Table 1.
Diagnostic Codes and Types of Medications Used to Identify Members with Chronic Conditions
| Condition | ICD-9* Code Numbers | Medications |
|---|---|---|
| Diabetes mellitus | 250.xx (diabetes mellitus) | insulin |
| 357.2x (neuropathy in diabetes) | oral agents including sulfonylureas, | |
| 362.0x (diabetic retinopathy) | thiazolidinediones, biguanides, and alpha-glucosidase inhibitors | |
| 366.41(diabetic cataract) | alpha-glucosidase inhibitors | |
| Hypertension | 401.0, 401.1, 401.9 (essential hypertension) | diuretics |
| 402.xx (hypertensive heart disease) | angiotensin converting enzyme inhibitors | |
| 403.xx (hypertensive renal disease) | angiotensin-II receptor antagonists | |
| 404.xx (hypertensive heart and renal disease) | beta-adrenergic receptor blockers | |
| calcium channel blockers | ||
| central and alpha-adrenergic antagonists | ||
| vasodilators | ||
| combinations of above | ||
| Heart failure | 398.91 (rheumatic heart failure) | loop diuretics |
| 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, 404.03, 404.13, 404.93 (hypertensive heart disease with heart failure) | angiotensin converting enzyme inhibitors | |
| angiotensin-II receptor antagonists | ||
| digoxin | ||
| 428.xx (heart failure) | select beta-adrenergic receptor blockers— | |
| carvedilol, metoprolol and bisoprolol | ||
| Arthritis | 714.xx (rheumatoid arthritis and other inflammatory polyarthropathies) | non-steroidal anti-inflammatory drugs |
| salicylates | ||
| 715.xx (osteoarthritis and allied disorders) | corticosteroids | |
| 716.xx (other and unspecified arthropathies) | disease modifying agents including gold | |
| salts, pencillamine, leflunomide, | ||
| etanercept, sulfasalazine, methotrexate, | ||
| hydroxychloroquine, azathioprine, and | ||
| cyclophosphamide | ||
| 720.xx (except 720.1: ankylosing spondylitis and other inflammatory spondylopathies) | ||
| 721.0 to 721.4x, 721.9x (spondylosis) | ||
| Chronic lung disease | 491.xx (chronic bronchitis) | oral and inhaled beta-adrenergic agonists |
| 492.xx (emphysema) | inhaled corticosteroids | |
| 493.xx (asthma) | leukotriene inhibitors | |
| 496.xx (chronic airway obstruction) | xanthine derivatives | |
| ipratropium | ||
| mast cell stabilizers | ||
| Glaucoma | 365.1x to 365.9x (types of glaucoma) | ocular beta-adrenergic blockers |
| 365.0x (borderline glaucoma or glaucoma suspect) | ocular cholinesterase inhibitors | |
| ocular cholinergic miotics | ||
| ocular carbonic anhydrase inhibitors | ||
| ocular sympathomimetics | ||
| ocular prostaglandin analogues |
*
International Classification of Diseases, 9th Clinical Modification where “x” indicates any digit.