TABLE 2.
Codes Used to Identify Chronic Conditions for MTM Eligibility Criteria from Medical or Pharmacy Claims Data During the Identification Periods
| Condition | ICD-9-CM Diagnosis, ICD-9-CM Procedure, HCPCS, CPT, or J Codes (Using Medical Claims Between January 1, 2013, and December 31, 2013) | GPI Codes (Using Pharmacy Claims Between October 1, 2013, and December 31, 2013) |
|---|---|---|
| Cardiovascular disease | ICD-9-CM diagnosis codes: 38.48, 401-405, 410, 412, 427.31, 427.32, 428, 430-435, 443.89, 443.9 | GPI2 level: 33, 34, 36; GPI4 level: 3720, 3760; GPI6 level: 379900, 409925; GPI8 level: 33300007 |
| Diabetes | ICD-9-CM diagnosis codes: 250, 357.2, 362.0, 366.41 | GPI2 level: 27 |
| Rheumatoid arthritis | ICD-9-CM diagnosis codes: 714.0, 714.1, 714.2, 714.81; J codes: J0129, J0135,J0718,J1438,J1600, J1745,J2910,J3262, J3590, J7500-J7502, J7515-J7518, J8530, J9070, J9080, J9090-J9097,J9250, J9310 | GPI4 level: 6620, 6627, 6628, 6629, 6640; GPI8 level: 04000040, 13000020, 21101020, 21300050, 21353060, 52500060, 52505020, 52505040, 66250050, 66260010, 66270015, 66270040, 66500070, 99200030, 99402020, 99403030, 99406010 |
| Dyslipidemia | ICD-9-CM diagnosis codes: 272.0, 272.1, 272.3, 272.4 | GPI4 level: 3910, 3920, 3940, 3999; GPI6 level: 409925; GPI8 level: 39450050, 77103010, 77103020; GPI14 level: 39300030000320 |
| End-stage renal disease | ICD-9-CM diagnosis codes: 582, 583, 585.1-585.6, 585.9, 586, 588, v42.0, v45.1, v45.11, v45.12; ICD-9-CM procedure codes: 38.95, 39.27, 39.42, 39.43, 39.53, 39.93-39.95, 54.98, 55.6, 55.61, 55.69; CPT codes: 36147, 36800, 36810, 36815, 36818-36821, 36831-36833, 50300, 50320, 50340, 50360, 50365, 50370, 50380, 90935, 90937, 90940, 90945, 90947, 90957-90962, 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, 99512; HCPCS codes: S2065, S9339, G0257 |
CPT = Current Procedural Terminology; GPI = generic product identifier; HCPCS = Healthcare Common Procedure Coding System; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; J code = part of the HCPCS classifications used to indicate that a drug was administered; MTM = medication therapy management.