Table 6.
Cardiovascular risk levels and codes, modified based on NCEP ATP III guidelines
| Risk Level | Code | |
|---|---|---|
| History of CV event | Myocardial infarction | ICD-9-CM: 410, 412 |
| Unstable angina | ICD-9-CM: 411.1, 411.81, 411.89 | |
| Coronary artery bypass graft | CPT-4: 33503-33545 | |
| Percutaneous coronary intervention | ICD-9 Procedure: 00.66, 36.09 | |
| Ischemic Stroke | ICD-9 CM: 434, 436, 437.0, 437.1, 438, 997.02 | |
| Modified CHD RE | Peripheral arterial disease | ICD-9-CM: 440.0x-440.4x, 440.8x-440.9x, 443.81, 443.9x |
| Abdominal aortic aneurysm | ICD-9-CM: 441.3x-441.4x | |
| Coronary artery disease | ICD-9-CM: 433.1x | |
| Diabetes | ICD-9-CM: 249.xx-250.xx | |
| Dyslipidemia | ICD-9-CM: 272.0x-272.4x | |
| Moderate risk | At least two of the following three risk factors identifiable from administrative claims data: a) hypertension (ICD-9-CM code or pharmacy claim for a blood pressure–lowering agent), b) age 45 years or older for men and 55 years or older for women c) pre-index high-density lipoprotein (HDL) cholesterol below 40 mg/dl. |
Hypertension: ICD-9-CM codes 401.1-401.9, 642.00-642.04, 401.0, 437.2, 402.00-405.99, 642.10-642.24, 642.70-642.94 |
| Low risk | Zero or one risk factor |
CHD RE coronary heart disease risk equivalent, CV cardiovascular, ICD-9-CM International Classifications of Diseases, 9th Revision Clinical Modifications, CPT Current Procedural Terminology, NCEP ATP III National Cholesterol Education Program Adult Treatment Panel III