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 Codes | Codes that, when meeting the trigger criteria, indicate an episode exists (See Table A) |
| SubTypes | Episodes 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 Diagnoses | These 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 Procedures | These 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 Pharmacy | These 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 Groups | Achalasia, 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 Type | Codes |
| 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 ID | Group Name | ICD-9-CM (DX) |
| DX03119 | Resp - laryngitis - chronic | *** |
| DX03129 | Resp - voice disturbance | *** |
| DX04100 | Resp - painful breathing | *** |
| DX04155 | laryngeal problems | *** |
| DX0496 | Resp - cough | *** |
| DX0498 | Resp - wheezing | *** |
| DX05282 | Unstable angina | *** |
| DX05345 | Orthostatic Hypotension / Dizziness | *** |
| DX06206 | GI - abdominal pain | *** |
| DX06207 | GI - flatulence / gas pain | *** |
| DX06208 | GI - symptoms - nec / nos | *** |
| DX06214 | GI - abdominal tenderness | *** |
| DX06218 | GI - abnormal abdominal imaging study | *** |
| DX06219 | GI - abnormal gi imaging study | *** |
| DX06221 | GI - personal hx of GI disease | *** |
| DX06267 | Nausea, vomiting | *** |
| DX06275 | Abdominal hernia | *** |
| DX06285 | Previous bowel surgery, ostomy status | *** |
| DX06313 | Esophageal Complications | *** |
| DX06316 | Achalasia, Esophageal Spasm, Dysphagia | *** |
| DX06317 | Acute esophagitis, acute gastritis, duodenitis | *** |
| DX06319 | Barrett's Esophagus | *** |
| DX06325 | Diaphragmatic Hernia | *** |
| DX06331 | Other Esophageal conditions | *** |
| DX06332 | Dysphagia | *** |
| DX06347 | Alcoholic Gastritis | *** |
| DX06364 | Heartburn | *** |
| DX06365 | Abdominal pain | *** |
| DX06366 | Abdominal mass | *** |
| DX06367 | Abdominal tenderness | *** |
| DX06369 | Esophageal Reflux and Other Esophagitis | *** |
| DX10109 | Protein Calorie Malnutrition | *** |
| DX1062 | Endo - vitamin a deficiency | *** |
| DX1063 | Endo - thiamin deficiency | *** |
| DX1064 | Endo - vitamin b deficiency | *** |
| DX1066 | Endo - other nutrl deficiencies | *** |
| DX1846 | Opportunistic Infections | *** |
| DX1923 | BH - other ds | *** |
| DX1963 | Anxiety Disorders | *** |
| DX2369 | Abnormal 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 ID | Group Name | ICD-10-CM (DX) |
| DXX01392 | Delirium, Encephalopathy | *** |
| DXX03119 | Resp - laryngitis - chronic | *** |
| DXX03129 | Resp - voice disturbance | *** |
| DXX04100 | Resp - painful breathing | *** |
| DXX04127 | empyema, lung abscess | *** |
| DXX04155 | laryngeal problems | *** |
| DXX0496 | Resp - cough | *** |
| DXX0498 | Resp - wheezing | *** |
| DXX05282 | Unstable angina | *** |
| DXX05345 | Orthostatic Hypotension / Dizziness | *** |
| DXX0608 | ID - other viral - nec / nos | *** |
| DXX06206 | GI - abdominal pain | *** |
| DXX06207 | GI - flatulence / gas pain | *** |
| DXX06214 | GI - abdominal tenderness | *** |
| DXX06218 | GI - abnormal abdominal imaging study | *** |
| DXX06219 | GI - abnormal gi imaging study | *** |
| DXX06221 | GI - personal hx of GI disease | *** |
| DXX06267 | Nausea, vomiting | *** |
| DXX06285 | Previous bowel surgery, ostomy status | *** |
| DXX06313 | Esophageal Complications | *** |
| DXX06316 | Achalasia, Esophageal Spasm, Dysphagia | *** |
| DXX06317 | Acute esophagitis, acute gastritis, duodenitis | *** |
| DXX06319 | Barrett's Esophagus | *** |
| DXX06325 | Diaphragmatic Hernia | *** |
| DXX06331 | Other Esophageal conditions | *** |
| DXX06332 | Dysphagia | *** |
| DXX06347 | Alcoholic Gastritis | *** |
| DXX06364 | Heartburn | *** |
| DXX06365 | Abdominal pain | *** |
| DXX06367 | Abdominal tenderness | *** |
| DXX06369 | Esophageal Reflux and Other Esophagitis | *** |
| DXX06375 | Allergic, Dietetic, Eosinophilic Gastroenteritis | *** |
| DXX06380 | Abdominal Hernia w/out Gangrene/Obstruction | *** |
| DXX0671 | GI - esophagitis | *** |
| DXX10109 | Protein Calorie Malnutrition | *** |
| DXX1062 | Endo - vitamin a deficiency | *** |
| DXX1063 | Endo - thiamin deficiency | *** |
| DXX1064 | Endo - vitamin b deficiency | *** |
| DXX1066 | Endo - other nutrl deficiencies | *** |
| DXX1846 | Opportunistic Infections | *** |
| DXX1923 | BH - other ds | *** |
| DXX1963 | Anxiety Disorders | *** |
| DXX2369 | Abnormal weight loss | *** |
| DXX2377 | Personal 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 ID | Group Name | ICD-9-CM (DX) |
| DX01391 | Meningitis / Encephalitis | *** |
| DX04126 | other lung complications | *** |
| DX04130 | Aspiration Pneumonia | *** |
| DX04142 | Respiratory Failure | *** |
| DX04154 | Respiratory Insufficiency | *** |
| DX04170 | Ventilator Associated Pnuemonia | *** |
| DX04177 | Ventilator Dependence | *** |
| DX04187 | Other lung problems | *** |
| DX05272 | dic, coagulation, hemorrhagic disorders | *** |
| DX05274 | transfusion, infusion related complications | *** |
| DX05275 | phlebitis, deep vein thrombosis (dvt) | *** |
| DX05298 | Fluid Electrolyte Acid Base Problems | *** |
| DX05299 | Shock / Cardiac Arrest | *** |
| DX05311 | Other Phlebitis, Lymphangitis, varices | *** |
| DX06268 | Complicated Hiatal Hernia | *** |
| DX06305 | C-Difficile Infection | *** |
| DX06306 | GI Bleed | *** |
| DX06307 | Intestinal Obstruction | *** |
| DX06313 | Esophageal Complications | *** |
| DX06338 | Complications of colostomy, enterostomy | *** |
| DX06347 | Alcoholic Gastritis | *** |
| DX09187 | wound infections | *** |
| DX09192 | Dermatitis, Urticaria | *** |
| DX10110 | Severe Protein Calorie Malnutrition | *** |
| DX11145 | Urinary Complications | *** |
| DX16296 | Hemorrhage | *** |
| DX1846 | Opportunistic Infections | *** |
| DX1849 | Other bacterial infections | *** |
| DX1850 | MRSA, Drug Resistant Infections | *** |
| DX1852 | Severe Sepsis | *** |
| DX1853 | Bacteremia, SIRS, no organ dysfunction | *** |
| DX2171 | Adverse effects of drugs | *** |
| DX2172 | Overdose, Poisonings | *** |
| DX2360 | Complication of Implanted device, graft | *** |
| DX2361 | complications of surgical procedures | *** |
| DX2362 | complications of medical care | *** |
| DX2370 | Fever & Chills | *** |
| DX9909 | HAC: Foreign Body Retained After Surgery | *** |
| DX9910 | HAC 02: Air Embolism | *** |
| DX9911 | HAC: Blood Incompatibility | *** |
| DX9915 | HAC: Catheter Associated UTIs | *** |
| DX9916 | HAC: 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 ID | Group Name | ICD-10-CM (DX) |
| DXX01391 | Meningitis / Encephalitis | *** |
| DXX01392 | Delirium, Encephalopathy | *** |
| DXX01403 | Complication of nervous system device | *** |
| DXX02147 | Complications after eye surgery | *** |
| DXX04126 | other lung complications | *** |
| DXX04127 | empyema, lung abscess | *** |
| DXX04130 | Aspiration Pneumonia | *** |
| DXX04142 | Respiratory Failure | *** |
| DXX04154 | Respiratory Insufficiency | *** |
| DXX04170 | Ventilator Associated Pnuemonia | *** |
| DXX04177 | Ventilator Dependence | *** |
| DXX04187 | Other lung problems | *** |
| DXX04188 | Other Bacterial Pneumonia | *** |
| DXX05272 | dic, coagulation, hemorrhagic disorders | *** |
| DXX05274 | transfusion, infusion related complications | *** |
| DXX05275 | phlebitis, deep vein thrombosis (dvt) | *** |
| DXX05298 | Fluid Electrolyte Acid Base Problems | *** |
| DXX05299 | Shock / Cardiac Arrest | *** |
| DXX05311 | Other Phlebitis, Lymphangitis, varices | *** |
| DXX05317 | Complications after heart procedures | *** |
| DXX06268 | Complicated Hiatal Hernia | *** |
| DXX06305 | C-Difficile Infection | *** |
| DXX06306 | GI Bleed | *** |
| DXX06307 | Intestinal Obstruction | *** |
| DXX06313 | Esophageal Complications | *** |
| DXX06338 | Complications of colostomy, enterostomy | *** |
| DXX06347 | Alcoholic Gastritis | *** |
| DXX09192 | Dermatitis, Urticaria | *** |
| DXX11145 | Urinary Complications | *** |
| DXX16296 | Hemorrhage | *** |
| DXX1846 | Opportunistic Infections | *** |
| DXX1849 | Other bacterial infections | *** |
| DXX1850 | MRSA, Drug Resistant Infections | *** |
| DXX1851 | Sepsis | *** |
| DXX1852 | Severe Sepsis | *** |
| DXX1853 | Bacteremia, SIRS, no organ dysfunction | *** |
| DXX1948 | Suicide or Self-inflicted Injury | *** |
| DXX2156 | adverse effects of drugs, correct use | *** |
| DXX2171 | Adverse effects of drugs | *** |
| DXX2360 | Complication of Implanted device, graft | *** |
| DXX2361 | complications of surgical procedures | *** |
| DXX2362 | complications of medical care | *** |
| DXX9909 | HAC: Foreign Body Retained After Surgery | *** |
| DXX9910 | HAC 02: Air Embolism | *** |
| DXX9911 | HAC: Blood Incompatibility | *** |
| DXX9916 | HAC: Infection due to central venous catheter | *** |
| XX0000 | Ungrouped 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 ID | Group Name | ICD-9-PCS (PX) |
| PX03229 | Nonoperative removal of foreign body - 229 | *** |
| PX06179 | CT scan abdomen - 179 | *** |
| PX06185 | Upper gastrointestinal X-ray - 185 | *** |
| PX06186 | Lower gastrointestinal X-ray - 186 | *** |
| PX06194 | Diagnostic ultrasound of gastrointestinal tract - 194 | *** |
| PX06196 | Diagnostic ultrasound of abdomen or retroperitoneum - 196 | *** |
| PX0668 | Injection or ligation of esophageal varices - 068 | *** |
| PX0669 | Esophageal dilatation - 069 | *** |
| PX0693 | Other non-OR upper GI therapeutic procedures - 093 | *** |
| PX0694 | Other OR upper GI therapeutic procedures - 094 | *** |
| PX0697 | Other gastrointestinal diagnostic procedures - 097 | *** |
| PX0698 | Other 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 ID | Group Name | ICD-10-PCS (PX) |
| PXX03229 | Nonoperative removal of foreign body - 229 | *** |
| PXX03231 | Other therapeutic procedures - 231 | *** |
| PXX04178 | CT scan chest - 178 | *** |
| PXX0441 | Other non-OR therapeutic procedures on respiratory system - 041 | *** |
| PXX0442 | Other OR therapeutic procedures on respiratory system - 042 | *** |
| PXX05226 | Other diagnostic radiology and related techniques - 226 | *** |
| PXX0561 | Other OR procedures on vessels other than head and neck - 061 | *** |
| PXX06179 | CT scan abdomen - 179 | *** |
| PXX06185 | Upper gastrointestinal X-ray - 185 | *** |
| PXX06186 | Lower gastrointestinal X-ray - 186 | *** |
| PXX06194 | Diagnostic ultrasound of gastrointestinal tract - 194 | *** |
| PXX06196 | Diagnostic ultrasound of abdomen or retroperitoneum - 196 | *** |
| PXX06239 | Bariatric Surgery: Open Other | *** |
| PXX0668 | Injection or ligation of esophageal varices - 068 | *** |
| PXX0669 | Esophageal dilatation - 069 | *** |
| PXX0686 | Other hernia repair - 086 | *** |
| PXX0693 | Other non-OR upper GI therapeutic procedures - 093 | *** |
| PXX0694 | Other OR upper GI therapeutic procedures - 094 | *** |
| PXX0697 | Other gastrointestinal diagnostic procedures - 097 | *** |
| PXX0698 | Other 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 ID | Group Name | CPT / HCPCS |
| CT0025 | Preventive Medicine, Care Coordination | *** |
| CT0026 | Medication Assisted Management (MAT) | *** |
| CT0080 | Imaging Abdomen | *** |
| CT0082 | Opioid Administration / Dispensing (OTP) | *** |
| CT0088 | Hepatitis B vaccine | *** |
| CT0089 | Metabolic Renal Hepatic Chemistry Panel | *** |
| CT0090 | Physical Therapy / Rehab | *** |
| CT0091 | Physician Services - Outpatient | *** |
| CT0092 | Physician Services - Inpatient | *** |
| CT0093 | Routine Immunizations | *** |
| CT0133 | Rx - central nervous system - symnpatholytic rx | *** |
| CT0136 | Rx - central nervous system - antidepressants | *** |
| CT0137 | Rx - central nervous system - tranq/antipsychotics | *** |
| CT01394 | Medications (Injections, infusions and other forms) | *** |
| CT01395 | DME and supplies | *** |
| CT0140 | Rx - central nervous system - barbiturates | *** |
| CT0141 | Rx - central nervous system - benzodiazepines | *** |
| CT0142 | Rx - central nervous system - anxiolytic/sedative/hypnot nec | *** |
| CT0160 | Tests - neuro - eeg | *** |
| CT0161 | Tests - neuro - muscle testing | *** |
| CT0162 | Tests - neuro - ncv / emg | *** |
| CT0163 | Tests - neuro - evoked potentials | *** |
| CT0165 | Tests - neuro - other | *** |
| CT0324 | Procedure - nasopharyngoscopy - dx | *** |
| CT0335 | Procedure - laryngoscopy - dx | *** |
| CT0336 | Procedure - laryngoscopy w / biopsy | *** |
| CT0337 | Procedure - laryngoscopy w dilation | *** |
| CT0338 | Procedure - laryngoscopy w foreign body removal | *** |
| CT0342 | Procedure - laryngoscopy - other | *** |
| CT0354 | Rx - eent - topical - eye/ear/nose/throat misc | *** |
| CT0378 | Tests - ent - swallowing evaluation | *** |
| CT0380 | Tests - ent - other dx | *** |
| CT0401 | Procedure - laryngoscopy - dx | *** |
| CT0424 | Rx - respiratory - beta agonists | *** |
| CT0425 | Rx - respiratory - phenylephrine | *** |
| CT0426 | Rx - respiratory - mucolytics/cold comb | *** |
| CT0427 | Rx - respiratory - methylxanthines | *** |
| CT04280 | Lung Function Tests | *** |
| CT04281 | Blood Gases, Pulse Oximetry | *** |
| CT04282 | Chest X-Ray | *** |
| CT0433 | Other care - respiratory - ventillator management | *** |
| CT0434 | Other care - respiratory - oxygen / oxygen concentrator | *** |
| CT0438 | Other care - respiratory - equipment / supplies - nebulizer | *** |
| CT0439 | Other care - respiratory - equipment / supplies - peak flow meter | *** |
| CT0440 | Other care - respiratory - equipment / supplies - spirometer | *** |
| CT0441 | Other care - respiratory - equipment / supplies - apnea monitor | *** |
| CT0442 | Other care - respiratory - equipment / supplies | *** |
| CT0443 | Other care - respiratory - other | *** |
| CT0444 | Other care - prevention - smoking cessation | *** |
| CT0446 | Imaging - cta - chest | *** |
| CT0447 | Imaging - mri - chest | *** |
| CT0448 | Imaging - mra - chest | *** |
| CT0453 | Tests - pulmonary - peak flow | *** |
| CT0463 | Tests - pulmonary - other | *** |
| CT05194 | Rx - cardiovascular system - cardiac glycosides | *** |
| CT05196 | Rx - cardiovascular system - beta blockers | *** |
| CT05199 | Rx - cardiovascular system - vasodilating rx | *** |
| CT05204 | Rx - diuretics, thiazides / related | *** |
| CT05205 | Rx - diuretics - diuretic, carb anhydrase inhib | *** |
| CT05233 | Tests - cardiac - ecg - ecg - 12 lead | *** |
| CT05258 | Tests - vascular - venous | *** |
| CT05260 | Tests - cardiovascular - other | *** |
| CT0610 | Procedure - dilation - esophagus | *** |
| CT06104 | Imaging - nuclear - shilling test | *** |
| CT06105 | Imaging - nuclear - shilling test - radiopharmaceutical | *** |
| CT06106 | Imaging - nuclear - gi blood loss | *** |
| CT06107 | Imaging - nuclear - other gi | *** |
| CT0611 | Procedure - injection / ligation - esophageal varices | *** |
| CT06110 | Imaging - x-ray - upper gi - esophagus - contrast | *** |
| CT06112 | Imaging - x-ray - upper gi - small bowel - contrast | *** |
| CT06113 | Imaging - x-ray - upper gi - duodenogram | *** |
| CT06114 | Imaging - x-ray - upper gi - other | *** |
| CT06118 | Tests - gi - esophageal balloon distension test | *** |
| CT06119 | Tests - gi - gastric motility study | *** |
| CT0612 | Procedure - esophageal / gastric intubation | *** |
| CT06120 | Tests - gi - duodeneal motility study | *** |
| CT06121 | Tests - gi - other dx | *** |
| CT06122 | Lab - gi - fat absorption | *** |
| CT0617 | Procedure - other procedures - esophagus | *** |
| CT0619 | Procedure - gastrostomy | *** |
| CT06304 | Esophageal Motility and Diagnostic Workup | *** |
| CT0653 | Procedure - laparoscopy - gi - other | *** |
| CT0659 | Procedure - other lower gi procedures - other non - or rx | *** |
| CT0690 | Procedure - anesthesia | *** |
| CT0692 | Therapy - neurostimulator - nausea / vomiting | *** |
| CT0693 | Rx - gi - antichol/antispasmodics | *** |
| CT0694 | Rx - gi - antiemetics | *** |
| CT0695 | Rx - gi - h2 antagonists | *** |
| CT0696 | Rx - gi drug misc,nec | *** |
| CT0697 | Rx - gi - ppis | *** |
| CT0698 | Rx - diagnostic rx - gastric function | *** |
| CT0733 | Imaging - x-ray - biliary tract - cholangiogram - intraoperative | *** |
| CT08113 | DME - heat/cold application | *** |
| CT08116 | DME - rehabilitation | *** |
| CT0857 | Rx - muscle relaxants - muscle relax, skeletal central | *** |
| CT0858 | Rx - muscle relaxants - muscle relax, skeletal, misc | *** |
| CT0859 | Rx - muscle relaxants - muscle relax, neuromusc block | *** |
| CT0959 | Procedure - other non - or rx - other non - or skin procedures | *** |
| CT0963 | Rx - skin / mucous membrane - antiinflam s/mm agnts / comb nec | *** |
| CT0964 | Rx - skin / mucous membrane - s/mm miscellaneous | *** |
| CT0965 | Other care - wound care | *** |
| CT0969 | Other care - chronic edema - surgical stockings | *** |
| CT1017 | Rx - vitamins - vitamin b / b complex | *** |
| CT1021 | Rx - vitamins - multivit prep | *** |
| CT1023 | Rx - diagnostic rx, misc | *** |
| CT1026 | Other care - diabetes care - glucose monitoring - lancet | *** |
| CT1027 | Other care - diabetes care - glucose monitoring | *** |
| CT10296 | Low dose steroids | *** |
| CT10297 | High dose steroids | *** |
| CT1036 | Other care - nutrition - assessment | *** |
| CT1038 | Other care - nutrition - enteral | *** |
| CT1039 | Other care - nutrition - enteral - tubing | *** |
| CT1040 | Other care - nutrition - enteral - formula | *** |
| CT1041 | Other care - nutrition - enteral - pump | *** |
| CT1042 | Other care - nutrition - parenteral - nutrition solution | *** |
| CT1043 | Other care - nutrition - parenteral | *** |
| CT1044 | Other care - nutrition - parenteral - pump | *** |
| CT1046 | Other care - nutrition - education | *** |
| CT1048 | Other care - nutrition - counseling - dietician | *** |
| CT1049 | Other care - other - weight management | *** |
| CT1146 | Therapy - dialysis - supplies | *** |
| CT1166 | Lab - urinalysis | *** |
| CT1167 | Lab - specimen collection - urine | *** |
| CT1620 | Therapy - phlebotomy | *** |
| CT1628 | Rx - hematopoietic system - iron / related | *** |
| CT1629 | Rx - hematopoietic system - hematopoietic growth factors | *** |
| CT16296 | Lipid Level Monitoring | *** |
| CT16297 | Blood Count | *** |
| CT16298 | NewBorn Blood Tests | *** |
| CT16299 | Bleeding Status | *** |
| CT1630 | Rx - coagulation system - anticoagulants | *** |
| CT1632 | Rx - coagulation system - hemostatics | *** |
| CT1633 | Rx - coagulation system - thrombolytic rx | *** |
| CT1635 | Rx - serums, toxoids, vaccines - serums | *** |
| CT1636 | Rx - serums, toxoids, vaccines - toxins | *** |
| CT1638 | Rx - administration - injection | *** |
| CT1639 | Rx - administration - infusion | *** |
| CT1647 | Lab - hematology - blood count | *** |
| CT1648 | Lab - hematology - blood count - eosinophil count | *** |
| CT1649 | Lab - other hematology | *** |
| CT1651 | Lab - immunology | *** |
| CT1806 | Rx - antibiotics - aminoglycosides | *** |
| CT1807 | Rx - antibiotics - cephalosporins | *** |
| CT1808 | Rx - b-lactam antibiotics | *** |
| CT1809 | Rx - antibiotics - chloramphenicol / comb | *** |
| CT1810 | Rx - antibiotics - macrolides | *** |
| CT1813 | Rx - antibiotics, misc | *** |
| CT1814 | Rx - antibiotics - quinolones | *** |
| CT1815 | Rx - antibiotics - sulfonamides / comb | *** |
| CT1821 | Lab - infectious agent antigen | *** |
| CT1823 | Lab - infectious agent dna | *** |
| CT1824 | Lab - microbiology - other | *** |
| CT1825 | Lab - microbiology - c & s | *** |
| CT1826 | Lab - microbiology - microscopic exam | *** |
| CT1827 | Lab - microbiology - viral culture | *** |
| CT1828 | Lab - microbiology | *** |
| CT1901 | Therapy - behavior - evaluation and therapy | *** |
| CT1903 | Therapy - behavior - medication management | *** |
| CT1905 | Therapy - behavior - partial hospilization | *** |
| CT1907 | Tests - neuro - sleep studies | *** |
| CT19304 | Psychiatry Services | *** |
| CT19378 | Laboratory - Chemistry and Hematology | *** |
| CT19381 | Smoking / Tobacco Cessation | *** |
| CT19384 | Peer Services | *** |
| CT2009 | Alcohol / Drug Use Screening | *** |
| CT20376 | Other Laboratory | *** |
| CT2301 | Therapy - allergy treatment | *** |
| CT2302 | Therapy - behavior - other | *** |
| CT2304 | Therapy - pt - exercises / activities | *** |
| CT2305 | Therapy - pt - modalities | *** |
| CT2309 | Therapy - activity therapy | *** |
| CT2314 | Therapy - vaccination - hepatitis a vaccine | *** |
| CT2315 | Therapy - vaccination - hepatitis b | *** |
| CT2320 | Therapy - vaccination - vaccine administration | *** |
| CT2329 | Other care - bladder / bowel care - other supplies - diaper / related | *** |
| CT2330 | Other care - bladder / bowel care - other supplies - skin barrier | *** |
| CT23307 | Vaccine for flu or Pneumonia | *** |
| CT23309 | Markers for Inflammation | *** |
| CT2331 | Other care - observation | *** |
| CT23311 | Current Tobacco / Cigarette Smoker | *** |
| CT2338 | Other care - other - education | *** |
| CT2339 | Other care - other - geriatric care | *** |
| CT23393 | Prophylactic vaccinations and inoculations | *** |
| CT23398 | Ancillary Services | *** |
| CT2341 | Other care - other - exercise classes | *** |
| CT2342 | Tests - allergy tests - percutaneous | *** |
| CT2343 | Tests - allergy tests - intradermal | *** |
| CT2344 | Tests - allergy tests - patch | *** |
| CT2345 | Tests - allergy tests - other | *** |
| CT2352 | DME - mobility aids | *** |
| CT2353 | DME - patient lifts | *** |
| CT9902 | E & M - consultation | *** |
| CT9903 | E & M - hospital | *** |
| CT9904 | E & M - emergency care | *** |
| CT9905 | E & M - home visit | *** |
| CT9906 | E & M - nursing home | *** |
| CT9907 | E & M - prevention | *** |
| CT9908 | E & M - other | *** |
| CT99102 | Other care - other | *** |
| CT99103 | Imaging - ct - follow - up | *** |
| CT99104 | Imaging - ct - other | *** |
| CT99106 | Imaging - cta - other | *** |
| CT99107 | Imaging - mri - other | *** |
| CT99109 | Imaging - mri - contrast agent | *** |
| CT9911 | Procedure - sedation | *** |
| CT99113 | Imaging - us - guide - biopsy | *** |
| CT99114 | Imaging - us - guide - other | *** |
| CT99115 | Imaging - us - other | *** |
| CT99127 | Imaging - nuclear - other - automated data add - on | *** |
| CT99129 | Imaging - nuclear - radiopharmaceutical - radiopharmaceutical - other | *** |
| CT99133 | Imaging - other imaging - fluoroscopy | *** |
| CT99136 | Imaging - other imaging | *** |
| CT99139 | Imaging - supplies - contrast agent - low osmolar | *** |
| CT99141 | Imaging - supplies - ultrasound related | *** |
| CT99142 | Lab - pathology consultation | *** |
| CT99143 | Lab - chemistry | *** |
| CT99148 | Lab - surgical pathology | *** |
| CT99149 | Lab - other clinical lab | *** |
| CT99169 | Lab - specimen collection - blood - venous - venipuncture | *** |
| CT99173 | Lab - specimen collection - specimen handling | *** |
| CT99174 | Lab - microscopic - wet mount | *** |
| CT99175 | Lab - microscopic - koh prep | *** |
| CT9918 | Procedure - related supplies - ablation - catheter | *** |
| CT99182 | Transportation - paramedic | *** |
| CT99183 | Transportation - other transportation | *** |
| CT99184 | DME - other | *** |
| CT99185 | DME - bath / toilet aids | *** |
| CT99186 | DME - beds / accessories | *** |
| CT99190 | DME - repair / maintenance | *** |
| CT99191 | Supplies | *** |
| CT99197 | Other - non - covered | *** |
| CT9922 | Procedure - related supplies - drainage | *** |
| CT9928 | Therapy - accupuncture | *** |
| CT99309 | Physician Services | *** |
| CT9931 | Therapy - rehabilitation - other | *** |
| CT99311 | Urine Protein | *** |
| CT99316 | Physician Services - Inpatient | *** |
| CT9937 | Therapy - neurostimulator - tens - leads | *** |
| CT9938 | Therapy - neurostimulator - tens - supplies | *** |
| CT9939 | Therapy - neurostimulator - other | *** |
| CT99392 | Other diagnostic procedures (interview, evaluation, consultation) | *** |
| CT9940 | Therapy - other | *** |
| CT9941 | Rx - allergy - antihistamines / comb | *** |
| CT9942 | Rx - gi - antichol/antispasmodics | *** |
| CT9943 | Rx - autonomic rx - parasympathomimetics | *** |
| CT9944 | Rx - autonomic rx - sympathomimetic rx | *** |
| CT9946 | Rx - analg/antipy/nsaids - nsaids | *** |
| CT9947 | Rx - analg/antipy/nsaids - narcotics | *** |
| CT9949 | Rx - electrolytic, caloric, water - calcium supplements | *** |
| CT9950 | Rx - electrolytic, caloric, water - potassium supp | *** |
| CT9951 | Rx - electrolytic, caloric, water - multi-mineral prep | *** |
| CT9952 | Rx - electrolytic, caloric, water - sodium chlor preps | *** |
| CT9953 | Rx - electrolytic, caloric, water - replacement preparations, misc | *** |
| CT9955 | Rx - electrolytic, caloric, water - caloric rx dextrose / rel | *** |
| CT9956 | Rx - electrolytic, caloric, water - hydration - unspecfied | *** |
| CT9957 | Rx - miscellaneous rx | *** |
| CT9958 | Rx - miscellaneous rx - enzymes | *** |
| CT9960 | Rx - miscellaneous rx - anesthetics, local | *** |
| CT9961 | Rx - diagnostic rx - roentgenography | *** |
| CT9962 | Rx - other | *** |
| CT9963 | Rx - pharmacy fee | *** |
| CT9964 | Other care - home care - specialized visit | *** |
| CT9965 | Other care - home care - physician supervision | *** |
| CT9966 | Other care - home care - nursing care | *** |
| CT9967 | Other care - home care - nursing care - rn | *** |
| CT9969 | Other care - home care - nursing care - np | *** |
| CT9970 | Other care - home care - rehabilitation - physical therapy | *** |
| CT9971 | Other care - home care - rehabilitation - occupational therapy | *** |
| CT9972 | Other care - home care - rehabilitation - speech therapy | *** |
| CT9973 | Other care - home care - social worker | *** |
| CT9974 | Other care - home care - home health aide | *** |
| CT9986 | Other care - hospice | *** |
| CT9990 | Other care - other - ancillary services | *** |
| CT9995 | Other care - other - irrigation | *** |
| CT9996 | Other care - other - lodging | *** |
| CT9997 | Other care - other - meals | *** |
| XX0000 | Ungrouped 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 ID | Group Name |
| RX001 | contrast media |
| RX002 | diagnostic agents |
| RX017 | hypnotics and sedatives |
| RX0320 | cough and cold preparations |
| RX0321 | decongestants and other nasal preparations for topical use |
| RX0322 | other otologicals |
| RX0324 | throat preparations |
| RX0425 | antihistamines for systemic use |
| RX0426 | Bronchodilators: adrenergics for systemic use |
| RX0427 | drugs for obstructive airway diseases - inhalants |
| RX0429 | other systemic drugs for obstructive airway diseases |
| RX0531 | Agents for hypertensive emergencies |
| RX0536 | calcium channel blockers |
| RX0538 | diuretics |
| RX0539 | i.v. solutions & additives |
| RX0540 | Nitrates and other antianginals |
| RX0541 | other antihypertensives |
| RX0546 | Antiplatelet Agents Thrombin Inhibitors |
| RX0645 | antacids |
| RX0646 | antidiarrheals intestinal adsorbents |
| RX0647 | antiemetics and antinauseants |
| RX0648 | digestives incl. enzymes |
| RX0649 | drugs for constipation |
| RX0650 | drugs for functional gastrointestinal disorders |
| RX0651 | drugs for peptic ulcer and gerd |
| RX0652 | intestinal antiinfectives |
| RX0653 | intestinal antiinflammatory agents |
| RX0654 | stomatological preparations |
| RX0755 | bile and liver therapy |
| RX0857 | antiinflammatory and antirheumatic products |
| RX0861 | opioids |
| RX0862 | other analgesics and antipyretics |
| RX0970 | antipruritics incl. antihistamines anesthetics etc. |
| RX1082 | antiobesity preparations excl. diet products |
| RX1086 | corticosteroids for systemic use |
| RX1087 | drugs affecting bone structure and mineralization |
| RX1088 | drugs for inborn errors of metabolism |
| RX16106 | iron preparations |
| RX16109 | vitamin b12 and folic acid |
| RX16112 | Blood Stimulating Agents Erythropoietin |
| RX18114 | agents against amoebiasis and other protozoal diseases |
| RX18115 | agents against leishmaniasis and trypanosomiasis |
| RX18116 | anthelmintics |
| RX18117 | antibacterials for systemic use |
| RX18119 | antiinfectives |
| RX19125 | anxiolytics |
| RX19126 | drugs used in addictive disorders |
| RX23129 | immune sera and immunoglobulins |
| RX23131 | mineral supplements |
| RX23133 | other nutrients |
| RX23134 | vaccines |
| RX23135 | vitamins |
| RX99137 | anesthetics local |
| RX99139 | Other Therapeutic Drugs |