You are viewing the site in preview mode

Skip to main content

Advertisement

Table 1 Case definitions applied to administrative health data for diabetes and comorbid conditions

From: Validity of the RAI-MDS for ascertaining diabetes and comorbid conditions in long-term care facility residents

Condition Case definition algorithm
Diabetes [13, 14] One or more inpatient hospital separations with an ICD code in any diagnosis field or two or more physician billing claims within two years with an ICD code.
ICD-9: 250
ICD-10-CA: E10, E11, E12, E13, E14
Alzheimer’s disease/dementia [15] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 290, 291, 294, 331
ICD-10-CA: F00, F01, F02, F03, F05.1, G30, G31.1
Arthritis [16, 17] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 714, 715, 446, 710, 720, 274, 711, 712, 713, 716,
717, 718 719, 721, 725 to 729, 739
ICD-10-CA: M05, M06, M15 to M19, M07, M10, M11 to M14, M30 to M36, M00 to M03, M20 to M25, M65 to M79
Cardiac dysrhythmia [17] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 427
ICD-10-CA: I47, I48, I49
Congestive heart failure [18, 19] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9 code: 428
ICD-10-CA: I50
Chronic obstructive pulmonary disease [18] One or more inpatient hospital separations with an ICD code in any diagnostic field or one or more physician billing claims with an ICD code.
ICD-9 code: 491, 492, 496
ICD-10-CA: J41, J42, J43, J44
Glaucoma [18] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician claims with an ICD code.
ICD-9 code: 365
ICD-10-CA: H40, H42
Hip fracture [20] One or more inpatient hospital separations with an ICD code in the first diagnosis field.
ICD-9: 820
ICD-10-CA: S72.0, S72.1, S72.2
Hypertension [21, 22] One or more inpatient hospital separations with an ICD code in any diagnosis field or two or more physician claims with an ICD code within two years.
ICD-9: 401 to 405
ICD-10-CA: I10 to I13, I15
Multiple sclerosis [15] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 340
ICD-10-CA: G35
Osteoporosis [23, 24] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 733.0 (hospital data) or 733 (physician data)
ICD-10-CA: M80, M81
Parkinson’s disease [15] One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.
ICD-9: 332
ICD-10-CA: G20
Stroke/transient ischemic attack [25] One or more inpatient hospital separations with an ICD code in the first diagnosis field.
ICD-9: 430, 431, 432, 433, 434, 435, 436, 437, or 438
ICD-10-CA: I60, I61, I62, I63 (excluding I63.6), I64, I65, I66, I67 (excluding I67.6), I68, I69, G45, G46, H34.
  1. Note: ICD-9 codes are used to ascertain cases in physician billing claims and in hospital records up to and including 2000/01 fiscal year; ICD-10-CA codes are used to ascertain cases in hospital records for 2001/02 onward and ICD-9 codes are used to ascertain cases in physician billing claims for 2001/02 onward.