Algorithms for Identifying Patients with Limited Life Expectancy^*

Congestive Heart Failure (CHF)
CHF ICD-9-CM diagnosis codes (1 inpatient or 2 outpatient codes during study interval† or 5 years prior): 398.91, 402.01, 402.11, 402.91,404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425, 428.x AND ≥ 1 hospitalizations OR ≥ 1 Emergency Room visit for CHF during the study interval or 1 year prior AND ≥ 1 of the following criteria for any category (A – F) during the study interval or 1 year prior for organ failure/ insufficiency: A. Renal Failure ICD-9-CM diagnosis codes: 584.x (2 outpatient codes or 1 inpatient code) 585.x, 586, 788.5 (1 outpatient or 1 inpatient code) OR ≥ 2 ICD-9-CM codes, CPT codes, or DSS clinic stops for dialysis on different days: ICD-9-CM procedure codes for dialysis: 38.95, 39.27, 39.42, 39.43, 39.53, 39.93, 39.94, 39.95, 54.98, V45.1, V56, V56.0, V56.8 CPT codes for dialysis: 36145, 36800, 36810, 36815, 36818, 36819, 36820, 36821, 36831, 36832, 36833, 90920, 90921, 90924, 90925, 90935, 90937, 90940, 90945, 90947, 90989, 90993, 90997, 90999, 99512 Dialysis DSS Clinic Stops: 602, 603, 604, 606, 607, 608, 610, 611 OR B. Respiratory Failure ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code) 518.0, 518.2, 518.4 , 518.5, 518.8x excluding 518.89 ICD-9-CM procedure codes (1 outpatient or 1 inpatient code): V46.1, V46.11, V46.13, V46.2, 96.01 – 96.05, 96.70 – 96.72 OR C. Liver Failure ICD-9-CM diagnosis code (1 outpatient or 1 inpatient code): 570 OR D. Intestinal Failure ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code): 557.0, 560.1 OR E. Cardiogenic Failure ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code): 785.51, 410.x OR F. Other Shock ICD-9-CM diagnosis codes (1 outpatient or inpatient code): 427.5, 572.4, 785.59, 799.1, 799.8, 995.0
Chronic Obstructive Pulmonary Disease (COPD)
COPD ICD-9-CM diagnosis codes (1 inpatient or 2 outpatient codes during study interval or 5 years prior): 491.x, 492.x, 493.2, 496 AND ≥ 1 of the following ICD-9-CM codes during the study interval or 1 year prior: ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code): 518.81 – 518.84 (respiratory failure), 799.1 (respiratory arrest)
Primary Cancers
Primary Cancers of the esophagus, peritoneum, liver, gallbladder, pancreas, pleura, or stomachICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code during study interval or 1 year prior): 150 – 151.9, 155 – 157.9, 158.8, 158.9, 163.x
Metastatic Cancers
Metastatic Cancers ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code during study interval or 1 year prior): 196 – 199.1
Dementia
Dementia ICD-9-CM diagnosis codes (1 inpatient or 2 outpatient codes during study interval or 5 years prior): 046.1, 046.3, 290 – 290.43, 291.2, 294.1, 294.x, 331.0 – 331.2, 331.7, 331.82, 331.89, 331.9, 332.0, 333.0, 333.4 AND ≥ 2 acute hospitalizations during the study interval or 1 year prior
End-Stage Liver Disease (ESLD)
ESLD ICD-9-CM diagnosis codes for cirrhosis (1 inpatient or 2 outpatient codes during study interval or 5 years prior): 571.2, 571.5, 571.6 AND ≥ 1 of the following ICD-9-CM or CPT codes during the study interval or 1 year prior: ICD-9-CM diagnosis codes (1 outpatient or 1 inpatient code): 571.0 (alcoholic fatty liver), 571.1 (acute alcoholic hepatitis), 572.2 (hepatic coma), 572.3 (portal hypertension), 572.4 (hepatorenal syndrome), 799.4 (cachexia) ICD-9-CM procedure codes (1 outpatient or 1 inpatient code): 39.1 (intra-abdominal venous shunt), 54.94 (peritoneovascular shunt) CPT Codes for intrahepatic portosystemic shunts: 37182, 37183, 37140 OR hospitalization for any of the following ICD-9-CM codes: ICD-9-CM diagnosis codes for esophageal varices with bleeding or ascites (1 outpatient or 1 inpatient code): 456.0, 456.20, 789.5 ICD-9-CM procedure code for injection of esophageal varices (1 outpatient or 1 inpatient code): 42.91

ICD-9-CM = International Classification of Diseases, Clinical Modification, 9^th Revision; CPT = Current Procedural Terminology; DSS = Decision Support System

^*Patients need only to meet the criteria for one of the conditions CHF, COPD, Primary Cancers, Metastatic Cancers, Dementia, or ESLD to be classified as having limited life expectancy

^†Study interval = Veterans Administration fiscal year 2007 (October 1, 2006 – September 30, 2007) plus 8-week follow up period

^‡All codes must appear on separate visits on separate days