ONLINE APPENDIX
Table 1: PAD-related ICD-9-CM Diagnosis and Procedure Codes
Diagnosis
Atherosclerosis of aorta plaques of fatty material in artery
Atherosclerosis of native arteries of the extremities unspecified
Atherosclerosis of native arteries of the extremities with intermittent claudication =
cramp in extremity, caused by obstruction of artery
Atherosclerosis of native arteries of the extremities with rest pain
Atherosclerosis of native arteries of the extremities with ulceration
Atherosclerosis of native arteries of the extremities with gangrene localized death
and decomposition of body tissue, result from obstructed circulation or infection
Other atherosclerosis of native arteries of the extremities
Atherosclerosis of unspecified bypass graft of the extremities medical procedure of
vein graft to create detour around blocked artery
Atherosclerosis of autologous vein bypass graft of the extremities
Autologous: obtained from same individual
Atherosclerosis of non-autologous biological bypass graft of the extremities
Chronic total occlusion of artery of the extremities
Occlusion = blockage/closing
Atherosclerosis of other specified arteries
Generalized and unspecified atherosclerosis
Other peripheral vascular disease
Peripheral vascular disease unspecified
Arterial embolism and thrombosis of arteries of the extremities
Arterial embolism and thrombosis of lower extremity
Arterial embolism and thrombosis of iliac artery
Arterial embolism and thrombosis, other
Arterial embolism and thrombosis of unspecified artery
Atheroembolism of lower extremity
Unspecified ulcer of lower limb
Ulcer of calf
Ulcer of ankle
Ulcer of heel and midfoot
Ulcer of other part of foot
Ulcer of other part of lower limb
Chronic ulcer of unspecified site
Pain in limb
Acute osteomyelitis - lower leg
Acute osteomyelitis -ankle and foot
Code
440.0
440.20
440.21
440.22
440.23
440.24
440.29
440.30
440.31
440.32
440.4
440.8
440.9
443.89
443.9
444.2
444.22
444.81
444.89
444.9
445.02
707.10
707.12
707.13
707.14
707.15
707.19
707.9
729.5
730.06
730.07
Chronic osteomyelitis - lower leg
Chronic osteomyelitis - ankle and foot
Gangrene
Procedures
Incision of vessel, embolectomy or thrombectomy, lower-limb arteries
Endarterectomy; abdominal arteries
Endarterectomy, lower-limb arteries
Resection of vessel with replacement, lower limb arteries
Other excision of vessel; lower limb arteries
Aorta-iliac-femoral bypass aorta and iliac, and leg arteries
Other (peripheral) vascular shunt or bypass
Other revision of vascular procedure
Angioplasty of other non-coronary vessel(s)
Repair of blood vessel with tissue patch graft
Repair of blood vessel with synthetic patch graft
Repair of blood vessel with unspecific type of patch graft
Insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s)
Lower limb amputation, not otherwise specified
Amputation of toe
Amputation through foot
Amputation of ankle through malleoli of tibia and fibula
Other amputation below knee
Amputation above knee
Excisional debridement of wound, infection, or burn
#
730.1
730.17
785.4
38.08
38.16
38.18
38.48
38.68
39.25
39.29
39.49
39.50
39.56
39.57
39.58
39.90
84.10#
84.11#
84.12#
84.14#
84.15#
84.17#
86.22
Codes suggestive of PAD when not found in combination with cancer or trauma diagnosis codes on medical claims
for the same service date.
ICD-9-CM: International classification of diseases, ninth revision, Clinical Modification; PAD: Peripheral Artery
Disease
Table 2: Lower Extremity ICD-9 Diagnosis and Procedure Codes for Cancer and Trauma [Used
to Exclude Other Etiologies of Leg Amputation]
Non-PAD related cancer or trauma
Code
Traumatic amputation of toe(s) (complete) (partial)
895, 895.x
Traumatic amputation of foot (complete) (partial)
Traumatic amputation of leg(s) (complete) (partial)
896, 896.x
897, 897.x
Malignant neoplasm; long bones of lower limb
170.7
Malignant neoplasm; short bones of lower limb
170.8
Malignant neoplasm; bone and articular cartilage, site unspecified 170.9
Malignant neoplasm; lower limb, including hip
172.7
Malignant; melanoma of skin, site unspecified
172.9
Personal history of malignant melanoma of; skin
V10.82
Other malignant neoplasm; skin of lower limb, including hip
173.7, 173.7x
Kaposi's sarcoma skin
176.0
Kaposi's sarcoma soft tissue
176.1
ICD-9-CM: International Classification of Diseases, ninth revision, Clinical Modification
Table 3: ICD-9-CM Diagnosis Codes Used to Identify Comorbid Conditions and Risk Factors
Comorbid
Condition/Risk
Factor
Hypertension
Diabetes
Myocardial
Infarction
Heart Failure
ICD-9-CM code
401.0, 401.1, 401.9, 402.00-405.99, 437.2, 642.00-642.04, 642.10-642.24, 642.70642.94
249.00-249.31, 249.40-249.91, 250.00-250.33, 250.40-250.93, 648.00-648.04,
775.1
410.00-410.92, 412
398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93,
428.0-428.9
Stroke
430, 431, 432.0-432.9, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01,
434.11, 434.91, 435.0, 435.1, 435.2, 435.3, 435.8, 435.9, 436, 437.0-437.9, 438.0,
438.10-438.19, 438.20-438.22, 438.30-438.32, 438.40-438.42, 438.50-438.53,
438.6, 438.7, 438.81-438.89, 438.9
Renal Failure
403.01, 403.11, 403.90, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93,
585.3, 585.4, 585.5, 585.6, 585.9, 586, V42.0, V45.1, V45.11, V45.12, V56.0V56.32, V56.8
Cancer
140.0-172.9, 174.0-175.9, 179-195.8, 196.0-199.1, 200.00-202.38, 202.50-203.01,
203.02-203.82, 203.8-203.81, 209.00-209.24, 209.25-209.3, 209.31-209.36,
209.70, 209.72, 209.73, 209.74, 209.75, 209.79, 238.6, 258.01-258.03, 273.3,
789.51
ICD-9-CM =International Classification of Diseases, ninth revision, Clinical Modification
Classification of ICD-9-CM codes into comorbidity categories was based on those used in Healthcare
Cost and Utilization Project Comorbidity Software[31]
Table 4: Billing Codes used to Identify Current and Recent Smokers*
Description
Smoking and tobacco use cessation counseling visit with physician,
intermediate 3-10 minutes
Smoking and tobacco use cessation counseling visit with physician, intensive
>10 minutes
Non-independent tobacco use disorder (defined as using tobacco in a
detrimental way to affect person’s health or social functioning), tobacco
dependence is included
Personal history of tobacco use
Toxic effect of other substances, tobacco
Code
99406 (CPT-4)
99407 (CPT-4)
305.1 (ICD-9-CM)
V15.82 (ICD-9-CM)
989.84 (ICD-9-CM)
2 NDC/Product Code
Zyban (Buproprion) sustain-release tablet, 150mg
Combinations
14 NDC/Product Code
Chantix (Varenicline) tablet, 0.5mg or 1mg
Combinations
438 NDC/Product Code
Nicotine replacement therapy
Combinations
*Homeopathic and non-FDA approved smoking cessation medications were not included
CPT-4: Current Procedural Terminology; ICD-9-CM: International Classification of Diseases, ninth
revision, Clinical Modification; NDC: National Drug Code
Table 5a: Cost and cost differences between smokers and non-smokers in total PAD cohort,
2011, stratified by concurrent CVD
Smoker
(n=1,995)
n=1,201
$80,222
[$73,603-$86,842]
Non-smoker
(n=20,208)
n=11,823
$61,901
[$59,866-$63,936]
Difference
(observed)
Difference
(predicted)
$18,321
[$11,470-$25,173]
$14,090
[$8,661-$20,069]
Total Professional
Costs
$10,266
[$9,492-$11,040]
$6,703
[$6,523-$6,882]
$3,564
[$2,774-$4,353]
$1,480
[$925-$2,090]
Total FacilityBased Care Costs
$69,956
[$63,714-$76,199]
$55,198
[$53,244-$57,153]
$14,758
[$7,958-$21,558]
$12,399
[$7,188-$18,100]
n=794
n=8,385
$39,566
[$33,097-$46,035]
$23,383
[$22,187-$24,579]
$16,183
[$9,587-$22,780]
$12,380
[$7,273-$17,970]
Total Professional
Costs
$7,208
[$6,281-$8,135]
$4,423
[$4,250-$4,595]
$2,786
[$1,838-$3,733]
$866
[$247-$1,512]
Total FacilityBased Care Costs
$32,358
[$26,078-$38,638]
$18,960
[$17,838-$20,082]
$13,398
[$6,912-$19,884]
$11,491
[$6,657-$16,877]
Concurrent CVD
Total Costs
No CVD
Total Costs
Table 5b: Cost and cost differences between smokers and non-smokers in pharmacy
subgroup, 2011, stratified by concurrent CVD
Smoker
(n=1,158)
n=634
Non-smoker
(n=7,869)
n=4,361
Difference
(observed)
Difference
(predicted)
Total Costs
$74,285
[$66,110-$82,460]
$61,239
[$57,818-$64,659]
$13,046
[$4,454-$21,639]
$7,715
[$0†-$16,350]
Total Professional
Costs
$11,892
[$10,674-$13,110]
$7,776
[$7,389-$8,163]
$4,116
[$2,866-$5,367]
$1,890
[904-2,978]
Total FacilityBased Care Costs
$59,529
[$51,927-$67,131]
$50,995
[$47,740-$54,251]
$8,533
[$643-$16,424]
$5,350
[$0†-$13,277]
n=524
n=3,508
$35,703
[$30,293-$41,112]
$24,882
[$22,908-$26,856]
$10,820
[$5,099-$16,542]
$7,480
[$2,523-$12,703]
Total Professional
Costs
$8,144
[$6,818-$9,471]
$5,242
[$4,917-$5,567]
$2,902
[$1,475-$4,329]
1,177
[$220-$2,246]
Total FacilityBased Care Costs
$25,416
[$20,416-$30,416]
$17,782
[$15,975-$19,588]
$7,634
[$2,341-$12,928]
$6,355
[$1,782-$11,273]
Concurrent CVD
No CVD
Total Costs
Difference data are reported as cost differences between smokers and non-smokers [95% confidence interval]
95% confidence intervals generated using bootstrap (percentile method)
Total costs includes costs for facility-based care (hospital- and skilled nursing facility-billed services and procedures) as well as
costs for professional care (primarily physician-billed services)
Predicted differences are adjusted for age, sex, hypertension, diabetes, renal failure, insurance type, and Minnesota residence