX0858antipsoriatics for systemic use
RX0859antipsoriatics for topical use
RX0860muscle relaxants
RX0861opioids
RX0862other analgesics and antipyretics
RX0863other drugs for disorders of the musculo-skeletal system
RX0864topical products for joint and muscular pain
RX0965agents for treatment of hemorrhoids and anal fissures for topical use
RX0968antibiotics and chemotherapeutics for dermatological use
RX0969antifungals for dermatological use
RX0970antipruritics incl. antihistamines anesthetics etc.
RX0971antiseptics and disinfectants
RX0973corticosteroids dermatological preparations
RX0974ectoparasiticides incl. scabicides insecticides and repellents
RX0976irrigating solutions
RX0977medicated dressings
RX0978other dermatological preparations
RX0979preparations for treatment of wounds and ulcers
RX0980Moisturizers and skin protective agents
RX1082antiobesity preparations excl. diet products
RX1086corticosteroids for systemic use
RX16106iron preparations
RX16109vitamin b12 and folic acid
RX18121antimycobacterials
RX19123antidepressants
RX19125anxiolytics
RX23130immunosuppressants
RX23131mineral supplements
RX23133other nutrients
RX23135vitamins
RX99137anesthetics local