Skip to main content
. Author manuscript; available in PMC: 2016 Oct 5.
Published in final edited form as: J Manag Care Spec Pharm. 2016 Mar;22(3):281–292. doi: 10.18553/jmcp.2016.22.3.281
Chronic Conditions Valid ICD-9-CM Codes Number/Type of Claims to Qualify
Acute myocardial infarction DX 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91 (ONLY first or second DX on the claim) At least 1 inpatient claim with DX codes prior to atrial fibrillation diagnosis
Chronic kidney disease DX 016.00, 016.01, 016.02, 016.03, 016.04, 016.05, 016.06, 095.4, 189.0, 189.9, 223.0, 236.91, 249.40, 249.41, 250.40, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 440.1, 442.1, 572.4, 580.0, 580.4, 580.81, 580.89, 580.9, 581.0, 581.1, 581.2, 581.3, 581.81, 581.89, 581.9, 582.0, 582.1, 582.2, 582.4, 582.81, 582.89, 582.9, 583.0, 583.1, 583.2, 583.4, 583.6, 583.7, 583.81, 583.89, 583.9, 584.5, 584.6, 584.7, 584.8, 584.9, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 585.9, 586, 587, 588.0, 588.1, 588.81, 588.89, 588.9, 591, 753.12, 753.13, 753.14, 753.15, 753.16, 753.17, 753.19, 753.20, 753.21, 753.22, 753.23, 753.29, 794.4 (any DX on the claim) At least 1 inpatient, SNF, or HHA claim or 2 HOP or carrier claims with DX codes prior to atrial fibrillation diagnosis
Diabetes DX 249.00, 249.01, 249.10, 249.11, 249.20, 249.21, 249.30, 249.31, 249.40, 249.41, 249.50, 249.51, 249.60, 249.61, 249.70, 249.71, 249.80, 249.81, 249.90, 249.91, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 366.41 (any DX on the claim) At least 1 inpatient, SNF, or HHA claim or 2 HOP or carrier claims with DX codes prior to atrial fibrillation diagnosis
Heart failure DX 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 (any DX on the claim) At least 1 inpatient, HOP, or carrier claim with DX codes prior to atrial fibrillation diagnosis
Hypertension DX 362.11, 401.0, 401.1, 401.9, 402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 403.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00, 404.01, 404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93, 405.01, 405.09, 405.11, 405.19, 405.91, 405.99, 437.2 (any DX on the claim) At least 1 inpatient, SNF, HHA, or 2 HOP or carrier claims with DX codes prior to atrial fibrillation diagnosis
Hypothyroidism DX 244.0, 244.1, 244.2, 244.3, 244.8, 244.9 (any DX on the claim) At least 1 inpatient, SNF, HHA, or 2 HOP or carrier claims with DX codes prior to atrial fibrillation diagnosis
Ischemic heart disease DX 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 411.0, 411.1, 411.81, 411.89, 412, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.12, 414.2, 414.3, 414.8, 414.9 (any DX on the claim) At least 1 inpatient, SNF, HHA, HOP, or carrier claim with DX codes prior to atrial fibrillation diagnosis
Stroke/transient ischemic attack DX 430, 431, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 435.0, 435.1, 435.3, 435.8, 435.9, 436, 997.02 (any DX on the claim) At least 1 inpatient claim or 2 HOP or carrier claims with DX codes prior to atrial fibrillation diagnosis

DX = diagnosis; HHA = home health agency; HOP=hospital outpatient; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; SNF = skilled nursing facility.