Table 1.
Secondary Prevention Criteria
| Diagnosis or Procedure | ICD-9-CM, DRG, or CPT Codes |
|---|---|
| HEDIS® Criteria | |
| AMI | ICD-9-CM: 410.x |
| DRG: 121, 122 | |
| PTCA | ICD-9-CM: 36.01, 36.02, 36.05, 36.09 |
| DRG: 112 | |
| CPT: 92980-92982, 92984, 92995, 92996 | |
| CABG | ICD-9-CM: 36.1, 36.2 |
| DRG: 106, 107, 109 | |
| CPT: 33510-33514, 33516-33519, 33521-33523, 33533-33539 | |
| NCEP ATP III Criteria | |
| Chronic IHD | ICD-9-CM: 414.1x, 414.8, 414.9 |
| Coronary atheroschlerosis | ICD-9-CM: 414.0, 414.01, 414.02, 414.03, 414.04, 414.05 |
| Diabetes mellitus (Type I or II)* | ICD-9-CM: 250.x |
*
Use of insulin or oral antidiabetic agents also verified by pharmacy claims.
HEDIS®, Health Plan Employer Data and Information Set; NCEP ATP III, National Cholesterol Education Program; ICD-9-CM, International Classification of Diseases, Ninth Revision, DRG, Diagnosis Related Group; CPT, Current Procedural Terminology; AMI, Acute Myocardial Infarction; PTCA, Percutaneous Transluminal Coronary Angioplasty; CABC, Coronary Artery Bypass Graft; IHD, Ischemic Heart Disease.