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 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

Current 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 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)
DX01108	NS - migraine	***
DX01109	NS - headache - tension	***
DX01110	NS - headache - other syndromes	***
DX01111	NS - headache - symptom	***
DX01186	NS - chronic pain - other	***
DX01405	Personal history of TIA	***
DX01412	Carotid Artery Stenosis	***
DX0179	NS - other cerebvasc ds	***
DX02124	Retinal Complications	***
DX02135	Pain, swelling, redness of eye	***
DX02176	Visual field defects	***
DX04105	Resp - hyperventillation	***
DX0458	Resp - resp failure	***
DX0493	Resp - other resp ds	***
DX0497	Resp - shortness of breath	***
DX0510	CV - essential ht	***
DX05104	CV - atherosclerosis - aorta	***
DX05105	CV - aneurysm - thoracic aorta - w/o rupture	***
DX05108	CV - aneurysm - thrc-abd aorta - w/o rupture	***
DX05111	CV - aneurysm - abdominal aorta - w/o rupture	***
DX05114	CV - aneurysm - aorta - nos - w/o rupture	***
DX05120	CV - other ascvd	***
DX05152	CV - screening - ischemic heart ds	***
DX05153	CV - screening - hypertension	***
DX05154	CV - screening - cv ds - nec	***
DX05156	CV - sxs nec nos	***
DX05158	CV - edema	***
DX0516	CV - elevated BP	***
DX05161	CV - abnl cv test nec nos	***
DX05164	CV - s/p cv ds nec nos	***
DX05188	CV - family hx	***
DX0524	CV - cardiac murmurs	***
DX05327	Hypertensive Heart Disease	***
DX05332	Pacemaker, Defibrillator in place	***
DX05334	Renovascular and other secondary hypertension	***
DX05344	Chronic Heart Failure, Degeneration	***
DX05345	Orthostatic Hypotension / Dizziness	***
DX05346	Premature Beats	***
DX0554	CV - av block - 1st degree	***
DX0559	CV - right bundle branch block	***
DX0588	CV - other heart ds	***
DX0592	CV - peripheral vascular ds	***
DX0593	CV - peripheral vascular ds - w/ claudication	***
DX0595	CV - peripheral vascular ds - w/ ulceration	***
DX0597	CV - peripheral vascular ds - nec / nos	***
DX06203	GI - anorexia	***
DX06311	Vascular Insufficiency of intestine	***
DX06363	Irritable Bowel and other functional GI disor	***
DX06365	Abdominal pain	***
DX07114	Hepatotoxicity	***
DX08949	MS - muscle - nos - muscle weakness	***
DX1007	Overweight	***
DX10106	hyperlipidemia	***
DX10107	Obesity	***
DX10108	Sleep Apnea	***
DX10109	Protein Calorie Malnutrition	***
DX10112	Severe Morbid Obesity	***
DX10113	Obstructive sleep apnea	***
DX1019	Morbid Obesity	***
DX1040	Endo - obesity	***
DX1069	Endo - abnl weight gain	***
DX1071	Endo - other	***
DX1094	Sxs - abnormal findings - lab or exam	***
DX1132	CV - ht w/ renal ds	***
DX1134	CV - renal artery ds	***
DX1155	GU - proteninuria	***
DX16257	Blood - abnormal coagulation test	***
DX16271	Blood - lymphadenitis	***
DX16275	Blood - other blood ds	***
DX16293	Iron deficiency and other anemias	***
DX1930	NS - hypersomnia	***
DX1931	NS - insomnia	***
DX1932	NS - other sleep ds	***
DX1963	Anxiety Disorders	***
DX2008	Tobacco Use	***
DX2103	NS - other sleep ds	***
DX2127	Othr - other	***
DX2329	Sxs - chronic fatique syndrome	***
DX2330	Sxs - general symptoms / debility / morbidity - nec	***
DX2332	Sxs - symptoms -other	***
DX2335	Sxs - abnormal findings - lab or exam	***
DX2337	Prvn - routine medical exam	***
DX2342	Prvn - encounter for lab test	***
DX2346	Othr - rehabilitation	***
DX2352	Othr - other	***
DX2355	Othr - follow-up exam - nec	***
DX2356	Othr - long-term use other medication	***
DX2357	Othr - longterm anticoaguation	***
DX2359	Othr - other aftercare	***
DX2369	Abnormal weight loss	***
DX2377	Personal 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 ID	Group Name	ICD-10-CM (DX)
DXX01108	NS - migraine	***
DXX01109	NS - headache - tension	***
DXX01110	NS - headache - other syndromes	***
DXX01111	NS - headache - symptom	***
DXX01186	NS - chronic pain - other	***
DXX01405	Personal history of TIA	***
DXX01412	Carotid Artery Stenosis	***
DXX0179	NS - other cerebvasc ds	***
DXX02124	Retinal Complications	***
DXX02135	Pain, swelling, redness of eye	***
DXX02176	Visual field defects	***
DXX04105	Resp - hyperventillation	***
DXX04112	Resp - abnormal chest sounds	***
DXX0458	Resp - resp failure	***
DXX0497	Resp - shortness of breath	***
DXX0510	CV - essential ht	***
DXX05104	CV - atherosclerosis - aorta	***
DXX05105	CV - aneurysm - thoracic aorta - w/o rupture	***
DXX05108	CV - aneurysm - thrc-abd aorta - w/o rupture	***
DXX05111	CV - aneurysm - abdominal aorta - w/o rupture	***
DXX05114	CV - aneurysm - aorta - nos - w/o rupture	***
DXX05120	CV - other ascvd	***
DXX05158	CV - edema	***
DXX0516	CV - elevated BP	***
DXX05161	CV - abnl cv test nec nos	***
DXX05164	CV - s/p cv ds nec nos	***
DXX0524	CV - cardiac murmurs	***
DXX05294	Malignant Hypertension with CKD	***
DXX05327	Hypertensive Heart Disease	***
DXX05332	Pacemaker, Defibrillator in place	***
DXX05334	Renovascular and other secondary hypertension	***
DXX05344	Chronic Heart Failure, Degeneration	***
DXX05345	Orthostatic Hypotension / Dizziness	***
DXX05346	Premature Beats	***
DXX05355	PVD w Ulcer	***
DXX05359	Family history of CV disease	***
DXX0554	CV - av block - 1st degree	***
DXX0559	CV - right bundle branch block	***
DXX0588	CV - other heart ds	***
DXX0592	CV - peripheral vascular ds	***
DXX0593	CV - peripheral vascular ds - w/ claudication	***
DXX0597	CV - peripheral vascular ds - nec / nos	***
DXX06203	GI - anorexia	***
DXX06277	Irritable Bowel and other functional GI disor	***
DXX06311	Vascular Insufficiency of intestine	***
DXX06365	Abdominal pain	***
DXX07114	Hepatotoxicity	***
DXX08949	MS - muscle - nos - muscle weakness	***
DXX1007	Overweight	***
DXX10106	hyperlipidemia	***
DXX10107	Obesity	***
DXX10108	Sleep Apnea	***
DXX10109	Protein Calorie Malnutrition	***
DXX10112	Severe Morbid Obesity	***
DXX10113	Obstructive sleep apnea	***
DXX1019	Morbid Obesity	***
DXX1040	Endo - obesity	***
DXX1069	Endo - abnl weight gain	***
DXX1071	Endo - other	***
DXX1094	Sxs - abnormal findings - lab or exam	***
DXX1134	CV - renal artery ds	***
DXX1155	GU - proteninuria	***
DXX16257	Blood - abnormal coagulation test	***
DXX16271	Blood - lymphadenitis	***
DXX16293	Iron deficiency and other anemias	***
DXX1930	NS - hypersomnia	***
DXX1931	NS - insomnia	***
DXX1932	NS - other sleep ds	***
DXX1963	Anxiety Disorders	***
DXX2008	Tobacco Use	***
DXX2103	NS - other sleep ds	***
DXX2328	Sxs - malaise / fatigue	***
DXX2329	Sxs - chronic fatique syndrome	***
DXX2332	Sxs - symptoms -other	***
DXX2335	Sxs - abnormal findings - lab or exam	***
DXX2337	Prvn - routine medical exam	***
DXX2352	Othr - other	***
DXX2356	Othr - long-term use other medication	***
DXX2357	Othr - longterm anticoaguation	***
DXX2359	Othr - other aftercare	***
DXX2369	Abnormal weight loss	***
DXX2379	Observation/Examination	***
DXX2380	Follow up after cancer treatment	***
DXX2381	Aftercare	***
DXX2382	Preventive 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 ID	Group Name	ICD-9-CM (DX)
DX01384	Hemorrhagic Stroke	***
DX01385	Thromboembolic Stroke	***
DX01388	Transient cerebral ischemia, TIA	***
DX01390	Coma, persistent vegetative state	***
DX01391	Meningitis / Encephalitis	***
DX01392	Delirium, Encephalopathy	***
DX01400	Persistent Cognitive and Gait Abnormalities	***
DX01409	Dissection of extracerebral arteries	***
DX02135	Pain, swelling, redness of eye	***
DX02141	Blurred vision / Diplopia	***
DX02175	Other visual impairment	***
DX04157	Hemoptysis	***
DX05264	arterial thromboembolism	***
DX05272	dic, coagulation, hemorrhagic disorders	***
DX05274	transfusion, infusion related complications	***
DX05275	phlebitis, deep vein thrombosis (dvt)	***
DX05281	STEMI	***
DX05289	Subendocardial infarct	***
DX05294	Malignant Hypertension with CKD	***
DX05297	Hypotension / Syncope	***
DX05298	Fluid Electrolyte Acid Base Problems	***
DX05299	Shock / Cardiac Arrest	***
DX05302	Malignant Hypertension	***
DX05303	Acute CHF / pulm edema	***
DX05308	Pulmonary Embolism	***
DX05309	IVC & other intra-abd venous thrombosis	***
DX05311	Other Phlebitis, Lymphangitis, varices	***
DX05342	Acute cor pulmonale	***
DX05347	Dissection of Aorta	***
DX06305	C-Difficile Infection	***
DX06306	GI Bleed	***
DX06317	Acute esophagitis, acute gastritis, duodenitis	***
DX09191	Decubitus Ulcer	***
DX09192	Dermatitis, Urticaria	***
DX1030	Diabetes, poor control	***
DX11137	rhabdomyolysis	***
DX11142	Acute Renal Failure	***
DX16296	Hemorrhage	***
DX1849	Other bacterial infections	***
DX1850	MRSA, Drug Resistant Infections	***
DX1851	Sepsis	***
DX1852	Severe Sepsis	***
DX1853	Bacteremia, SIRS, no organ dysfunction	***
DX2164	Accidental Falls	***
DX2171	Adverse effects of drugs	***
DX2172	Overdose, Poisonings	***
DX2361	complications of surgical procedures	***
DX2362	complications of medical care	***
DX9910	HAC 02: Air Embolism	***
DX9911	HAC: Blood Incompatibility	***
DX9912	HAC 04: Stage III and IV Pressure Ulcers	***
DX9914	HAC 09: Manifestations of Poor Glycemic Control	***
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)
DXX01384	Hemorrhagic Stroke	***
DXX01385	Thromboembolic Stroke	***
DXX01388	Transient cerebral ischemia, TIA	***
DXX01390	Coma, persistent vegetative state	***
DXX01391	Meningitis / Encephalitis	***
DXX01392	Delirium, Encephalopathy	***
DXX01409	Dissection of extracerebral arteries	***
DXX02135	Pain, swelling, redness of eye	***
DXX02141	Blurred vision / Diplopia	***
DXX02175	Other visual impairment	***
DXX04157	Hemoptysis	***
DXX04187	Other lung problems	***
DXX05264	arterial thromboembolism	***
DXX05272	dic, coagulation, hemorrhagic disorders	***
DXX05274	transfusion, infusion related complications	***
DXX05275	phlebitis, deep vein thrombosis (dvt)	***
DXX05281	STEMI	***
DXX05289	Subendocardial infarct	***
DXX05291	Recent AMI	***
DXX05297	Hypotension / Syncope	***
DXX05298	Fluid Electrolyte Acid Base Problems	***
DXX05299	Shock / Cardiac Arrest	***
DXX05303	Acute CHF / pulm edema	***
DXX05308	Pulmonary Embolism	***
DXX05309	IVC & other intra-abd venous thrombosis	***
DXX05311	Other Phlebitis, Lymphangitis, varices	***
DXX05342	Acute cor pulmonale	***
DXX05347	Dissection of Aorta	***
DXX06305	C-Difficile Infection	***
DXX06306	GI Bleed	***
DXX06317	Acute esophagitis, acute gastritis, duodenitis	***
DXX09191	Decubitus Ulcer	***
DXX09192	Dermatitis, Urticaria	***
DXX10111	Diabetes, other manifestation	***
DXX1030	Diabetes, poor control	***
DXX11137	rhabdomyolysis	***
DXX11142	Acute Renal Failure	***
DXX16296	Hemorrhage	***
DXX1849	Other bacterial infections	***
DXX1850	MRSA, Drug Resistant Infections	***
DXX1851	Sepsis	***
DXX1852	Severe Sepsis	***
DXX1853	Bacteremia, SIRS, no organ dysfunction	***
DXX19103	Altered mental status	***
DXX2156	adverse effects of drugs, correct use	***
DXX2164	Accidental Falls	***
DXX2171	Adverse effects of drugs	***
DXX2361	complications of surgical procedures	***
DXX2362	complications of medical care	***
DXX9910	HAC 02: Air Embolism	***
DXX9911	HAC: Blood Incompatibility	***
DXX9912	HAC 04: Stage III and IV Pressure Ulcers	***
DXX9914	HAC 09: Manifestations of Poor Glycemic Control	***
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)
PX01177	Computerized axial tomography (CT) scan head - 177	***
PX01199	Electroencephalogram (EEG) - 199	***
PX03215	Other physical therapy and rehabilitation - 215	***
PX03231	Other therapeutic procedures - 231	***
PX04178	CT scan chest - 178	***
PX04217	Other respiratory therapy - 217	***
PX05189	Contrast aortogram - 189	***
PX05190	Contrast arteriogram of femoral and lower extremity arteries - 190	***
PX05193	Diagnostic ultrasound of heart (echocardiogram) - 193	***
PX05197	Other diagnostic ultrasound - 197	***
PX05201	Cardiac stress tests - 201	***
PX05205	Arterial blood gases - 205	***
PX05225	Conversion of cardiac rhythm - 225	***
PX0554	Other vascular catheterization, not heart - 054	***
PX06223	Enteral and parenteral nutrition - 223	***
PX08213	Physical therapy exercises, manipulation, and other procedures - 213	***
PX11108	Indwelling catheter - 108	***

*** 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)
PXX01177	Computerized axial tomography (CT) scan head - 177	***
PXX01199	Electroencephalogram (EEG) - 199	***
PXX03215	Other physical therapy and rehabilitation - 215	***
PXX03231	Other therapeutic procedures - 231	***
PXX04178	CT scan chest - 178	***
PXX04217	Other respiratory therapy - 217	***
PXX05189	Contrast aortogram - 189	***
PXX05190	Contrast arteriogram of femoral and lower extremity arteries - 190	***
PXX05193	Diagnostic ultrasound of heart (echocardiogram) - 193	***
PXX05197	Other diagnostic ultrasound - 197	***
PXX05201	Cardiac stress tests - 201	***
PXX05205	Arterial blood gases - 205	***
PXX05225	Conversion of cardiac rhythm - 225	***
PXX0554	Other vascular catheterization, not heart - 054	***
PXX06223	Enteral and parenteral nutrition - 223	***
PXX08213	Physical therapy exercises, manipulation, and other procedures - 213	***
PXX11108	Indwelling 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 ID	Group Name	CPT / HCPCS
CT0025	Preventive Medicine, Care Coordination	***
CT0080	Imaging Abdomen	***
CT0082	Opioid Administration / Dispensing (OTP)	***
CT0083	Blood Type, Coomb's test	***
CT0087	Hearing Test	***
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	***
CT0094	Screen for amino acid disorders	***
CT0119	Procedure - block - nerve	***
CT01395	DME and supplies	***
CT0141	Rx - central nervous system - benzodiazepines	***
CT0144	Imaging - ct - head / brain	***
CT0148	Imaging - cta - head / neck	***
CT0149	Imaging - mri - brain	***
CT0152	Imaging - nuclear - csf - scan	***
CT0159	Tests - vascular - cerebrovascular	***
CT0160	Tests - neuro - eeg	***
CT0161	Tests - neuro - muscle testing	***
CT0162	Tests - neuro - ncv / emg	***
CT0163	Tests - neuro - evoked potentials	***
CT0165	Tests - neuro - other	***
CT0238	Imaging - us - eye	***
CT0251	Tests - eye - dx - other	***
CT0361	Imaging - mra - head	***
CT0380	Tests - ent - other dx	***
CT04280	Lung Function Tests	***
CT04281	Blood Gases, Pulse Oximetry	***
CT04282	Chest X-Ray	***
CT0429	Other care - respiratory therapy	***
CT0430	Other care - respiratory - tracheostomy care	***
CT0433	Other care - respiratory - ventillator management	***
CT0434	Other care - respiratory - oxygen / oxygen concentrator	***
CT0435	Other care - respiratory - equipment / supplies - ventilator	***
CT0436	Other care - respiratory - equipment / supplies - cpap	***
CT0437	Other care - respiratory - equipment / supplies - ippb	***
CT0438	Other care - respiratory - equipment / supplies - nebulizer	***
CT0442	Other care - respiratory - equipment / supplies	***
CT0443	Other care - respiratory - other	***
CT0445	Imaging - ct - chest	***
CT0446	Imaging - cta - chest	***
CT0447	Imaging - mri - chest	***
CT0448	Imaging - mra - chest	***
CT0463	Tests - pulmonary - other	***
CT05112	Procedure - artery - extremity - angioplasty - transluminal / percutaneous	***
CT05113	Procedure - artery - extremity - atherectomy - transluminal / percutaneous	***
CT05118	Procedure - artery - nos - angioplasty / stenting	***
CT05124	Procedure - artery - nos - thrombolysis	***
CT0513	Procedure - pacemaker / defibrillator - transcutaneous pacing	***
CT05133	Procedure - artery / vein - nos - closure / closure device	***
CT05135	Procedure - artery / vein - nos - other	***
CT05150	Procedure - vein - vena cava - filter	***
CT05159	Procedure - vein - nos - angioplasty	***
CT05163	Procedure - vascular - occlusion / embolization - transcatheter	***
CT05165	Procedure - vascular - related supplies - atherectomy	***
CT05171	Procedure - central venous catheter - insertion	***
CT05172	Procedure - central venous catheter - fluoroscopy - guidance	***
CT05174	Procedure - central venous catheter - repair / maintenance	***
CT05175	Procedure - central venous catheter - removal	***
CT05176	Procedure - peripheral venous catheter	***
CT05178	Procedure - catheter - venous - other - other	***
CT05181	Procedure - catheter - arterial - selective branch catheter	***
CT05194	Rx - cardiovascular system - cardiac glycosides	***
CT05195	Rx - cardiovascular system - antiarrhythmic rx	***
CT05202	Rx - diuretics, loop diuretics	***
CT05215	Imaging - cta - aorta	***
CT05216	Imaging - us - intravascular	***
CT05217	Imaging - nuclear - venous thrombosis - scan	***
CT05220	Imaging - arteriography - other	***
CT0523	Procedure - cardioversion	***
CT05230	Tests - cardiac stress tests - cardiac stress tests - other	***
CT05231	Tests - other cardiac scans - infarct scan	***
CT05232	Tests - other cardiac scans	***
CT05234	Tests - cardiac - ecg - other	***
CT05241	Tests - cardiac - doppler	***
CT05250	Tests - cardiac - electrophysiology - other	***
CT05252	Tests - cardiac - swan ganz	***
CT05256	Tests - cardiac - radiopharmaceuticals	***
CT05257	Tests - vascular - arterial - extremity	***
CT05258	Tests - vascular - venous	***
CT05259	Tests - vascular - other	***
CT05260	Tests - cardiovascular - other	***
CT05306	Heart Echo / Ultrasound	***
CT05307	Electrocardiogram - EKG monitoring	***
CT05308	Cardiac Stress Test	***
CT05309	Cardiac cath & Angiogram	***
CT0573	Procedure - artery - abdomen - angioplasty - transluminal / open	***
CT0574	Procedure - artery - abdomen - angioplasty - transluminal / percutaneous	***
CT0575	Procedure - artery - abdomen - atherectomy - transluminal / open	***
CT0576	Procedure - artery - abdomen - atherectomy - transluminal / percutaneous	***
CT06112	Imaging - x-ray - upper gi - small bowel - contrast	***
CT06114	Imaging - x-ray - upper gi - other	***
CT0612	Procedure - esophageal / gastric intubation	***
CT06120	Tests - gi - duodeneal motility study	***
CT06121	Tests - gi - other dx	***
CT0619	Procedure - gastrostomy	***
CT0667	Procedure - other anal / rectal procedures - other procedures - rectum / anus	***
CT0694	Rx - gi - antiemetics	***
CT08106	Imaging - x-ray - other - joint survey	***
CT0872	Imaging - mri - lower extremity	***
CT0877	Imaging - us - extremity	***
CT0959	Procedure - other non - or rx - other non - or skin procedures	***
CT0965	Other care - wound care	***
CT1017	Rx - vitamins - vitamin b / b complex	***
CT1026	Other care - diabetes care - glucose monitoring - lancet	***
CT10295	Thyroid Function Tests	***
CT10296	Low dose steroids	***
CT10297	High dose steroids	***
CT1036	Other care - nutrition - assessment	***
CT1055	Imaging - venography - other	***
CT1061	Lab - endocrine response test	***
CT1122	Procedure - gu - other non - or rx	***
CT1150	Imaging - nuclear - kidney - scan	***
CT1151	Imaging - nuclear - bladder / ureter	***
CT1155	Imaging - x-ray - urinary tract - cystography / voiding cystourethrogram	***
CT1156	Imaging - x-ray - urinary tract - other	***
CT1158	Imaging - venography - other	***
CT1159	Tests - gu - post void residual / bladder capacity	***
CT1164	Tests - gu - urodynamics - voiding pressure	***
CT1166	Lab - urinalysis	***
CT14388	Magnetic resonance imaging	***
CT1615	Therapy - transfusion - administration	***
CT1616	Therapy - transfusion - blood	***
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	***
CT1634	Rx - coagulation system - antiplatelet rx	***
CT1635	Rx - serums, toxoids, vaccines - serums	***
CT1638	Rx - administration - injection	***
CT1639	Rx - administration - infusion	***
CT1640	Imaging - nuclear - red cell survival	***
CT1642	Imaging - nuclear - platelet kinetics	***
CT1643	Imaging - nuclear - other blood / related	***
CT1645	Lab - blood gases	***
CT1646	Lab - hematology - coagulation	***
CT1647	Lab - hematology - blood count	***
CT1649	Lab - other hematology	***
CT1651	Lab - immunology	***
CT1652	Lab - transfusion medicine	***
CT1807	Rx - antibiotics - cephalosporins	***
CT1813	Rx - antibiotics, misc	***
CT1817	Rx - antivirals	***
CT1821	Lab - infectious agent antigen	***
CT1822	Lab - infectious agent antibody	***
CT1823	Lab - infectious agent dna	***
CT1824	Lab - microbiology - other	***
CT1825	Lab - microbiology - c & s	***
CT1826	Lab - microbiology - microscopic exam	***
CT1827	Lab - microbiology - viral culture	***
CT1901	Therapy - behavior - evaluation and therapy	***
CT1902	Therapy - behavior - electroconvulsive therapy	***
CT1903	Therapy - behavior - medication management	***
CT1907	Tests - neuro - sleep studies	***
CT19303	Psychiatry Evaluations	***
CT19304	Psychiatry Services	***
CT19378	Laboratory - Chemistry and Hematology	***
CT19381	Smoking / Tobacco Cessation	***
CT2004	Lab - chemistry	***
CT2009	Alcohol / Drug Use Screening	***
CT2101	Lab - therapeutic drug assay	***
CT2301	Therapy - allergy treatment	***
CT2302	Therapy - behavior - other	***
CT2304	Therapy - pt - exercises / activities	***
CT2308	Therapy - biofeedback	***
CT2311	Therapy - vaccination - mmr / related	***
CT2312	Therapy - vaccination - dtp / related	***
CT2313	Therapy - vaccination - hib vaccine	***
CT2314	Therapy - vaccination - hepatitis a vaccine	***
CT2315	Therapy - vaccination - hepatitis b	***
CT2316	Therapy - vaccination - poliovirus vaccine	***
CT2317	Therapy - vaccination - chicken pox	***
CT2319	Therapy - vaccination - other vaccine	***
CT2320	Therapy - vaccination - vaccine administration	***
CT2321	Therapy - vaccination - hpv vaccine	***
CT23307	Vaccine for flu or Pneumonia	***
CT23309	Markers for Inflammation	***
CT2331	Other care - observation	***
CT23311	Current Tobacco / Cigarette Smoker	***
CT23393	Prophylactic vaccinations and inoculations	***
CT2342	Tests - allergy tests - percutaneous	***
CT2343	Tests - allergy tests - intradermal	***
CT2344	Tests - allergy tests - patch	***
CT2345	Tests - allergy tests - other	***
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	***
CT9909	Procedure - maintenance - cns / spinal pump / port	***
CT9910	Procedure - anesthesia	***
CT99103	Imaging - ct - follow - up	***
CT99104	Imaging - ct - other	***
CT99105	Imaging - ct - guidance	***
CT99107	Imaging - mri - other	***
CT99108	Imaging - mri - guidance	***
CT99109	Imaging - mri - contrast agent	***
CT9911	Procedure - sedation	***
CT99110	Imaging - us - head / neck	***
CT99111	Imaging - us - retroperitoneum	***
CT99113	Imaging - us - guide - biopsy	***
CT99114	Imaging - us - guide - other	***
CT99115	Imaging - us - other	***
CT99117	Imaging - nuclear - bone scan - radiopharmaceutical	***
CT99118	Imaging - nuclear - blood / plasma volume - scan	***
CT9912	Procedure - anesthesia - related supplies	***
CT99120	Imaging - nuclear - lymphatics	***
CT99125	Imaging - nuclear - localization of inflammation	***
CT99127	Imaging - nuclear - other - automated data add - on	***
CT99128	Imaging - nuclear - other	***
CT99131	Imaging - venography - other	***
CT99133	Imaging - other imaging - fluoroscopy	***
CT99134	Imaging - other imaging - fluoroscopy - guidance	***
CT99136	Imaging - other imaging	***
CT99137	Imaging - therapeutic procedure - abscess drainage	***
CT99138	Imaging - therapeutic procedure - other therapeutic procedure	***
CT99139	Imaging - supplies - contrast agent - low osmolar	***
CT99142	Lab - pathology consultation	***
CT99143	Lab - chemistry	***
CT99144	Lab - tissue typing	***
CT99146	Lab - cytology	***
CT99147	Lab - cytogenetics	***
CT99148	Lab - surgical pathology	***
CT99149	Lab - other clinical lab	***
CT99169	Lab - specimen collection - blood - venous - venipuncture	***
CT99171	Lab - specimen collection - blood - venous - venous port	***
CT99172	Lab - specimen collection - blood - arterial - arterial puncture	***
CT99173	Lab - specimen collection - specimen handling	***
CT99183	Transportation - other transportation	***
CT99191	Supplies	***
CT9928	Therapy - accupuncture	***
CT99309	Physician Services	***
CT99311	Urine Protein	***
CT99316	Physician Services - Inpatient	***
CT9935	Therapy - hyperbaric oxygen	***
CT99392	Other diagnostic procedures (interview, evaluation, consultation)	***
CT9940	Therapy - other	***
CT9944	Rx - autonomic rx - sympathomimetic rx	***
CT9947	Rx - analg/antipy/nsaids - narcotics	***
CT9952	Rx - electrolytic, caloric, water - sodium chlor preps	***
CT9956	Rx - electrolytic, caloric, water - hydration - unspecfied	***
CT9957	Rx - miscellaneous rx	***
CT9960	Rx - miscellaneous rx - anesthetics, local	***
CT9964	Other care - home care - specialized visit	***
CT9965	Other care - home care - physician supervision	***
CT9967	Other care - home care - nursing care - rn	***
CT9970	Other care - home care - rehabilitation - physical therapy	***
CT9971	Other care - home care - rehabilitation - occupational 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	***
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
RX015	antiepileptics
RX016	antimigraine preparations
RX017	hypnotics and sedatives
RX0425	antihistamines for systemic use
RX0427	drugs for obstructive airway diseases - inhalants
RX0530	agents acting on the renin-angiotensin system
RX0531	Agents for hypertensive emergencies
RX0534	Anticoagulants
RX0535	beta blocking agents
RX0536	calcium channel blockers
RX0537	cardiac glycosides and cardiac stimulants
RX0538	diuretics
RX0539	i.v. solutions & additives
RX0540	Nitrates and other antianginals
RX0541	other antihypertensives
RX0542	other cardiac preparations
RX0543	peripheral vasodilators
RX0544	statins and lipid modifying agents
RX0546	Antiplatelet Agents Thrombin Inhibitors
RX0645	antacids
RX0647	antiemetics and antinauseants
RX0648	digestives incl. enzymes
RX0649	drugs for constipation
RX0861	opioids
RX0862	other analgesics and antipyretics
RX13101	other gynecologicals
RX16106	iron preparations
RX16109	vitamin b12 and folic acid
RX16110	vitamin k and other hemostatics
RX16111	Agents to stop bleeding
RX19125	anxiolytics
RX23131	mineral supplements
RX23133	other nutrients
RX23135	vitamins