- 154 -
APPENDIX C – CLAIMS DATA SPECIFICATIONS
ASTHMA
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 02_03: Patients with the diagnosis of
moderate-to-severe asthma should have been
prescribed a beta2-agonist inhaler for symptomatic
relief of exacerbations to use as needed.
Emergency room contact
for asthma
ERASMA*
Hopitalizations for
asthma
Prescriptions for
asthma medications
IPASMA*
ASMARX*
Date
All dates on which there was an
emergency room visit for the
primary diagnosis of asthma (all
FROMDATE where DIAG1 = 493 and
SITE_CDE=7,8,10)
Date
All dates on which there was a
hospitalization for the primary
diagnosis of asthma (all FROMDATE
where DIAG1 = 493 and SITE_CDE=4)
Date
All dates on which there is a
prescription for asthma
medications (all FILLDATE where
NDCCODE = see ASMARX list
following specifications for
asthma measures)
ASMARX NDC codes are
from NCQA's list of
medications that
indicate treatment of
asthma
- 155 -
Item Definition
Variable Name Format
Outpatient visits for
asthma
OPASMA*
Evidence of moderate
to severe asthma
during first year of
study
MODSEVAS
Claims Data Algorithm
Date
All dates on which there was an
outpatient visit for asthma (all
FROMDATE where any DIAG* = 493
and SITE_CDE=1)
1=yes;0=no
Evidence of moderate to severe
asthma if any of the following
are true:(1) at least 4 asthma
medication dispensing events (4
unique dates for ASMARX*) in
first year of study (ELIGBEG to
ELIGBEG + 12 months)OR(2) at
least 1 ER visit for asthma in
first year of study (ERASMA* <
ELIGBEG + 12 months)OR(3) at
least 1 hospitalization for
asthma in first year of study
(IPASMA* < ELIGBEG + 12
months)OR(4) at least 4 asthma
visits in first year of study (4
unique dates for OPASMA* that are
between ELIGBEG to ELIGBEG + 12
months) AND at least 2 asthma
medication dispensing events (2
unique dates for ASMARX* that are
between ELIGBEG to ELIGBEG + 12
months)
NOTES
- 156 -
Item Definition
Variable Name Format
Eligible for 02_03
(diagnosis of moderate
to severe asthma)
E02_03
Prescription for
beta2-agonist inhaler
ordered
BETAINH
Pass 02_03 (beta2agonist inhaler
prescribed)
S02_03
Claims Data Algorithm
NOTES
1=yes;0=no
Eligible if MODSEVAS = 1
Using HEDIS algorithm
and 1st year of data to
identify asthma
severity, therefore
only scoring on care
delivered during the
2nd year of the study.
1=yes;0=no
Beta2-agonist list
derived from the multum
ndc_denorm table,
medications were
selected if
route=inhaled and
active ingredients =
Albuterol, Bitolterol,
Any prescription during 2nd year Epinephrine,
Isoetharine,
of study for beta2-agonist (any
Isoproterenol,
FILLDATE where FILLDATE >=
Metaproterenol,
1/1/1999 and NDC = see BETAINH
list at the end of specifications Pirbuterol,
Racepinepine
for asthma measures)
1=yes;0=no
Pass if BETAINH = 1
- 157 -
Item Definition
Variable Name Format
Claims Data Algorithm
INDICATOR 02_05: Patients with moderate-to-severe
asthma should not receive beta-blocker medications
(e.g., atenolol, propranolol).
Eligible for 02_05
(diagnosis of moderate
to severe asthma,
where severity can be
estimated with
encounter and
medication
information)
E02_05
Prescription for betablocker medication
ordered
BETABLK
Pass 02_05 (NO
prescription for a
beta-blocker)
S02_05
NOTES
Using 1st year of data
to identify asthma
severity, therefore
only scoring on care
delivered during the
2nd year of the study.
1=yes;0=no
Eligible if MODSEVAS = 1
1=yes;0=no
Beta blocker list
derived from the multum
ndc_denorm table,
medications were
selected if route=oral
and active ingredients
=
Acebutolol, Atenolol,
Any prescription for betaBetaxolol, Bisoprolol,
blockers during the second year
Carteolol, Metoprolol,
of the study (any FILLDATE >
ELIGBEG + 12 months where NDCCODE Nadolol, Penbutolol,
= corresponds to code on BETABLK Pindolol, Propranolol,
Sotalol, Timolol
worksheet)
1=yes;0=no
Pass if BETABLK=0
- 158 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 02_06: Patients requiring chronic
treatment with systemic corticosteroids during any
12 month period should have been prescribed
inhaled corticosteroids during that same 12 month
period.
Oral corticosteroid
prescriptions
POCORT*
Date
Oral corticosteroid
list derived from the
multum ndc_denorm
table, medications were
selected if route=oral
and active ingredients
=
aminoglutethimide,
betamethasone,
cortisone acetate,
dexamethasone,
fludrocortisone
acetate, fluphenazine,
hydrocortisone,
All prescription dates for oral
methylprednisolone,
coritcosteroids (all FILLDATE
where NDCCODE corresponds to code prednisolonse,
in the POCORT file listed at the presnisolone sodium
phosphate, prednisone,
end of the claims data
triamcinolon
specifications)
- 159 -
Item Definition
Variable Name Format
Chronic treatment with
systemic
corticosteroids
CHRNCORT
Eligible for 02_06
(chronic treatment
with systemic
corticosteroids)
E02_06
Prescription for
inhaled
corticosteroids
ordered
INHCORT
Claims Data Algorithm
NOTES
1=yes;0=no
At least 1 prescription for oral
corticosteroids during the study
that was for at least 28 days
(any POCORT* where DAY_SPLY>=28)
OR
at least 2 tapers within 12
months (2 or more POCORT* within
12 months where DAY_SPLY < 28
days)
1=yes;0=no
Eligible if CHRNCORT=1 and
MODSEVAS=1
1=yes;0=no
Inhaled corticosteroid
list derived from the
multum ndc_denorm
table, medications were
selected if
route=inhaled and
active ingredients =
beclomethasone
dipropionate,
Any prescription for inhaled
budesonide,
coritcosteroids (any FILLDATE
where NDCCODE corresponds code on flunisolide,
INHCORT file listed at the end of flucticasone
proprionate,
the specifications for asthma
triamcinolone acetonide
measures)
- 160 -
Item Definition
Pass 02_06
(prescription for
inhaled
corticosteroids)
Variable Name Format
Claims Data Algorithm
S02_06
Pass if INHCORT = 1
1=yes;0=no
NOTES
INDICATOR 02_07: Patients on chronic theophylline
(dose > 600 mg/day for at least 6 months) should
have at least one serum theophylline level
determination per year.
Dates of prescriptions
for theophylline
THEO*
Daily dose of
theophylline
DDTHEO*
Earliest date where
theophylline was > 600
mg/day
GT600
Date
Theophylline list
derived from the multum
ndc_denorm table,
medications were
All dates (FILLDATE) where a
prescription for theophylline was selected if route=oral
and active ingredients
filled (NDCCODE = see THEO file
=
listed at the end of the asthma
theophylline
specifications)
Continuous
The daily dose for each
theophylline prescription (for
each FILLDATE that equals THEO*,
daily dose = ((DRUG_STR *
QTY_DRUG)/DAY_SPLY)
Date
Earliest date where theophylline
was > 600 mg/day (Min(THEO* where
DDTEHO* >600))
- 161 -
Item Definition
Eligible for 02_07
(Daily dose of
theophylline)
Theophllyine level
checked
Pass 02_07
(theophylline level
checked)
Variable Name Format
Claims Data Algorithm
E02_07
1=yes;0=no
Eligible if high theophllyine
dose in first year of study
(GT600 <= (ELIGBEG + 12 months))
AND MODSEVAS=1
Date
All dates on which the patient's
theophylline level was checked
(all CPTDATE where CPTCODE =
80198 and all FROMDATE where
PROC1-6=80198)
1=yes;0=no
Pass if theophllyine level
checked within 1 year of high
dose (GT600 < any THELVL* <=
(GT600+12 months))
THELVL*
S02_07
INDICATOR 02_17: Patients admitted to the hospital
for asthma exacerbation should have oxygen
saturation measured.
Hopitalizations for
asthma
Eligible for 02_17
(admitted to the
hospital for asthma
exacerbation)
IPASMA*
Date
All dates on which there was a
hospitalization for the primary
diagnosis of asthma (all FROMDATE
where DIAG1 = 493 and SITE_CDE=4)
E02_17*
1=yes;0=no
Eligible if IPASMA*<>NA
NOTES
- 162 -
Item Definition
Oxygen saturation
measured
Pass 02_17 (oxygen
saturation measured
during the
hospitalization)
Variable Name Format
Claims Data Algorithm
O2SAT*
Date
Oxygen saturation measured during
asthma hospitalization
(PROC*=82805-82810)
S02_17*
1=yes;0=no
Pass if any O2SAT* = IPASMA*
INDICATOR 02_24: Patients with a hospitalization
for asthma exacerbation should receive outpatient
follow-up contact within 14 days.
Hopitalizations for
asthma
IPASMA*
Discharge date for
asthma
ASMADC*
Eligible for 02_24
(patient hospitalized
for asthma)
E02_24*
Date
All dates on which there was a
hospitalization for the primary
diagnosis of asthma (all FROMDATE
where DIAG1 = 493 and SITE_CDE=4)
Date
Discharge date for asthma
hospitalizations (the THRUDATE
corresponding to each IPASMA*)
1=yes;0=no
Eligible if IPASMA*<>NA
NOTES
- 163 -
Item Definition
Variable Name Format
Outpatient visits for
asthma
OPASMA*
Pass 02_24 (asthma
follow-up within 14
days of discharge)
S02_24
Claims Data Algorithm
Date
All dates on which there was an
outpatient visit for asthma (all
FROMDATE where any DIAG* = 493
and SITE_CDE=1)
1=yes;0=no
Pass if outpatient visit for
asthma within 14 days of
discharge (ASMADC* < any OPASMA*
<= (ASMADC* + 14 days))
NOTES
- 164 -
CORONARY ARTERY DISEASE
Item Definition
Variable Name Format
Claims Data Algorithm
Diagnosis codes for
CAD
CADDX
DIAG*: 410xx-414xx
REVCODE: 49x, 50x, 51x, 52x, 53x,
76x, 82x, 83x, 84x, 85x, 88x, 92x,
94x, 96x, 972, 973, 974, 975, 976,
977, 978, 979, 982, 983, 984, 985,
986, 988, 989
Encounter codes
(outpatient/non-acute
inpatient)
OUTPT
CPT: 99201-99205, 99211-99215,
99217-99220, 99241-99245, 9927199275, 99354-99355, 99381-99387,
99391-99397, 99401-99404, 9941199412, 99499
REVCODE: 45x, 981
Encounter codes (ER)
Encounter codes
(acute inpatient)
ER
IP
CPT: 99281-99288
REVCODE: 10x-16x, 20x-22x, 72x,
80x, 987
CPT: 99221-99223, 99231-99233,
99238-99239, 99251-99255, 9926199263, 99291-99292,
NOTES
ICD9 codes are under
the ischemic heart
disease section
- 165 -
Item Definition
Variable Name Format
New diagnosis of CAD
(flag)
NEWCAD
1=yes;0=no
New diagnosis of CAD
(date)
NEWCADDT
DATE
Prior CAD (flag)
CADPREV
1=yes;0=no
First CAD visit date
FSTCADVS
DATE
Claims Data Algorithm
At least 2 outpatient or inpatient
encounters (codes above) where
there was a diagnosis for CAD
(DIAG*=410-414) and the earliest
FROMDATE with the diagnosis code
is during the 2nd year of the
study (on or after 1/1/1999).
If NEWCAD=1, then NEWCADDT is the
earliest FROMDATE where there is a
diagnosis of CAD and one of the
above encounter codes.
At least 2 outpatient or inpatient
encounters (codes above) where
there was a diagnosis for CAD
(DIAG*=410-414) and the earliest
FROMDATE with the diagnosis code
is during the 1st year of the
study (on or before 12/31/1998).
If CADPREV=1 (& NEWCAD=0), then
FSTCADVS is the earliest from date
where there is a diagnosis of CAD
(DIAG*=410xx-414xx) and one of the
above encounter codes (for any
setting)
NOTES
- 166 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 11_01: Patients newly diagnosed with CAD
should receive aspirin (at a dose of at least 81
mg/day continued indefinitely) within one week of
the diagnosis of CAD unless they have a
contraindication to aspirin.
ICD9 codes 578 are for
gastrointestinal
bleeding; CPT 36430
and ICD9 Proc 990x are
for transfusions
Bleeding or
transfusion (CI to
aspirin)
BLDASA*
Date(s)
Eligible for 08_01
(new CAD diagnosis
and aspirin not
contraindicated)
E11_01
1=yes;0=no
All FROMDATE/CPTDATE where any of
the following are true:
DIAG*=578xx
PROC* or CPTCODE=36430, 990X
Eligible if new CAD diagnosis
(NEWCADDT<>NA) and No bleeding or
transfusions on or within 4 weeks
prior to new CAD diagnosis (no
BLDASA* between NEWCADDT-4 weeks
and NEWCADDT)
Date(s)
The NDC codes for
aspirin came from the
dnorm_ndc table in the
multum database; all
oral meds with
"aspirin" as active
ingredient were
selected; the list
All dates (FILLDATE) on which a
prescription (NDCCODE) for aspirin includes combination
medications that would
was dispensed (see aspirin file
list at the end of the CAD measure not typically be
prescribed for CAD.
specifications)
Aspirin prescribed
ASARX*
- 167 -
Item Definition
Pass 11_01 (patient
offered aspirin
within 1 week of CAD
diagnosis)
Variable Name Format
S11_01
1=yes;0=no
Claims Data Algorithm
NOTES
Pass if any ASARX* is on or within
1 week after NEWCADDT
(NEWCADDT<=ASARX*<=(NEWCADDT+7days
))
INDICATOR 11_02: Patients with a prior diagnosis
of CAD who are not on aspirin and do not have
contraindications to aspirin should receive
aspirin (at a dose of at least 81 mg/day continued
indefinitely) within one week of any visit to a
provider in which CAD was addressed.
Aspirin prescription
filled
ASARX*
DATE(s)
Bleeding or
transfusion (CI to
aspirin)
BLDASA*
Date(s)
The NDC codes for
aspirin came from the
dnorm_ndc table in the
multum database; all
oral meds with
"aspirin" as active
ingredient were
selected; the list
All dates (FILLDATE) on which a
prescription (NDCCODE) for aspirin includes combination
medications that would
was dispensed (see aspirin file
list at the end of the CAD measure not typically be
prescribed for CAD.
specifications)
ICD9 codes 578 are for
gastrointestinal
All FROMDATE where any of the
bleeding; CPT 36430
following are true:
and ICD9 Proc 990x are
DIAG*=578xx
for transfusions
PROC*=36430, 990X
- 168 -
Item Definition
Eligible for 1_02
(prior diagnosis of
CAD and not on
aspirin and no
contraindications to
aspirin)
Aspirin prescribed
Pass 11_02 (patient
offered aspirin
within one week of
CAD visit)
Variable Name Format
Claims Data Algorithm
Eligible
year, no
prior to
bleeding
prior to
11_02
1=yes;0=no
ASARX*
DATE(s)
11_02
1=pass;0=fail
NOTES
if visit for CAD in 1st
aspirin prescription
the CAD visit and no
within 4 weeks on or
the CAD visit:
FSTCADVS<>NA and (ASARX*=NA or
ASARX* >= FSTCADVS) and (No
BLDASA* on or between FSTCADVS-4
weeks and FSTCADVS)
The NDC codes for
aspirin came from the
dnorm_ndc table in the
multum database; all
oral meds with
"aspirin" as active
ingredient were
selected; the list
All dates (FILLDATE) on which a
prescription (NDCCODE) for aspirin includes combination
medications that would
was dispensed (see aspirin file
list at the end of the CAD measure not typically be
prescribed for CAD.
specifications)
Pass if any aspirin prescribed
within a week of CAD visit
(FSTCADVS <= ASARX*<= FSTCADVS+7
days)
- 169 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 14: Patients discharged after an acute
myocardial infarction who do not have
contraindications to aspirin should be discharged
on aspirin at a dose of at least 81 mg/day.
Discharge date for
AMI hospitalization
AMIDSCH
Bleeding or
transfusion (CI to
aspirin)
BLDASA*
Eligible for 08_14
(discharged for AMI
and aspirin not
contraindicated)
E11_14
Aspirin prescribed
Pass 08_14 (patient
offered aspirin at
DATE
Discharge date (THRUDATE) where
there was a diagnosis of AMI (any
DIAG*=410xx) and SITE_CDE=4 and
Reveune/CPT codes for inpatient
stay (codes listed prior to
indicators) **FACILITY FILE ONLY**
All FROMDATE/CPTDATE where any of
the following are true:
DIAG*=578xx
PROC*/CPTCODE=36430, 990X
Date(s)
Eligible if discharged for an AMI
(AMIDSCH<>NA) and no
bleeding/transfusion in past for
weeks (No BLDASA* on or between
1=eligible;
0=not eligible AMIDSCH- 4 weeks and AMIDSCH)
ASARX*
DATE(s)
S11_14
1=pass;0=fail
ICD9 codes 578 are for
gastrointestinal
bleeding; CPT 36430
and ICD9 Proc 990x are
for transfusions
The NDC codes for
aspirin came from the
dnorm_ndc table in the
multum database; all
All dates (FILLDATE) on which a
prescription (NDCCODE) for aspirin oral meds with
"aspirin" as active
was dispensed (see aspirin file
list at the end of the CAD measure ingredient were
selected
specifications)
Pass if any ASARX* is within 1
week on or after AMIDSCH
- 170 -
Item Definition
discharge)
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 15: Patients discharged after an acute
myocardial infarction should be discharged on a
beta-blocker (unless they have contraindications
to beta-blockers).
Discharge date for
AMI hospitalization
Diagnostic
contraindications to
beta blocker
AMIDSCH
CONDXBET
DATE
Discharge date (THRUDATE) where
there was a diagnosis of AMI (any
DIAG1=410xx) and SITE_CDE=4 and
REVCODE or PROC* for inpatient
stay (codes listed above prior to
indicators) **FACILITY FILE
ONLY**
1=yes;0=no
Any FROMDATE on or prior to the
AMI discharge (AMIDSCH) where any
DIAG*=
250.x1, 250.x3, 493, 426.0,
426.12, 426.13, 426.2, 426.3,
426.4, 426.51, 426.52, 426.53,
426.54, 426.7, 427.81, 427.89,
398.91, 402.01, 402.11, 402.91,
404.01, 404.11, 404.13, 404.91,
404.03, 404.93, 428.0, 428.1,
491.20, 491.21, 492.0, 492.8, 496,
518.2, 506.4
CI to beta blockers
from HEDIS. ICD9
codes are for insulin
dependent diabetes,
ashtma, heart block >
1 degree, sinus
braycardia, heart
failure, left
ventricular
dysfunction, COPD
- 171 -
Item Definition
Variable Name Format
Precription for a
medication that
treats a condition
that contraindicates
beta blockers
CONRXBB
Eligible for 1_15
(discharged for AMI
and beta blockers not
contraindicated)
E11_15
Beta blocker
prescription dates
BBRX*
Pass 11_15 (patient
offered beta blocker
at discharge)
S11_15
Claims Data Algorithm
NOTES
Medications that treat
diagnoses that
Any prescription (FILLDATE) within contraindicate beta
blockers are: asthma
7 days after or anytime on or
meds (inhaled
prior to the AMI discharge
corticosteroids and
(AMIDSCH) for a medication that
would contraindicate beta blockers leukotriene
antagonists) and
(see list at the end of
insulin
specifications of CAD measures)
1=yes;0=no
Eligible if discharged for an AMI
at least 60 days into study and at
least 7 days prior to the end
(ELIGBEG + 60 <= AMIDSCH <=
ELIGEND - 7 days) and there are no
contraindications to beta blockers
1=eligible;
0=not eligible (CONDXBET=0 and CONRXBB=0)
NDC codes are from
Multum's ndc_dnorm
table and includes all
oral meds where active
ingredient was:
acebutolol, atenolol,
betaxolol, bisoprolon,
carteaolol, labetalol,
All prescription dates (FILLDATE) metoprolol, nadolol,
penbutolol, pindolol,
where NDCCODE for a beta-blocker
(see beta-blocker list at the end propranolol, satalol,
timolol
of the CAD specifications)
DATE(s)
Pass if any beta-blocker
prescription (BBRX*) within 60
days prior to or 7 days after the
1=pass; 0=fail AMI discharge (AMIDSCH)
- 172 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 11d_03:
Patients with newly diagnosed
CAD should have a 12-lead ECG at the time of
diagnosis
Eligible for 11d_03
Eligible if first diagnosis of CAD
(new diagnosis of
1=eligible;
is in 2nd year of study
CAD)
E11d_03
0=not eligible (NEWCADDT<>NA)
All FROMDATE/CPTDATE where any
12-lead ECG performed ECGDT*
DATE(s)
PROC*/CPTCODE = 93000-93010, 8952
Pass if any ECG was performed
Pass 11d_03 (12-lead
(ECGDT*) on or within 2 days prior
ECG offered within 2
days before or after
to or 2 days after the initial CAD
new CAD diagnosis)
S11d_03
1=pass;0=fail visit (NEWCADDT)
INDICATOR 11d_04A: Patients newly diagnosed with
any of the conditions listed below should have a
hemoglobin and/or hematocrit measured at the time
of diagnosis:
a. Stable Angina;
New diagnosis of
stable angina
Eligible for 11_04A
(new diagnosis of
angina)
NEWANG
E11d_04A
As an attempt to
New diagnosis of stable angina if isolate new diagnoses
of angina, I have only
the first diagnosis occurs in
accepted cases where
months 13-23 of the study
the 1st diagnosis is
in the 2nd year of the
Min FROMDATE where DIAG1=413.xx
and (1/1/1999<=FROMDATE<12/1/1999) study.
DATE
Eligible if new diagnosis of
1=eligible;0=n stable angina (NEWANG<>NA) and
ot eligible
diagnosis was made during an
- 173 -
Item Definition
Variable Name Format
Hemoglobin/hematocrit
tested
HEMTST*
Pass 11d_04A
(hemoglobin and/or
hematocrit measured
within 2 days before
or after new
diagnosis of angina) S11d_04A
Claims Data Algorithm
office visit (SITE_CDE=1)
DATE(s)
All CPTDATE where CPTCODE and all
FROMDATE where PROC* = 85013,
85018-85031
1=pass;0=fail
Pass if any HEMTST* is on or
within 3 months prior to or 1
month after new angina dx (NEWANG)
NOTES
INDICATOR 11d_04B: Patients newly diagnosed with
any of the conditions listed below should have a
hemoglobin and/or hematocrit measured at the time
of diagnosis:
unstable angina OR MI
Hospitalization for
unstable angina or MI IPANGMI
DATE
For angina, I have
only include 411.1,
which provides
unstable in its list
From hospital file:
Earliest date patient admitted to of diagnoses, should
look to see if people
hospital with unstable angina or
are admitted for
MI as primary dx (FROMDATE where
angina pectoris
SITE_CDE=4 and DIAG1=410xx or
(413.xx) and if those
411.1 and REVCODE/PROC* for
codes should be
inpatient stay) **FACILITY FILE
included.
ONLY**
- 174 -
Item Definition
Eligible for 11d_04B
(new diagnosis of
unstable angina)
Variable Name Format
E11d_04B
Hemoglobin/hematocrit
tested
HEMTST*
Pass 11d_04B
(hemoglobin and/or
hematocrit measured
within 1 day before
or after new
diagnosis of unstable
angina)
S11d_04B
Claims Data Algorithm
1=Eligible;
Eligible if patient hospitalized
0=not eligible for MI or angina (IPANGMI<>NA)
All CPTDATE where CPTCODE and all
FROMDATE where PROC* = 85013,
Could not ID a ICD-9
DATE(s)
85018-85031
proc code
1=pass;0=fail
Pass if any HEMTST* is on or
between 1 day prior to and 1 day
after the hospitalization
INDICATOR 11d_5E: Patients being evaluated for
"unstable angina" or "rule out unstable angina"
should have an examination at the time of
evaluation documenting all of the following: a 12lead ECG.
Presenting with
unstable angina
Eligible for 11d_05E
(presenting with
unstable angina)
USANG
E11d_05E
12-lead ECG performed ECGDT*
NOTES
DATE
Earliest date where primary
diagnosis was unstable angina
(FROMDATE where DIAG1=411.1)
**any encounter type OK, look in
FACILITY and DOCTOR files)
1=eligible;0=n
o eligible
Eligible if USANG<>NA
All FROMDATE/CPTDATE where any
DATE(s)
PROC*/CPTCODE = 93000-93010, 8952
The date associated
with the blood work
will probably be the
admission date
(FROMDATE) and equal
to IPANGMI
- 175 -
Item Definition
Variable Name Format
Pass 11d_05E (12-lead
ECG performed at
presentation with
unstable angina)
S11d_05E
1=pass;0=fail
Claims Data Algorithm
Pass if any ECG done on the day
patient presented with unstable
angina (ECGST* = USANG)
INDICATOR 11d_06:
Patients admitted with
unstable angina should be placed on cardiac
monitoring (i.e., telemetry).
Date of unstable
angina admission
Eligible for 11d_06
(admitted for
unstable angina)
Patient placed on
cardiac monitoring
Pass 11d_06 (patient
placed on cardiac
monitoring)
IPUSDT
DATE
Earliest date where patient was
admitted for unstable angina
FROMDATE where SITE_CDE=4 and
DIAG1=411.1 and REVCODE/PROC* for
inpatient stay) **FACILITY FILE
ONLY**
TELEM
1=eligible;0=n
ot eligible
Eligible if IPUSDT<>NA
Date (FROMDATE) where patient was
admitted to the coronary care unit
(REVCODE=21x) on or between
admission and discharge for
unstable angina
DATE
S11d_06
1=pass;0=fail
E11d_06
INDICATOR 11d_08: Patients admitted with unstable
angina should have a repeat ECG 12-36 hours after
admission.
Pass if TELEM <> NA
NOTES
- 176 -
Item Definition
Date of unstable
angina admission
Eligible for 11d_08
(admitted for
unstable angina)
Variable Name Format
Claims Data Algorithm
NOTES
Earliest date where patient was
admitted for unstable angina
FROMDATE where SITE_CDE=4 and
DIAG1=411.1 and REVCODE/PROC* for
inpatient stay) **FACILITY FILE
ONLY**
IPUSDT
DATE
11d_08
1=eligible;0=n
ot eligible
Eligible if IPUSDT<>NA
12-lead ECG performed ECGHOSP
Pass 11d_08 (12-lead
ECG repeated 12 -36
hours after
admission)
11d_08
1=yes;0=no
1=pass;0=fail
INDICATOR 11d_09A: Patients admitted with
unstable angina who have any one of the conditions
below should have a measurement of LVEF by
echocardiogram, radionuclide scan, or
ventriculogram during their hospitalization or
within 10 days of discharge unless a prior LVEF is
documented in the past year: a history of prior
MI;
2 or more codes for an ECG during
unstable angina hospitalization
(PROC*/CPTCODE = 93000-93010,
8952)
Pass if ECGHOSP=1
NOTE - cannot specify
date/time that ECG
occurred during the
hospitalization
- 177 -
Item Definition
Variable Name Format
Date of unstable
angina admission
IPUSDT*
DATE
History of prior MI
MIHX*
1=yes;0=no
LVEF measured
Eligible for 11d_09A
(admitted for
unstable angina and
has history of AMI)
Pass 11d_09A (LVEF
measured during or
within 10 days after
admission for
unstable angina)
Claims Data Algorithm
NOTES
Earliest date where patient was
admitted for unstable angina
FROMDATE where SITE_CDE=4 and
DIAG1=411.1 and REVCODE/PROC* for
inpatient stay) **FACILITY FILE
ONLY**
History of MI if any MI diagnosis
prior to unstable angina admission
any FROMDATE < IPUSDT* where any
DIAG*=410xx
All CPTCODE or PROC* where:
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
ICD9 codes will only
ICD-9 procedure codes:
be in the PROC* field
8872, 8850-8854
(not CPTCODE field)
Eligible if unstable angina visit
in 2nd year of study, a prior
history of MI and no LVEF
measurement in prior 12 months
LVEF*
DATE(s)
E11d_09A
(IPUSDT*>ELIGBEG+ 12 months) and
1=eligible;0=n MIHX*=1 and (no LVEF* between
IPUSDT*-12months and IPUSDT*-1day)
ot eligible
S11d_09A
1=pass;0=fail
Pass if any LVEF* is on or within
10 days after IPUSDT
- 178 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 11d_9C: Patients admitted with unstable
angina who have any one of the conditions below
should have a measurement of LVEF by
echocardiogram, radionuclide scan, or
ventriculogram during their hospitalization or
within 10 days of discharge unless a prior LVEF is
documented in the past year: cardiomegaly
Date of unstable
angina admission
cardiomegaly
LVEF measured
IPUSDT*
CRDMEG*
LVEF*
DATE
1=yes;0=no
DATE(s)
Earliest date where patient was
admitted for unstable angina
FROMDATE where SITE_CDE=4 and
DIAG1=411.1 and REVCODE/PROC* for
inpatient stay) **FACILITY FILE
ONLY**
Diagnosis of cardiomegaly during
unstable angina admission (Any
DIAG*=429.3 on IPUSDT*)
All CPTCODE or PROC* where:
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
ICD-9 procedure codes:
There are other ICD-9
codes that include
cardiomegaly, but they
have other diagnoses
in them as well:
746.80-congenital
271.0- glycogen
402.90 - hypertensive
ICD9 codes will only
be in the PROC* field
(not CPTCODE field)
- 179 -
Item Definition
Variable Name Format
Claims Data Algorithm
8872, 8850-8854
Eligible if unstable angina visit
in 2nd year of study, cardiomegaly
presentI and no LVEF measurement
in prior 12 months
Eligible for 11d_09C
(admitted for
unstable angina and
has cardiomegaly)
Pass 11d_09C (LVEF
measured within
during the
hospitalization or
within 10 days after
discharge for
unstable angina)
E11d_09C
S11d_09C
(IPUSDT*>ELIGBEG+ 12 months) and
1=eligible;0=n CRDMEG*=1 and (no LVEF* between
IPUSDT*-12months and IPUSDT*-1day)
ot eligible
1=pass;0=fail
Pass if any LVEF* is during the
hospitalization or within 10 days
after discharge (IPUSDT<= any
LVEF*<= THRUDATE+10days)
NOTES
- 180 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR11d_9d: Patients admitted with unstable
angina who have any one of the conditions below
should have a measurement of LVEF by
echocardiogram, radionuclide scan, or
ventriculogram during their hospitalization or
within 10 days of discharge unless a prior LVEF is
documented in the past year: a diagnosis of heart
failure.
Date of unstable
angina admission
Heart failure
diagnosis
LVEF measured
IPUSDT*
HFHOSP*
LVEF*
DATE(s)
1=yes;0=no
DATE(s)
Earliest date where patient was
admitted for unstable angina
FROMDATE where SITE_CDE=4 and
DIAG1=411.1 and REVCODE/PROC* for
inpatient stay) **FACILITY FILE
ONLY**
Diagnosis of heart failure during
unstable angina admission
any DIAG*= 428.xx, 398.91, 402.x1,
404.x1, 404.x3, 425.4x, 425.5x
where FROMDATE=IPUSDT*
All CPTCODE or PROC* where:
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
ICD-9 procedure codes:
8872, 8850-8854
ICD9 codes will only
be in the PROC* field
(not CPTCODE field)
- 181 -
Item Definition
Variable Name Format
Eligible for 11d_09d
(admitted for
unstable angina and
diagnosis of heart
failure)
E11d_09D
Pass 11d_09D (LVEF
measured within 1
year prior or 10 days
after admission for
unstable angina)
S11d_09D
Claims Data Algorithm
Eligible if unstable angina
hospitalization in 2nd year of
study, diagnosis of heart failure
during hospitalization and no LVEF
measurement in prior 12 months
(IPUSDT*>ELIGBEG+ 12 months) and
1=eligible;0=n HFHOSP*=1 and (no LVEF* between
IPUSDT*-12months and IPUSDT*-1day)
ot eligible
1=pass;0=fail
Pass if any LVEF* is during the
hospitalization or within 10 days
after discharge (IPUSDT<= any
LVEF*<= THRUDATE+10days)
INDICATOR 11d_12: Patients hospitalized with an MI
should have an assessment of LVEF prior to
discharge if they have any risk factors for low
LVEF (unless it is noted during hospitalization
that prior to admission LVEF was <=40%).
Admitted for AMI
AMIIP*
DATE(s)
All dates where patient was
admitted for AMI
FROMDATE where SITE_CDE=4 and
DIAG1=410xx and REVCODE/PORC* for
inpatient stay
NOTES
- 182 -
Item Definition
Heart failure
diagnosis
Cardiomegaly
diagnosis
Variable Name Format
Claims Data Algorithm
HFAMI*
Diagnosis of heart failure during
AMI admission
any DIAG*= 428.xx, 398.91, 402.x1,
404.x1, 404.x3, 425.4x, 425.5x
where FROMDATE=AMIIP**
CARAMI*
Pulmonary congestion
or edema diagnosis
LUNG*
Eligible for 11d_12
(admitted for AMI and
has risk for low LVEF
-- HF, cardiomegally,
pulmonary congestion
or edema)
E11d_12
LVEF measured
LVEF*
1=yes;0=no
1=yes;0=no
1=yes;0=no
Diagnosis of cardiomegaly during
AMI admission
any DIAG*=429.3 where
FROMDATE=AMIIP*
Diagnosis of pulmonary congestion
or edema during AMI admission:
any other DIAG*=486, 506.1, 514,
518.4, 518.5
NOTES
There are other ICD-9
codes that include
cardiomegaly, but they
have other diagnoses
in them as well:
746.80-congenital
271.0- glycogen
402.90 - hypertensive
Eligible if admitted for AMI and
has a risk factor for low LVEF
1=eligible;0=f AMIIP*<>NA and (HFAMI*=1 or
CARAMI*=1 or LUNG*=1)
ail
All CPTCODE or PROC* where:
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
DATE(s)
ICD-9 procedure codes:
8872, 8850-8854
ICD9 codes will only
be in the PROC* field
(not CPTCODE field)
- 183 -
Item Definition
Variable Name Format
Pass 11d_12 (LVEF
measured prior to
discharge or noted to
be <= 40%)
S11d_12
1=pass;0=Fail
Claims Data Algorithm
Pass if LVEF measured during
hospitalization
any LVEF*=on ore between AMIIP*
and corresponding discharge data
INDICATOR 11_13: Patients hospitalized with an MI
who have a history of prior MI, but no risk
factors for low LVEF, should have an assessment of
LVEF during the hospitalization or within 2 weeks
of discharge (unless it is noted during
hospitalization that prior to admission LVEF was
<=40%).
All dates where patient was
admitted for AMI
FROMDATE where SITE_CDE=4 and
DIAG1=410xx and REVCODE/PORC* for
inpatient stay
Diagnosis of AMI prior to AMI
admission
Admitted for AMI
AMIIP*
DATE(s)
History of AMI
AMIHX*
1=yes;0=no
any DIAG*=410xx where FROMDATE <
AMIIP*
1=yes;0=no
Diagnosis of heart failure during
AMI admission
any DIAG*= 428.xx, 398.91, 402.x1,
404.x1, 404.x3, 425.4x, 425.5x
where FROMDATE=AMIIP**
Heart failure
diagnosis
HFAMI*
NOTES
- 184 -
Item Definition
Cardiomegaly
diagnosis
Variable Name Format
Claims Data Algorithm
CARAMI*
1=yes;0=no
Diagnosis of cardiomegaly during
AMI admission
any other DIAG*=429.3 where
FROMDATE=AMIIP*
1=yes;0=no
Diagnosis of pulmonary congestion
or edema during AMI admission:
any other DIAG*=486, 506.1, 514,
518.4, 518.5
Pulmonary congestion
or edema diagnosis
LUNG*
Eligible for 11d_13
(admitted for AMI and
has a history of AMI
and no risk factors
for low LVEF -- HF,
cardiomegally,
pulmonary congestion
or edema)
E11d_13
LVEF measured
LVEF*
NOTES
There are other ICD-9
codes that include
cardiomegaly, but they
have other diagnoses
in them as well:
746.80-congenital
271.0- glycogen
402.90 - hypertensive
Eligible if admitted for AMI
during 2nd year of study, have a
history of AMI and no risk factors
for low LVEF
AMIIP*>=(ELIGBEG + 12 months) and
1=eligible;0=n AMIHX*=1 and HFAMI*=0 and
ot eligible
CARAMI*=0 and LUNG*=0
All CPTCODE or PROC* where:
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
DATE(s)
ICD-9 procedure codes:
8872, 8850-8854
ICD9 codes will only
be in the PROC* field
(not CPTCODE field)
- 185 -
Item Definition
Variable Name Format
Pass 11d_13 (LVEF
measured prior to
discharge or within 2
weeks of discharge or
LVEF noted to be <=
40%)
S11d_13
Claims Data Algorithm
Pass if LVEF measured during
hospitalization or within 2 weeks
of discharge
1=pass;0=fail
(AMIIP*<=LVEF*<=THRUDATE of
hospitalization + 2 weeks)
INDICATOR 11d_14: Patients < 75 years old with an
MI should be offered symptom-limited stress
testing or coronary angiography within 8 weeks of
the MI (unless they have contraindications to
revascularization).
Admitted for AMI
AMIIP*
DATE(s)
Discharged for AMI
AMIDCH*
DATE(s)
All dates where patient was
admitted for AMI: FROMDATE where
SITE_CDE=4 and DIAG1=410xx and
REVCODE/PORC* for inpatient stay
Discharge date from AMI
hospitalization
THRUDATE where FROMDATE=AMIIP*
age at MI hospitalization
Age
MIAGE*
continuous
Diagnosis of a
malignancy (CI to
revascularization)
AMIMAL*
1=yes;0=no
AMIIP*-DOB (from enrollment file)
Any diagnosis of malignancy during
or prior to AMI hospitalization
any DIAG*=140-208 where
FROMDATE<=AMIIP*
NOTES
- 186 -
Item Definition
Diagnosis of severe
COPD (CI to
revascularization)
Variable Name Format
AMICOP*
1=yes;0=no
Diagnosis of AIDS (CI
to revascularization) AMIAID*
1=yes;0=no
Diagnosis of hepatic
cirrhosis (CI to
revascularization)
AMICIR*
1=yes;0=no
Stroke within month
prior to reduced LVEF
(CI to
revascularization)
AMISTK*
1=yes;0=no
Digitalis
intoxication (CI to
revascularization)
AMIDIG*
1=yes;0=no
Progressive renal
insufficiency (CI to
revascularization)
AMIREN*
1=yes;0=no
Claims Data Algorithm
Any diagnosis of COPD during AMI
hospitalization any DIAG*=4912x,
492xx, 4932x, 494xx, 495xx, 496xx
where FROMDATE=AMIIP*
Any diagnosis of AIDS during or
prior to the AMI hospitalization
any DIAG*=042 where
FROMDATE<=AMIIP*
Any diagnosis of cirrhosis of
liver during AMI hospitalization
any DIAG*=571.2, 571.5,
571.6=AMIDT*
Any strike/acute CVD during or
within 1 month prior to AMI
hospitalization
any DIAG*=430-436 where ((AMIIP*-1
month) <=FROMDATE <=AMIIP*)
Digitalis intoxication diagnosed
during the AMI hospitalization
any DIAG*=972.1 where
FROMDATE=AMIIP*
Any diagnosis of renal
insufficiency during the
hospitalization any DIAG*=593.9
where FROMDATE=AMIIP*
NOTES
- 187 -
Item Definition
Active
gastrointestinal
bleeding (CI to
revascularization)
Active infection,
sepsis or fever due
to infection (CI to
revascularization)
Variable Name Format
Claims Data Algorithm
AMIGI*
GI bleeding during AMI admission
any other DIAG*=578xx where
FROMDATE=AMIIP*
AMIINF*
Two or more prior
CABS operations (CI
to revascularization) PRICAB*
Eligible for 11d_14
(admitted for AMI,
less than 75 years
and no
contraindications to
revascularization)
E11d_14*
1=yes;0=no
1=yes;0=no
NOTES
I have included ICD9
codes for everything
under the "Other
Bacterial Diseases"
Any bacterial infection during the heading -- probably
overly inclusive and
AMI hospitalization any other
may exclude people
DIAG*=030-041 where
from eligibility
FROMDATE=AMIIP*
Two or more CABS PRIOR to AMI
hospitalization
2 or more FROMDATE<AMIDI* where
PROC*=33510-33514, 33516-33519,
33521-33523, 33533-33536, 361x,
362x
1=yes;0=no
Eligible if less than 75
discharged from AMI
hospitalization at least 8 weeks
prior to ELIGEND and have no CI to
revascualrization:
AMIDCH*<(ELIGEND - 8 weeks) and
AMIAGE<75 and AMIMAL*=0 and
AMICOP*=0 and AMIAID*=0 and
AMICIR*=0 and AMISTK*=0 and
1=eligible;0=f AMIDIG*=0 and AMIREN*=0 and AMIGI*
and AMIINF*=0 and PRICAB*=0
ail
- 188 -
Item Definition
Variable Name Format
Coronary angiography
performed
ANGIOG*
1=yes;0=no
Claims Data Algorithm
NOTES
Coronary catheterization performed
during AMI hospitalization or
within 8 weeks after discharge
from doctor or facility: any
PROC* or CPTCODE=93501-93561 where
(AMIDT*<=
FROMDATE<=AMIDCH*+8weeks) OR
from facility file: any PROC*
=3721-3723 where (AMIDT*<=
FROMDATE<=AMIDCH*+8weeks)
Stress test performed during AMI
hospitalization or within 8 weeks
after discharge from doctor or
facility: any PROC* or
CPTCODE=93015-93018, 93024 where
(AMIDT*<=
FROMDATE<=AMIDCH*+8weeks) OR
from facility file: any PROC* =
8941-8944 where (AMIDT*<=
FROMDATE<=AMIDCH*+8weeks)
Pass if coronary angiography or
stress test performed during AMI
hospitalization or within 8 weeks
post discharge
Stress test performed STRTST*
1=yes;0=no
Pass 11d 14 (coronary
angiography or stress
test offered within 8
weeks for MI)
S11d_14*
1=pass; 0=fail ANGIOG*=1 or STRTST*=1
- 189 -
DIABETES
Item Definition
Variable Name Format
Identifying Diabetics
Claims Data Algorithm
Diagnosis and encounter/revenue
codes are listed in the 3 rows
below to define a flag for
diabetics.
Flag for diagnosis of
diabetes
DIABFL
Diagnosis of Type 1
or Type 2 diabetes
1=yes; 0=no
Set flag to 1 if:
(1) diagnosis of diabetes coded on
at least 2 DIFFERENT dates of
service in an ambulatory setting
or non-acute inpatient setting
OR
(2) diagnosis of diabetes on at
least 1 face-to-face encounter in
an acute inpatient or emergency
room setting
Any of the following ICD-9
diagnosis codes - DIAG*:
250.xx= diabetes mellitus
357.2x= neuropathy in diabetes
362.0x= diabetic retinopathy
366.41= diabetic cataract
Exclude if :
648.8x= gestational diabetes
NOTES
- 190 -
Item Definition
Variable Name Format
Encounter in an
ambulatory setting or
non-acute inpatient
setting
Acute inpatient/ER
encounter
INDICATOR 13_02A: Patients with the diagnosis of
Type 1/Type 2 diabetes should have all of the
following:
a. Glycosylated hemoglobin or fructosamine every
6 months.
Claims Data Algorithm
Revenue codes (REVCODE) on date
where diagnosis (see above codes)
was for diabetes:
49X-53X, 55X-59X, 65X, 66X, 76X,
82X-85X, 88X, 92X, 94X, 96X, 972979, 982-986, 988, 989
OR
CPT codes: 92002-92014, 9920199205, 99211-99215, 99217-99220,
99241-99245, 99271-99275, 9930199303, 99311-99333, 99341-99355,
99381-99387, 99391-99397, 9940199404, 99411, 99412, 99420-99429,
99499
Revenue codes (REVCODE):
10X-16X, 20X-22X, 45X, 72X, 80X,
981, 987
OR
CPT codes: 99221-99223, 9923199233, 99238-99239, 99251-99255,
99261-99263, 99281-99288, 9929199292, 99356-99357
NOTES
- 191 -
Item Definition
Eligible for 13_02A
(diagnosis of Type
1/Type 2 diabetes)
Dates of glycosylated
hemoglobin or
fructosamine tests
Pass 13_02A
(Glycosylated
hemoglobin or
fructosamine tested
every 6 months)
Variable Name Format
Claims Data Algorithm
E13_02A
1=yes;0=no
DIABFL =1
DIABBLD
DATE
All FROMDATE where CPTCODE or
PROC* =83036
S13_02A
1=yes;0=no
At least 3 HbA1c tests (DIABBLD)
90 days apart
INDICATOR 13_02B: Patients with the diagnosis of
Type 1 or Type 2 diabetes should have all of the
following:
b. Eye and visual exam (annual).
Eligible for 13_02B
(diagnosis of Type 1
or Type 2 diabetes)
E13_02B
1=yes; 0=no
Eligible if DIABFL=1
NOTES
- 192 -
Item Definition
Variable Name Format
Dates of eye exam
DIAEYE
Pass 13_02B (2 eye
exams during 2 year
study period at least
180 days apart)
S13_02B
DATE
Claims Data Algorithm
NOTES
Using physician claims, dates
where:
provider type is optometrist or
ophthalmologist (PRV_TYP = 08 or
22)
AND
(one of the following CPT codes
for an eye exam:
67101, 67105, 67107-67110, 67112,
67141, 67145,
67208,67210,67218,67227,67228,9200
2,92004,92012,92014,92018,92019,92
225,92226,92230,
92235,92240,92250,92260,92287,
99204, 99205, 99214, 99215, 9924299245 OR
one of the following ICD proc
codes:
14.1x-14.5x, 14.9x, 95.02-95.04,
95.11, 95.12, 95.16)
1=yes; 0=no
Yes if at least 2 eye exams
(DIAEYE) 180 days apart
INDICATOR 13_02C: Patients with the diagnosis of
Type 1 or Type 2 diabetes should have all of the
following:
c. Total serum cholesterol and HDL cholesterol
tests documented.
- 193 -
Item Definition
Variable Name Format
Eligible for 13_02C
(diagnosis of Type 1
or Type 2 diabetes)
E13_02C
1=yes; 0=no
Any serum cholesterol
test performed
SERCHODT
1=yes; 0=no
HDL cholesterol test HDLCHODT
Pass 13_02C (Total
serum cholesterol and
HDL cholesterol tests
documented)
S13_02C
1=yes; 0=no
Eligible if DIABFL=1
Yes if any CPTCODE or PROC* =
80061, 82465
Yes if any CPTCODE or PROC* =
80061, 83716, 83718
1=yes; 0=no
Yes if at least 1 total
(SERCHODT=1) and HDL cholesterol
test (HDLCHODT=1)
INDICATOR 13_02D: Patients with the diagnosis of
Type 1 or Type 2 diabetes should have all of the
following:
d. Measurement of urine protein (annual)
documented.
Eligible for 13_02D
(diagnosis of Type 1
or Type 2 diabetes)
E13_02D
1=yes;0=no
Dates of urine
protein test
Pass 13_02D (annual
measurement of urine
protein)
Claims Data Algorithm
Eligible if DIABFL=1
URNPROT
DATE
FROMDATE where CPTCODE or PROC* =
81000-81003, 82042, 82043, 82044
S13_02D
1=yes;0=no
Pass if 2 or more urine protein
tests at least 180 days apart
NOTES
- 194 -
Item Definition
Variable Name Format
Claims Data Algorithm
NOTES
INDICATOR 13_08: Diabetics with proteinuria should
be offered an ACE inhibitor within 3 months of the
notation of proteinuria unless contraindicated.
Diagnosis of
Earliest FROMDATE where any
proteinuria
PROTEIN
DATE
DIAG*=791.0
Eligible for 13_08
Eligible if any proteinuria
(diabetic with
diagnosis (PROTEIN<>NA) AND DIABFL
proteinuria)
E13_08
1=yes;0=no
=1
Prescription for ACE
inhibitor ordered
within 3 months on or
after diagnosis of
proteinuria
ACERX
Pass 13_08 (ACE
inhibitor offered
within 3 months of
proteinuria)
S13_08
1=yes;0=no
List of NDCs for Ace
Inhibitors was derived
from the Multum d_norm
table, taking all oral
medications where
active ingredient =
benazepril, captopril,
enalapril, fosinopril,
Any FILLDATE within 3 months on or irbesartan, lisinopril,
after PROTEIN with NDCCODE= code
losartan, moexipril,
from ACE Inhibitors file & listed quinapril, ramipril,
after the diabetes claims
telmisartan,
specifications
trandolapril, valsartan
1=yes;0=no
Pass if ACERX=1
INDICATOR 13_09: All patients with diabetes should
have a follow-up visit at least every 6 months.
- 195 -
Item Definition
Eligible for 13_09
(diabetic)
Variable Name Format
Claims Data Algorithm
E13_09
1=yes; 0=no
Eligible if DIABFL=1
At least 2 outpatient visits per
year (1998 and 1999) >= 90+ days
apart:
FROMDATE where CPTCODE = 9920299215, 99241-99245
1=yes; 0=no
Pass if DIABETFU=1
Follow-up visit for
diabetes
DIABETFU
Pass 13_09 (follow-up
visit for diabetes
every 6 months)
S13_09
1=yes; 0=no
NOTES
- 196 -
HEART FAILURE
Item Definition
Variable
Name
Format
Claims Data Algorithm
NOTES
Earliest FROMDATE with a
diagnosis for heart failure where
encounter was outpatient, er or
inpatient.
(1) any DIAG* = 428.xx, 398.91,
402.x1, 404.x1, 404.x3, 425.4x,
425.5x
AND
(2)REVCODE: 49x, 50x, 51x, 52x,
53x, 55x, 56x, 57x, 58x, 59x,
65x, 66x, 76x, 82x, 83x, 84x,
85x, 88x, 92x, 94x, 96x, 972,
973, 974, 975, 976, 977, 978,
979, 982, 983, 984, 985, 986,
988, 989, 10x, 11x, 12x, 13x,
14x, 15x, 16x, 20x, 21x, 22x,
45x, 72x, 80x, 981, 987
First heart failure
contact
FSTCHFDX
DATE
Heart failure diagnosis
codes (DIAG*):
428.xx - heart failure
398.91 - rheumatic
heart failure
402.x1 - hypertensive
heart renal disease w/
CHF
CPT: 99201-99205, 99211-99215,
404.x1 - hypertensive
99217-99220, 99241-99245, 99271- heart and renal disease
99275, 99354-99355, 99381-99387, w/ CHF
99391-99397, 99401-99404, 99411- 404.x3 - hypertensive
99412, 99420-99429, 99341-99343, heart and renal disease
99351-99353, 99499, 92002-92014, w/ CHF and renal
99301-99303, 99311-99313, 99321- failure
99323, 99331-99333, 99221-99223, 425.4x - other primary
99231-99233, 99238-99239, 99251- cardiomyopathies
99255, 99261-99263, 99291-99292, 425.5x - alcoholic
99281-99288, 99356-99357
cardiomopathy
- 197 -
Variable
Name
Item Definition
New diagnosis of heart
failure (used for
multiple indicators)
NEWCHFDX
Hospital admission for
heart failure (used for
multiple indicators)
HFHOSP*
INDICATOR 17_01:
heart failure who
should receive an
fraction within 1
Format
DATE
DATE(s)
Array
Patients newly diagnosed with
are beginning medical treatment
evaluation of their ejection
month of the start of treatment.
Claims Data Algorithm
New CHF diagnosis is the fist CHF
contact in the study, if the
first contact is in the 2nd year
of the study (if patient has
contact in 1st year for heart
failure, consdiered to be a
prevalent,not incident, case of
heart failure)
NEWCHFDX=FSTCHFDX if
FSTCHFDX>ELIGBEG+12 months, else
NEWCHFDX=NA
All hosptializations with a
primary diagnosis of heart
failure:
All FROMDATE where:
(a) DIAG1 = 428.xx, 398.91,
402.x1, 404.x1, 404.x1, 404.x3,
425.4x, 425.5x
AND
(b) SITE_CDE=4
NOTES
There are no specific
ICD-9 codes to identify
new diagnoses, will
therefore proxy "new"
diagnosis by
identifying patients
with a heart failure
code in the 1999, but
no heart failure code
in 1998.
- 198 -
Item Definition
Variable
Name
Prescription for heart
failure medications
(diuretics, ace
inhibitors, hydralazine,
nitrates, digoxin)
CHFRX
Format
DATE
Claims Data Algorithm
NOTES
The medication was
derived using the
Multum d_norm table
selecting oral
medications with the
following active
ingredients:
DIURETICS: amiloride,
bendroflumethiazide,
benzthiazide,
bumetanide,
cholorothiazide,
chlorthalidone,
dichlorphenamide,
ethacrynic acid,
furosemide,
hydrochlorothiazide,
hydroflumethiazide,
methyclothiazide,
Earliest FILLDATE after the
metolazone,
diagnosis of heart failure
polythiazide,
(NEWCHFDX) where the
NDCCODE=entry on CHFRX list found spironolactone,
torsemide, triamterene,
at the end of the heart failure
trichlormethiazide
specifications
- 199 -
Item Definition
Variable
Name
Eligible for 17_01 (new
diagnosis of heart
failure and started on
medication)
E17_01
Format
1=yes;0=no
Claims Data Algorithm
Eligible if new diagnosis of
heart failure in 1999
(NEWCHFDX<>NA) and treatment
initiated within 6 months after
diagnosis but at least 1 month
prior to the end of the study[
(CHFRX <= (NEWCHFDX + 6 months))
and (CHFRX <= 12/1/1999)]
NOTES
CHFRX meds continued.
Hydralazine, Digitoxin,
Digoxin
NITRATES (all routes):
amyl nitrate,
isosorbide,
nitroglycerin
ACE INHIBITORS:
benazepril, captopril,
enalapril, fosinopril,
irbesartan, lisinopril,
losartan, moexipril,
quinapril, ramipril,
telmisartan,
trandolapril, valsartan
- 200 -
Item Definition
Variable
Name
Measurement of ejection
fraction by
echocardiogram,
radionuclide test or
coronary angiogram
EFMEAS
Pass 17_01 (Measurement
of ejection fraction
within one month prior
to initiation of
medication)
S17_01
Format
Claims Data Algorithm
Any CPTCODE or PROC* for
measurement of echocardiogram
between 3 months prior to and 1
month after the initiation of
treatment (CHFRX).
CPT codes are:
78414, 78459-78472, 78478-78481,
78491-78496, 93303-93325, 9350193572
1=yes;0=no
ICD-9 procedure codes:
8872, 8850-8854
1=yes;0=no
Pass if EFMEAS=1
INDICATOR 17_04A: Patients with a new diagnosis
of heart failure should be offered all of the
following studies within 1 month of the diagnosis
(unless performed within the prior 3 months):
Chest x-ray;
Eligible for 17 04A (new
diagnosis of heart
failure)
E17_04A
1=yes; 0=no
Eligible if new diagnosis of
heart failure is 1 month prior to
the end of the study period
(NEWCHFDX<= 12/1/1999)
NOTES
- 201 -
Item Definition
Variable
Name
Format
Claims Data Algorithm
NOTES
Any CPTCODE or PROC* for chest xray between 3 months prior to and
1 month after diagnosis of heart
failure (NEWCHFDX).
CPT codes are:
71010-71035
Chest x-ray performed
CHSTPERF 1=yes; 0=no
Pass 17_04A (patient
offered chest x-ray
within 1 month prior to
or 3 months after
diagnosis of heart
failure)
S17_04A 1=yes; 0=no
ICD-9 procedure codes are:
8744, 8749
Pass if CHSTPERF=1
INDICATOR 17_04B: Patients with a new diagnosis
of heart failure should be offered all of the
following studies within 1 month of the diagnosis
(unless performed within the prior 3 months): EKG;
Eligible for 17 04B (new
diagnosis of heart
failure)
E17_04B
1=yes; 0=no
Eligible if new diagnosis of
heart failure is 1 month prior to
the end of the study period
(NEWCHFDX<= 12/1/1999)
- 202 -
Item Definition
Variable
Name
Format
Claims Data Algorithm
Any CPTCODE or PROC* for EKG
between 3 months prior to and 1
month after the diagnosis of
heart failure (NEWCHFDX).
CPT codes are:
93000-93024, 93224-93237
EKG performed
Pass 17_04B (patient
offered EKG within 1
month prior to or 3
months after diagnosis
of heart failure)
EKGPERF
1=yes; 0=no
ICD-9 procedure codes are:
8951-8954
S17_04B
1=yes; 0=no
Pass if EKGPERF=1
INDICATOR 17_04C: Patients with a new diagnosis
of heart failure should be offered all of the
following studies within 1 month of the diagnosis
(unless performed within the prior 3 months):
Complete blood count;
Eligible for 17 04C (new
diagnosis of heart
failure)
E17_04C
1=yes; 0=no
Eligible if new diagnosis of
heart failure is 1 month prior to
the end of the study period
(NEWCHFDX<= 12/1/1999)
NOTES
- 203 -
Item Definition
Complete blood count
performed
Pass 17_04C (patient
offered CBC within 1
month prior to or 3
months after diagnosis
of heart failure)
Variable
Name
Format
Claims Data Algorithm
NOTES
Any CPTCODE or PROC* for complete
blood count between 3 months
prior to and 1 month after
diagnosis of heart failure
(NEWCHFDX).
CBCPERF
1=yes; 0=no
CPT codes are:
85022-85025
S17_04C
1=yes; 0=no
Pass if CBCPERF=1
INDICATOR 17_04D: Patients with a new diagnosis
of heart failure should be offered all of the
following studies within 1 month of the diagnosis
(unless performed within the prior 3 months):
Serum sodium, potassium, and bicarbonate;
Eligible for 17 04D (new
diagnosis of heart
failure)
E17_04D
1=yes; 0=no
Eligible if new diagnosis of
heart failure is 1 month prior to
the end of the study period
(NEWCHFDX<= 12/1/1999)
- 204 -
Item Definition
Variable
Name
Format
Serum sodium, potassium,
and bicarbonate
performed
ELCTPERF 1=yes; 0=no
Pass 17_04D (patient
offered measurement of
serum sodium, potassium,
and bicarbonate within 1
month prior to or 3
months after diagnosis
of heart failure)
S17_04D 1=yes; 0=no
Claims Data Algorithm
Any CPTCODE or PROC* for
electrolyte panel or individual
chemistries for sodium,
potassium, and bicarbonate
between 3 months prior to and 1
month after diagnosis of heart
failure (NEWCHFDX)
CPT codes are:
80048 or 80050 or 80051 or
80053 or 80069 or (84295 & 84132
& 82374) or G0096 or G0097 or
G0098
Pass if ELCTPERF=1
INDICATOR 17_04E: Patients with a new diagnosis
of heart failure should be offered all of the
following studies within 1 month of the diagnosis
(unless performed within the prior 3 months):
Serum creatinine.
Eligible for 17 04E (new
diagnosis of heart
failure)
E17_04E
1=yes; 0=no
Eligible if new diagnosis of
heart failure is 1 month prior to
the end of the study period
(NEWCHFDX<= 12/1/1999)
NOTES
- 205 -
Item Definition
Variable
Name
Format
Serum creatinine tested CRETPERF 1=yes; 0=no
Pass 17_04E (patient
offered measurement of
serum creatinine within
1 month prior to or 3
months after diagnosis
of heart failure)
S17_04E 1=yes; 0=no
INDICATOR 17_07A: Patients who are hospitalized
for heart failure should have the following
performed within one day of hospitalization:
Serum electrolytes; and
Eligible for 17_07A
(admission for symptoms
1=yes;0=no
of heart failure)
E17_07A* array
Serum electrolytes
measured
ELECIP*
1=yes;0=no
array
Claims Data Algorithm
NOTES
Any CPTCODE or PROC* for serum
creatinine between 3 months prior
to and 1 month after diagnosis of
heart failure (NEWCHFDX).
CPT codes are:
80048, 80050, 80083, 80069,
G0096, G0098
Pass if CRETPERF=1
Eligible if HFHOSP*<>NA
Any CPTCODE or PROC* for serum
electrolytes during
hospitalization for heart failure
(HFHOSP*)
CPT codes are:
80048, 80050, 80051, 80053,
80069, G0096, G0097, G0098
- 206 -
Item Definition
Pass 17_07A (serum
electrolytes measured
within one day of
hospitalization)
Variable
Name
Format
1=yes;0=no
S17_07A* array
Claims Data Algorithm
Pass if ELECTRO=1
INDICATOR 17_07B: Patients who are hospitalized
for heart failure should have the following
performed within one day of hospitalization: Serum
creatinine.
Eligible for 17_07B
(admission for symptoms
1=yes;0=no
of heart failure)
E17_07B* array
Eligible if HFHOSP*<>NA
Any CPTCODE or PROC* for serum
creatinine during hospitalization
for heart failure (HFHOSP).
1=yes;0=no
array
Serum creatinine tested CRETIP*
Pass 17_07B (serum
electrolytes measured
within one day of
1=yes;0=no
hospitalization)
S17_07B* array
INDICATOR 17_09A: Patients with the diagnosis of
heart failure who are on an ACE inhibitor should
have the following checked every year:
Serum potassium;
CPT codes are:
80048, 80050, 80083, 80069,
G0096, G0098
Pass if CRETIP*=1
NOTES
- 207 -
Item Definition
Variable
Name
Patient on ACEI
ACEIRX
1=yes;0=no
Eligible for 17_09A
(diagnosis of heart
failure and on ACEI)
E17_08A
1=yes;0=no
Serum potassium measured
during first 13 months
of study
POTAS
Pass 17_09A (Serum
potassium measured at
least once a year)
S17_08A
Format
Claims Data Algorithm
NOTES
List of NDCs for Ace
Inhibitors was derived
from the Multum d_norm
table, taking all oral
medications where
active ingredient =
benazepril, captopril,
2 or more filled prescriptions
enalapril, fosinopril,
for ACE Inhibitors during 1998
(2+ FILLDATE where NDCCODE is for irbesartan, lisinopril,
ACEI)
losartan, moexipril,
quinapril, ramipril,
List of ACE Inhibitors at end of telmisartan,
heart failure specifications
trandolapril, valsartan
Eligible if contact for CHF in
1st year of study (FSTCHFDX <=
ELIGBEG+12 months) and at least
2 ACEI prescription during 1st
year of study (ACEIRX=1)
Any CPTCODE or PROC* for serum
potassium between 1/1/1998 and
1/31/1999.
1=yes;0=no
CPT codes are:
80048 or 80050 or 80051 or
80053 or 80069 or (84295 & 84132
& 82374) or G0096 or G0097 or
G0098
1=yes;0=no
Pass if POTAS=1
- 208 -
Item Definition
Variable
Name
Format
Claims Data Algorithm
NOTES
INDICATOR 17_09B: Patients with the diagnosis of
heart failure who are on an ACE inhibitor should
have the following checked every year: Serum
creatinine
Prescription for ACEI
filled
ACEIRX
1=yes;0=no
Eligible for 17_08B
(diagnosis of heart
failure and on ACEI)
E17_09B
1=yes;0=no
Serum creatinine tested CRETPERF 1=yes;0=no
Pass 17_08B (Serum
creatinine measured at
S17_09B 1=yes;0=no
List of NDCs for Ace
Inhibitors was derived
from the Multum d_norm
table, taking all oral
medications where
active ingredient =
2 or more filled prescriptions
benazepril, captopril,
for ACE Inhibitors during 1998
(2+ FILLDATE where NDCCODE is for enalapril, fosinopril,
irbesartan, lisinopril,
ACEI)
losartan, moexipril,
See separate SAS file for list of quinapril, ramipril,
ACE Inhibitors (same list as used telmisartan,
for the diabetes measure)
trandolapril, valsartan
Eligible if contact for CHF in
1st year of study (FSTCHFDX <=
ELIGBEG+12 months) and at least
2 ACEI prescription during 1st
year of study (ACEIRX=1)
Any CPTCODE or PROC* for serum
creatinine between 1/1/1998 and
1/31/1999
CPT codes are:
80048, 80050, 80083, 80069,
G0096, G0098
Pass if CRETPERF=1
- 209 -
Item Definition
least once a year)
Variable
Name
Format
Claims Data Algorithm
NOTES
INDICATOR 17_12: Patients who have been
hospitalized for heart failure should have followup contact within 4 weeks of discharge.
Discharge date for heart
DATE(s)
Maximum THRUDATE associated with
failure admission
HFDSCH* array
heart failure hospitalization
Eligible if hospitalized for
heart failure and discharged
Eligible for 17_12
prior to 12/1/1999. (HFHOSP*<>NA
(admitted for heart
1=yes;0=no
AND HFDSCH*<12/1/1999)
failure)
E17_11* array
An outpatient visit within 4
weeks of discharge.
FROMDATE where CPTCODE=
99205,
99211-99215,
99217-99220,
99241-99245,
99271-99275,
99354-99355,
99381-99387,
99391-99397,
99401-99404,
99411-99412,
99420-99429
Follow-up for heart
failure
CHFFU*
1=yes;0=no
array
99201-
and (HFDSCH* < FROMDATE <=
HFDSCH* + 4 weeks)
- 210 -
Variable
Item Definition
Name
Format
Pass 17_12 (follow-up
visit for heart failure
within 1 month of
1=yes;0=no
discharge)
S17_12
array
Claims Data Algorithm
Pass if CHFFU*=1
NOTES
- 211 -
PNEUMONIA
Item Definition
Variable Name
Format
Claims Data Algorithm
NOTES
- 212 -
Item Definition
Variable Name
Format
INDICATOR 09_05: Patients over 65 years of age
or with coexisting illness, and a diagnosis of
pneumonia should receive the following blood
tests on the day of presentation:
a. WBC
b. BUN or Creatinine
New diagnosis of
pneumonia in outpatient
setting (community
acquired)
PNEUDX*
Date
Face-to-face encounter
in an ambulatory
setting or ER setting
Age at time of pnemonia
diagnosis
PNEUAGE*
countinous
Claims Data Algorithm
All dates on which the
patient presented to the
office or ER with a primary
diagnosis of pneumonia (all
FROMDATE where any DIAG*=
480-486, 487.0 and SITE CDE
<> 4)
Revenue codes (REVCODE):
45X, 49X-53X, 55X-59X, 65X,
66X, 76X, 82X-85X, 88X,
92X, 94X, 96X, 972-979,
981, 982-986, 988, 989
OR
CPT codes: 92002-92014,
99201-99205, 99211-99215,
99217-99220, 99241-99245,
99271-99275, 99301-99303,
99311-99333, 99341-99355,
99381-99387, 99391-99397,
99401-99404, 99411, 99412,
99420-99429, 99499
Age at time of pnemonia
diagnosis (PNEUDX* - DOB)
NOTES
Did not include
hospitalizations b/c may be
hard to distinguish
community acquired versus
nosocomial infection
- 213 -
Item Definition
Variable Name
Format
Dx of lung problems on
or prior to pneumonia
diagnosis
LUNGDX*
1=yes;0=no
Diagnosis of heart
problems on or prior to
pneumonia diagnosis
HEARTDX*
1=yes;0=no
Diagnosis of renal
problems on or prior to
pneumonia diagnosis
RENALDX*
1=yes;0=no
Diagnosis of diabetes
on or prior to
pneumonia diagnosis
1=yes;0=no
DIABETDX*
Claims Data Algorithm
Dx of lung problems on or
prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 490496, 500-508, 510-519)
Diagnosis of heart problems
on or prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 410414.9, 415-417.9, 420429.9)
Diagnosis of renal problems
on or prior to pneumonia
diagnosis ((any FROMDATE
<=PNEUDX* where (DIAG* =
580-589.9, 590-593.9 or
PROC* = 90918-90937)) OR
(any CPTDATE,=PNEUDX*
where CPTCODE = 9091890937))
Diagnosis of diabetes on or
prior to pneumonia
diagnosis (any FROMDATE
<=PNEUDX* where DIAG* =
250,357.2,362.0,366.41,648.
0)
NOTES
- 214 -
Item Definition
Immune dysfunction on
or prior to pneumonia
diagnosis
Variable Name
IMMUNEDX*
Eligible for 09 05 (new
diagnosis of community
acquired pneumonia and
over 65 years or with
coexisting disease)
E09_05
Format
1=yes;0=no
1=yes;0=no
Claims Data Algorithm
NOTES
Code Key:
· AIDS - Acquired immune
deficiency syndrome - 042
· Asplenia, Anatomic or
functional Asplenia 759.0,
746.87
· DiGeorge's syndrome
(thymic hypoplasia) 279.11
· Congenital
immunodeficiency 279
· Sickle cell anemia 282.6
Cancer 140-208
· Organ or bone marrow
Immune dysfunction on or
transplantation 38240-38241,
prior to pneumonia
33945, 33935, 47135, 47136,
diagnosis (any FROMDATE
32850-32852, 48160, 48550,
<=PNEUDX* where (DIAG* =
48554, 48556, 50360, 50365,
042, 759.0, 746.87,
50380
279.11, 279, 282.6, 140208) OR (PROC*=38240-38241, · Immunosuppressive therapy
33945, 33935, 47135, 47136, · Current therapy with
32850-32852, 48160, 48550, alkylating agents,
48554, 48556, 50360, 50365, antimetabolites, and
radiation 77520-77523,
50380,77520-77523, 7740277406, 77401, 77412-77416, 77402-77406, 77401, 7741277416, 77407-77411, 77427
77407-77411, 77427)
Eligible if a diagnosis of
pneumonia without a
diagnosis of pneumonia in
the previous 4 months
(PNEUVS* <> NA)
AND
the patient is over 65
(PNEUAGE* >65) OR the
- 215 -
Item Definition
WBC performed
Variable Name
PNEUWBC*
BUN or creatinine
performed
PNEUBUN*
Pass 09_05A (WBC
performed on day of
pneumonia presentation) S09_05A
Pass 09_05B (BUN or
creatinine lab
performed on day of
pneumonia presentation) S09_05B
Format
Claims Data Algorithm
patient has a coexisting
illness (LUNGDX*=1 or
HEARTDX*=1 or RENALDX*=1 or
DIABETDX*=1 or IMMUNEDX*=1)
1=yes;0=no
WBC performed ((all
FROMDATE where PROC*=
85007, 85009, 85021, 85022,
85023, 85024, 85025, 85031,
85048) and (all CPTDATE
where CPTCODE = 85007,
85009, 85021, 85022, 85023,
85024, 85025, 85031, 85048)
BUN or creatinine performed
((all FROMDATE where
PROC*=84520-84525, 82565)
and (all CPTDATE where
CPTCODE = 84520-84525,
82565))
Pass if (any PNEUWBC* =
PNEUVS*) AND (any
PNEUBUN*=PNEUVS*)
1=yes;0=no
Pass if (any PNEUWBC* =
PNEUVS*) AND (any
PNEUBUN*=PNEUVS*)
Date
Date
NOTES
- 216 -
Item Definition
Variable Name
Format
Claims Data Algorithm
NOTES
INDICATOR 09_08: Non-hospitalized persons <= 65
years of age diagnosed with pneumonia without a
known bacteriologic etiology and without
coexisting illness should be offered an oral
empiric macrolide, unless allergic.
New diagnosis of
pneumonia in outpatient
setting (community
acquired)
PNEUDX*
Face-to-face encounter
in an ambulatory
setting or ER setting
Date
All dates on which the
patient presented to the
office or ER with a primary
diagnosis of pneumonia (all
FROMDATE where any DIAG*=
480-486, 487.0 and SITE CDE
<> 4)
Revenue codes (REVCODE):
45X, 49X-54X, 55X-59X, 65X,
66X, 76X, 82X-85X, 88X,
92X, 94X, 96X, 972-979,
981, 982-986, 988, 989
OR
CPT codes: 92002-92014,
99201-99205, 99211-99215,
99217-99220, 99241-99245,
99217-99220, 99241-99245,
99271-99275, 99301-99303,
99311-99333, 99341-99355,
99381-99387, 99391-99397,
99401-99404, 99411, 99412,
Did not include
hospitalizations b/c may be
hard to distinguish
community acquired versus
nosocomial
- 217 -
Item Definition
Variable Name
Format
Pneumonia without a
known bacteriologic
etiology
PNEUBA*
1=yes;0=no
Hospitalized for
pneumonia
IPPNEU*
Date
Age at time of pnemonia
diagnosis
PNEUAGE*
countinous
Dx of lung problems on
or prior to pneumonia
diagnosis
LUNGDX*
1=yes;0=no
Diagnosis of heart
problems on or prior to
pneumonia diagnosis
HEARTDX*
1=yes;0=no
Claims Data Algorithm
99420-99429, 99499
Yes if DIAG1 on PNEUDX* =
480, 481, 485, 486, 487.1
All dates on which the
patient was hospitalized
with a diagnosis of
pneumonia (all FROMDATE
where DIAG*= 480-486 and
SITE_CDE = 4)
Age at time of pnemonia
diagnosis (PNEUDX* - DOB)
Dx of lung problems on or
prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 490496, 500-508, 510-519)
Diagnosis of heart problems
on or prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 410414.9, 415-417.9, 420-
NOTES
- 218 -
Item Definition
Variable Name
Format
Diagnosis of renal
problems on or prior to
pneumonia diagnosis
RENALDX*
1=yes;0=no
Diagnosis of diabetes
on or prior to
pneumonia diagnosis
1=yes;0=no
DIABETDX*
Claims Data Algorithm
429.9)
Diagnosis of renal problems
on or prior to pneumonia
diagnosis ((any FROMDATE
<=PNEUDX* where (DIAG* =
580-589.9, 590-593.9 or
PROC* = 90918-90937)) OR
(any CPTDATE,=PNEUDX*
where CPTCODE = 9091890937))
Diagnosis of diabetes on or
prior to pneumonia
diagnosis (any FROMDATE
<=PNEUDX* where DIAG* =
250,357.2,362.0,366.41,648.
0)
NOTES
- 219 -
Item Definition
Immune dysfunction on
or prior to pneumonia
diagnosis
Variable Name
IMMUNEDX*
Format
1=yes;0=no
Claims Data Algorithm
NOTES
Code Key:
· AIDS - Acquired immune
deficiency syndrome - 042
· Asplenia, Anatomic or
functional Asplenia 759.0,
746.87
· DiGeorge's syndrome
(thymic hypoplasia) 279.11
· Congenital
immunodeficiency 279
· Sickle cell anemia 282.6
Cancer 140-208
· Organ or bone marrow
Immune dysfunction on or
transplantation 38240-38241,
prior to pneumonia
33945, 33935, 47135, 47136,
diagnosis (any FROMDATE
32850-32852, 48160, 48550,
<=PNEUDX* where (DIAG* =
48554, 48556, 50360, 50365,
042, 759.0, 746.87,
50380
279.11, 279, 282.6, 140208) OR (PROC*=38240-38241, · Immunosuppressive therapy
33945, 33935, 47135, 47136, · Current therapy with
32850-32852, 48160, 48550, alkylating agents,
48554, 48556, 50360, 50365, antimetabolites, and
radiation 77520-77523,
50380,77520-77523, 7740277406, 77401, 77412-77416, 77402-77406, 77401, 7741277416, 77407-77411, 77427
77407-77411, 77427)
- 220 -
Item Definition
Variable Name
Eligible for 09 08 (new
diagnosis of pneumonia
and 65 years or younger
without a known
bacteriologic etiology
and without coexisting
illness treated in an
outpatient setting)
E09_08
Empiric oral macrolide
ordered
RXMACRO
Format
1=yes;0=no
Claims Data Algorithm
Eligible if a diagnosis of
pneumonia of unknown
bacteriologic etiology in
outpatient setting (PNEUVS*
<> NA and PNEUBA*=1)
without a diagnosis of
pneumonia in the previous 4
months and without a
hospitalization of
pneumonia within the month
prior to or after the
outpatient diagnosis of
pneumonia (no IPPNEU*
within =/- 1 omnth of
PNEUVS*)
AND
the patient is 65 or
younger (PNEUAGE* <= 65)
AND
the patient does not have a
coexisting illness
(LUNGDX*=0 or HEARTDX*=0 or
RENALDX*=0 or DIABETDX*=0
or IMMUNEDX*=0)
NOTES
Date
The list of macrolides was
derived from the Multum
ndc_dnorm table; The list
was limited to route=oral;
All FILLDATE where NDCCODE took all with active
ingredients of :
= code from MACROLIDE
worksheet (see list of NDCs amoxicillin, azithromycin,
at the end of the pneumonia clarithromycin, clindamycin,
data specifications)
dirithromycin, erythromycin,
- 221 -
Item Definition
Variable Name
Pass 09_08 ( offered
oral empiric macrolide) S09_08
Format
1=yes;0=no
INDICATOR 09_09: Non-hospitalized persons > 65
years of age diagnosed with pneumonia without a
known bacteriologic etiology and with coexisting
illnesses should be offered one of the following
oral empiric antibiotic regimens:
- a second generation cephalosporin;
- trimethoprim-sulfamethoxazole; or
- a beta-lactam/beta-lactamase inhibitor
combination
Claims Data Algorithm
Pass if any RXMACRO* within
2 days on or after PNEUVS*
NOTES
lincomycin, troleandomycin
- 222 -
Item Definition
Variable Name
Format
New diagnosis of
pneumonia in outpatient
setting (community
acquired)
PNEUDX*
Date
Face-to-face encounter
in an ambulatory
setting or ER setting
Pneumonia without a
known bacteriologic
etiology
PNEUBA*
1=yes;0=no
Hospitalized for
pneumonia
Date
IPPNEU*
Claims Data Algorithm
All dates on which the
patient presented to the
office or ER with a primary
diagnosis of pneumonia (all
FROMDATE where any DIAG*=
480-486, 487.0 and SITE CDE
<> 4)
Revenue codes (REVCODE):
45X, 49X-54X, 55X-59X, 65X,
66X, 76X, 82X-85X, 88X,
92X, 94X, 96X, 972-979,
981, 982-986, 988, 989
OR
CPT codes: 92002-92014,
99201-99205, 99211-99215,
99217-99220, 99241-99245,
99217-99220, 99241-99245,
99271-99275, 99301-99303,
99311-99333, 99341-99355,
99381-99387, 99391-99397,
99401-99404, 99411, 99412,
99420-99429, 99499
Yes if DIAG1 on PNEUDX* =
480, 481, 485, 486, 487.1
All dates on which the
patient was hospitalized
with a diagnosis of
pneumonia (all FROMDATE
where DIAG*= 480-486 and
SITE_CDE = 4)
NOTES
Did not include
hospitalizations b/c may be
hard to distinguish
community acquired versus
nosocomial
- 223 -
Item Definition
Variable Name
Format
Age at time of pnemonia
diagnosis
PNEUAGE*
countinous
Dx of lung problems on
or prior to pneumonia
diagnosis
LUNGDX*
1=yes;0=no
Diagnosis of heart
problems on or prior to
pneumonia diagnosis
HEARTDX*
1=yes;0=no
Diagnosis of renal
problems on or prior to
pneumonia diagnosis
RENALDX*
1=yes;0=no
Diagnosis of diabetes
on or prior to
pneumonia diagnosis
1=yes;0=no
DIABETDX*
Claims Data Algorithm
Age at time of pnemonia
diagnosis (PNEUDX* - DOB)
Dx of lung problems on or
prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 490496, 500-508, 510-519)
Diagnosis of heart problems
on or prior to pneumonia
diagnosis (any FROMDATE <=
PNEUDX* where DIAG* = 410414.9, 415-417.9, 420429.9)
Diagnosis of renal problems
on or prior to pneumonia
diagnosis ((any FROMDATE
<=PNEUDX* where (DIAG* =
580-589.9, 590-593.9 or
PROC* = 90918-90937)) OR
(any CPTDATE,=PNEUDX*
where CPTCODE = 9091890937))
Diagnosis of diabetes on or
prior to pneumonia
diagnosis (any FROMDATE
<=PNEUDX* where DIAG* =
250,357.2,362.0,366.41,648.
0)
NOTES
- 224 -
Item Definition
Immune dysfunction on
or prior to pneumonia
diagnosis
Variable Name
IMMUNEDX*
Format
1=yes;0=no
Claims Data Algorithm
NOTES
Code Key:
· AIDS - Acquired immune
deficiency syndrome - 042
· Asplenia, Anatomic or
functional Asplenia 759.0,
746.87
· DiGeorge's syndrome
(thymic hypoplasia) 279.11
· Congenital
immunodeficiency 279
· Sickle cell anemia 282.6
Cancer 140-208
· Organ or bone marrow
Immune dysfunction on or
transplantation 38240-38241,
prior to pneumonia
33945, 33935, 47135, 47136,
diagnosis (any FROMDATE
32850-32852, 48160, 48550,
<=PNEUDX* where (DIAG* =
48554, 48556, 50360, 50365,
042, 759.0, 746.87,
50380
279.11, 279, 282.6, 140208) OR (PROC*=38240-38241, · Immunosuppressive therapy
33945, 33935, 47135, 47136, · Current therapy with
32850-32852, 48160, 48550, alkylating agents,
48554, 48556, 50360, 50365, antimetabolites, and
radiation 77520-77523,
50380,77520-77523, 7740277406, 77401, 77412-77416, 77402-77406, 77401, 7741277416, 77407-77411, 77427
77407-77411, 77427)
- 225 -
Item Definition
Variable Name
Eligible for 09_09
(new diagnosis of
pneumonia without a
known bacteriologic
etiology and older than
65 with a coexisting
illness)
E09_09
Format
1=yes;0=no
Claims Data Algorithm
Eligible if a diagnosis of
pneumonia of unknown
bacteriologic etiology in
outpatient setting (PNEUVS*
<> NA and PNEUBA*=1)
without a diagnosis of
pneumonia in the previous 4
months and without a
hospitalization of
pneumonia within the month
prior to or after the
outpatient diagnosis of
pneumonia (no IPPNEU*
within =/- 1 omnth of
PNEUVS*)
AND
the patient is older than
65 (PNEUAGE* > 65)
AND
the patient has a
coexisting illness
(LUNGDX*=1 or HEARTDX*=1 or
RENALDX*=1 or DIABETDX*=1
or IMMUNEDX*=1)
NOTES
- 226 -
Item Definition
Variable Name
Format
Prescription for oral
empiric antibiotic
treatment filled
EMPABX*
Date
Pass 09_09 (oral
empiric antibiotic
dispensed)
S09_09*
1=yes;0=no
INDICATOR 09_12: Persons treated for pneumonia
should have follow-up contact with a provider
within 6 weeks after discharge or diagnosis.
Claims Data Algorithm
NOTES
The list of oral empiric
antibiotics was derived from
the Multum ndc_dnorm table;
The list was limited to
route=oral; took all with
active ingredients of :
amoxicillin, ampicillin,
cefaclor, cefadroxil,
cefdinir, cefixime,
cefpodoxime, cefprozil,
ceftibuten, cefuroxime,
cephalexin, cephradine,
loracarbef, sulfadiazine,
sulfadoxine, sulfamethizole,
sulfamethoxazole,
All FILLDATE where NDCCODE= sulfasalazine,
sulfinpryazone,
code on "Empiric
antibiotic" worksheet list sulfisoxazole, trimethoprim
Pass if EMPABX is on or
within 2 days after PNEUDX*
(see NDC list at the end of
the Pneumonia
specifications)
- 227 -
Item Definition
Variable Name
New diagnosis of
pneumonia in outpatient
setting (community
acquired)
PNEUDX*
Format
Date
Claims Data Algorithm
All dates on which the
patient presented to the
office or ER with a primary
diagnosis of pneumonia (all
FROMDATE where any DIAG*=
480-486, 487.0 and SITE CDE
<> 4)
Revenue codes (REVCODE):
45X, 49X-54X, 55X-59X, 65X,
66X, 76X, 82X-85X, 88X,
92X, 94X, 96X, 972-979,
981, 982-986, 988, 989
OR
CPT codes: 92002-92014,
99201-99205, 99211-99215,
99217-99220, 99241-99245,
99217-99220, 99241-99245,
99271-99275, 99301-99303,
99311-99333, 99341-99355,
99381-99387, 99391-99397,
99401-99404, 99411, 99412,
99420-99429, 99499
Eligible if a diagnosis of
pneumonia without a
diagnosis of pneumonia in
the previous 4 months
(PNEUVS* <> NA)
All office visit dates (All
FROMDATE where SITE_CDE =
1)
1=yes;0=no
Pass if any FUPNEU* within
6 weeks after PNEUDX*
Date
Face-to-face encounter
in an ambulatory
setting or ER setting
Eligible for 09_12
(diagnosis of
pneumonia)
E09_12*
Follow-up contact for
pneumonia
FUPNEU*
Pass 09_12 (follow-up
for pneumonia within 6
weeks of diagnosis)
S09_12*
1=yes;0=no
NOTES
Did not include
hospitalizations b/c may be
hard to distinguish
community acquired versus
nosocomial
- 228 -
PREVENTIVE CARE
Item Definition
Variable Name
Format
Claims Data Algorithm
NOTES
- 229 -
Item Definition
Variable Name
Format
INDICATOR 27_01: For patients under age 50,
notation of the date that a patient received a
tetanus/diphtheria booster within the last ten
years should be included in the medical record.
Age
ELIGAGE
integer
Eligible for 27_01
(patient less than 50) E27_01
1=yes;0=no
Tetanus immunization
administered
Pass 27_01 (tetanus
status known)
Claims Data Algorithm
age (in years) on 1/1/1998
TETGIVN
1=yes;0=no
eligible if ELIGAGE < 50
Any of these codes at any
time:
CPT=90700-90703, 9071890721
HCPC = J1670
ICD9 Proc = 9938, 9939
ICD9 V codes: V03.7, V06.1,
V06.2, V06.3, V06.5
S27_01
1=yes;0=no
Pass if TETGIVN=1
INDICATOR 27_02: There should be documentation
in the medical record that patients over the age
of 50 were offered a tetanus/diphtheria booster
after their 50th birthday or in the last 10
years.
Age
ELIGAGE
integer
age (in years) on 1/1/1998
Eligible for 27_01
(patient 50 years or
older)
E27_02
1=yes;0=no eligible if ELIGAGE>= 50
NOTES
- 230 -
Item Definition
Tetanus immunization
administered
Pass 27_02 (tetanus
status known)
Variable Name
Format
TETGIVN
1=yes;0=no
Claims Data Algorithm
Any of these codes at any
time:
CPT=90700-90703, 9071890721
HCPC = J1670
ICD9 Proc = 9938, 9939
ICD9 V codes: V03.7, V06.1,
V06.2, V06.3, V06.5
S27_02
1=yes;0=no
Pass if TETGIVN=1
INDICATOR 27_04: All patients aged 65 and over
should have been offered influenza vaccine
annually or have documentation that they
received it elsewhere.
Age
ELIGAGE
integer
Eligible for 27_04
(patient 65 years or
older)
E27_04
1=yes;0=no
Influenza vaccine given
(during study period) FLUGIVN
Pass 27_04 (patient
offered/received flu
vaccine)
S27_04
age (in years) on 1/1/1998
Eligible if ELIGAGE>=65
Any of the codes during the
study period:
CPT=90657-90660, 90724
HCPC=Q0034, G0008
ICD9 Proc=9952
1=yes; 0=no ICD9 Vcode=V04.8
1=yes; 0=no Pass if FLUGIVN=1
NOTES
- 231 -
Item Definition
Variable Name
Format
Claims Data Algorithm
NOTES
INDICATOR 27_05: All patients under age 65 with
any of the following conditions should have been
offered influenza vaccination annually:
a. Living in a nursing home;
b. Chronic obstructive pulmonary disease;
d. Chronic cardiovascular disorders;
e. Renal failure;
f. Immunosuppression;
g. Diabetes mellitus;
h. Hemoglobinopathies (e.g. sickle cell).
Age
ELIGAGE
integer
age (in years) on 1/1/1998
Living in a nursing
home
Diagnosis of COPD
CPT codes from the following
headings: Comprehensive
nursing facility
assessments; Subsequent
nursing facility care;
Domiciliary, rest home or
custodial care services
NURSHOME
Any of the following CPT
encounter codes:
CPT=99301-99303, 9931199313, 99321-99323, 993311=yes; 0=no 99333
COPDDX
ICD9 codes are for all
conditions under the heading
"Chronic obstructive
Any of the following DIAG*: pulmonary disease and allied
conditions"
1=yes; 0=no 490xx-496xx
- 232 -
Item Definition
Variable Name
Format
Claims Data Algorithm
NOTES
Diagnosis of CVD
CVDDX
ICD9 codes are for all
Any of the following DIAG*: conditions under the heading
"Cerebrovascular disease"
1=yes; 0=no 430xx-438xx
Diagnosis of renal
failure
RENFAIL
Any of the following DIAG*:
1=yes; 0=no 584xx-588xx
- 233 -
Item Definition
Immunosupressed
Variable Name
IMMUNSUP
Format
Claims Data Algorithm
Any of the following DIAG*=
042, 759.0, 746.87,
279.11, 279, 282.6, 140-208
OR
Any PROC*=38240-38241,
33945, 33935, 47135, 47136,
32850-32852, 48160, 48550,
48554, 48556, 50360, 50365,
50380,77520-77523, 7740277406, 77401, 77412-77416,
1=yes; 0=no 77407-77411, 77427
NOTES
Code Key:
· AIDS - Acquired immune
deficiency syndrome - 042
· Asplenia, Anatomic or
functional Asplenia 759.0,
746.87
· DiGeorge's syndrome
(thymic hypoplasia) 279.11
· Congenital
immunodeficiency 279
· Sickle cell anemia 282.6
Cancer 140-208
· Organ or bone marrow
transplantation 38240-38241,
33945, 33935, 47135, 47136,
32850-32852, 48160, 48550,
48554, 48556, 50360, 50365,
50380
· Immunosuppressive therapy
· Current therapy with
alkylating agents,
antimetabolites, and
radiation 77520-77523,
77402-77406, 77401, 7741277416, 77407-77411, 77427
- 234 -
Item Definition
Diagnosis of diabetes
Eligible for 27_05
(less than 65 and at
risk for flu
complications)
Variable Name
DIABETDX
E27_05
Influenza vaccine given
(once in a 1 year time
period)
FLUGIVN
Pass 27_05 (patient
offered/received flu
vaccine)
S27_05
Format
Claims Data Algorithm
Any DIAG* =
1=yes; 0=no 250,357.2,362.0,366.41
Eligible if ELIGAGE < 65
and (NURSHOME, COPDDX,
CVDDX, RENFAIL, IMMUNSUP or
1=yes; 0=no DIABETDX = 1)
Any of the codes during the
study period:
CPT=90657-90660, 90724
HCPC=Q0034, G0008
ICD9 Proc=9952
1=yes; 0=no ICD9 Vcode=V04.8
1=yes; 0=no Pass if FLUGIVN=1
INDICATOR 27_06A: There should be documentation
that all patients in the following groups and
otherwise presenting for care were offered
pneumococcal vaccine at least once: Patients
aged 65 and older
Age
ELIGAGE
integer
age (in years) on 1/1/1998
Eligible for 27_06A
(patient 65 years or
older)
E27_06A
1=yes; 0=no Eligible if ELIGAGE >= 65
NOTES
- 235 -
Item Definition
Variable Name
Pneumococcal vaccine
administered
ADMINPNE
Pass 27_06A
(pneumococcal vaccine
offered at least once) S27_06A
Format
Claims Data Algorithm
Any of the codes at any
time:
CPT=90669, 90732
HCPC=G0009
ICD9 Proc= .
1=yes; 0=no ICD9 Vcode=V03.82, V06.6
1=yes; 0=no Pass if ADMNPNE=1
INDICATOR 27_06B: There should be documentation
that all patients in the following groups and
otherwise presenting for care were offered
pneumococcal vaccine at least once: at least
one risk condition, less than 65 and not
institutionalized
Age
ELIGAGE
integer
Diagnosis of COPD
COPDDX
Diagnosis of CVD
CVDDX
Diagnosis of diabetes
DIABETDX
NOTES
age (in years) on 1/1/1998
ICD9 codes are for all
conditions under the heading
"Chronic obstructive
Any of the following DIAG*: pulmonary disease and allied
conditions"
1=yes; 0=no 490xx-496xx
ICD9 codes are for all
Any of the following DIAG*: conditions under the heading
"Cerebrovascular disease"
1=yes; 0=no 430xx-438xx
Any DIAG* =
1=yes; 0=no 250,357.2,362.0,366.41
- 236 -
Item Definition
Immunosupressed
Variable Name
IMMUNSUP
Format
Claims Data Algorithm
Any of the following DIAG*=
042, 759.0, 746.87,
279.11, 279, 282.6, 140-208
OR
Any PROC*=38240-38241,
33945, 33935, 47135, 47136,
32850-32852, 48160, 48550,
48554, 48556, 50360, 50365,
50380,77520-77523, 7740277406, 77401, 77412-77416,
1=yes; 0=no 77407-77411, 77427
NOTES
Code Key:
· AIDS - Acquired immune
deficiency syndrome - 042
· Asplenia, Anatomic or
functional Asplenia 759.0,
746.87
· DiGeorge's syndrome
(thymic hypoplasia) 279.11
· Congenital
immunodeficiency 279
· Sickle cell anemia 282.6
Cancer 140-208
· Organ or bone marrow
transplantation 38240-38241,
33945, 33935, 47135, 47136,
32850-32852, 48160, 48550,
48554, 48556, 50360, 50365,
50380
· Immunosuppressive therapy
· Current therapy with
alkylating agents,
antimetabolites, and
radiation 77520-77523,
77402-77406, 77401, 7741277416, 77407-77411, 77427
- 237 -
Item Definition
Living in a nursing
home
Eligible for 27_06B
(diagnosis of chronic
heart or pulmonary
condition)
Pneumococcal vaccine
administered
Pass 27_06B
(pneumococcal vaccine
administered at least
once)
Variable Name
NURSHOME
E27_06B
ADMINPNE
S27_06B
Format
Claims Data Algorithm
Any of the following CPT
encounter codes:
CPT=99301-99303, 9931199313, 99321-99323, 993311=yes; 0=no 99333
Eligible if ELIGAGE <65 and
(COPDDX, CVDDX, DIABETDX,
or IMMUNSUP =1) and
1=yes; 0=no NURSEHOME=0
Any of the codes at any
time:
CPT=90669, 90732
HCPC=G0009
ICD9 Proc= .
1=yes; 0=no ICD9 Vcode=V03.82, V06.6
1=yes;0=no
Pass if pneumococcal
vaccine administered at
least once (ADMINPNE=1)
INDICATOR 27_11: Mantoux tests should be read by
a health professional or other trained personnel
within 48-72 hours.
Earliest date where: CPT=
86580-86585
PPD test performed
PPDDT
Date
Eligible for 27_11
(PPD/Mantoux test
administered)
E27_11
1=yes; 0=no Eligible if PPDDT<>NA
NOTES
CPT codes from the following
headings: Comprehensive
nursing facility
assessments; Subsequent
nursing facility care;
Domiciliary, rest home or
custodial care services
- 238 -
Item Definition
Variable Name
Format
Claims Data Algorithm
Any FROMDATE 2 or 3 days
after PPDDT where
REVCOE = 49x, 50x, 51x,
52x, 53x, 55x, 56x, 57x,
58x, 59x, 65x, 66x, 76x,
82x, 83x, 84x, 85x, 88x,
92x, 94x, 96x, 972, 973,
974, 975, 976, 977, 978,
979, 982, 983, 984, 985,
986, 988, 989
Office visit (2-3 days
after Mantoux test)
RDPPD
Pass 27_11 (Mantoux
test read by health
professional 58-72
hours after
administration)
S27_11
CPT codes: 99201-99205,
99211-99215, 99217-99220,
99241-99245, 99271-99275,
99354-99355, 99381-99387,
99391-99397, 99401-99404,
1=yes; 0=no 99411-99412, 99420-99429
Pass if office visit 2-3
days after Mantoux text
1=yes; 0=no (RDPPD=1)
INDICATOR 27_25A: Women who have not had a Pap
smear within the last 3 years should have one
performed (unless never sexually active with men
or have had a hysterectomy for benign
indications).
Gender
GENDER
Yes if GENDER (from
1=yes; 0=no enrollment file) = F
NOTES
- 239 -
Item Definition
Variable Name
History of hysterectomy HXHYSTER
Eligible for 27_25A
(female patient over
age 18 who is sexually
active and has not had
a hysterectomy)
E27_25A
Format
Claims Data Algorithm
NOTES
CPT codes: 51925, 56308,
58150, 58152, 58200, 58210,
58240, 58260, 58262, 58263,
58267, 58270, 58275, 58280,
58285, 58550, 58551, 58951,
59135, 59525
Hysterectomy codes are from
HEDIS cervical cancer
screening measure
1=yes; 0=no ICD9 Proc = 68.4-68.8
Eligible if GENDER=female
1=yes; 0=no and HXHYSTER=0
CPT codes: 88141-88145,
88147, 88148, 88150-88158,
88164-88167
ICD9 Proc: 91.46
ICD9 dx: V76.2
Dates of pap smears
Pass 27CC_02 (most
recent pap smear was
within the past 3
years)
PAPDATE
1=yes; 0=no Revenue code: 923
S27CC_02
Pass if pap smear performed
1=yes; 0=no (PAPDATE=1)