Appendix Table.
Variable definitions based on procedure and diagnoses available in claims used to develop the clinical indication prediction model for clinical indication.
| Variable Category | Procedure and Diagnosis Codesa | Format | Inclusion in final model?b | If included, timing relative to breast MRI |
|---|---|---|---|---|
| Breast MRI | CPT: 76093-76094; 77058-77059 HCPCS: C8903-C8908 |
Indicator | Yes | Within 250 days before |
| Age | 5 year age groups | Yes | Concurrent | |
| Calendar year | Continuous | Yes | Concurrent | |
| Breast cancer (invasive or in situ) | ICD-9 Dx: 174; 233.0; V10.3 | Indicator | Yes | Anytime before MRI |
| Other breast disease | ICD-9 Dx: 217; 610; 611(except 611.7) | Indicator | Yes | Within 45 days after |
| Screening | CPT: 76083; 76085; 77057; | |||
| Mammogram | HCPCS: G0202 ICD-9 Dx: V76.1 |
Indicator | No | |
| Breast Cancer Risk Markers | Indicator | Yes | Concurrent | |
| Genetics | 96040; 99401 HCPCS: S3818-23 |
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| BRCA or Family History | ICD-9 Dx:V10.43; V16.3; V16.41; V84.01-V84.02 | |||
| Other | ICD-9 Dx: 183; 201 | |||
| Sign, Symptom or Abnormal image of breast | ICD-9 Dx: 611.7; 793.8 | Indicator | Yes, with age interaction | Current or within 45 days before or after (as 3 variables) |
| Other Breast Disorders | ICD-9 Dx: 611.0-611.9 except 611.7 | Indicator | Yes, with age interaction | Within 45 days after |
| Diagnostic Work-up | Indicator | Yes | Within 6 months before | |
| Imaging | CPT: 76082-91; 76645; 77051-6 HCPCS: G0203-G0207; G0236 |
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| Biopsy | CPT: 19100-19103; 19120-19126; 76095-76096; 77031-77032 ICD-9 Px: 85.11-85.12; 85.19-85.20 |
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| Other diagnostic px | CPT: 19000-19001; 19105; 76086-76089; 76939; 77053-77054 ICD-9 Px: 85.91; 87.35-87.37; 88.73 |
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| Treatment | Indicator | Yes | Within 6 months before or after (as 2 variables) | |
| Chemotherapy | ICD-9 Px: 85.92; 99.25 CPT: 96400-96549 CPT II: 0519F HCPCS: C9280; J1100, J8520-J8540; J9000-J9100; J9200-J9209; J9211; J9230-J9249; J9260-J9399; J9999 |
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| Radiation | CPT: 77261-77499 | |||
| Surgery | ICD-9 Px: 40.22-40.23; 40.3; 40.51; 85.22-85.25; 85.41-85.48 CPT: 19160-19162; 19180-19182; 19200-19272; 19301-19307; 19340; 19361-19369; 38525; 38740-38745; 76998 HCPCS: S3854 |
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| Breast implant complication | ICD-9 Dx: 996.54; 996.79 | Indicator | No |
a
Code Types: CPT = Common Procedure Terminology; HCPCS = Healthcare Common Procedure Coding System; ICD-9 Dx = International Classification of Diseases Version 9 Diagnoses; ICD-9 Px = ICD-9 Procedures
b
Predictor variables for the occurrence at 15, 30, 45, 60, 90 and 180 days before and after the breast MRI were examined during model development.