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Table 1 Case definitions applied to administrative health data for diabetes and comorbid conditions

From: Validity of the RAI-MDS for ascertaining diabetes and comorbid conditions in long-term care facility residents

Condition

Case definition algorithm

Diabetes [13, 14]

One or more inpatient hospital separations with an ICD code in any diagnosis field or two or more physician billing claims within two years with an ICD code.

ICD-9: 250

ICD-10-CA: E10, E11, E12, E13, E14

Alzheimer’s disease/dementia [15]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 290, 291, 294, 331

ICD-10-CA: F00, F01, F02, F03, F05.1, G30, G31.1

Arthritis [16, 17]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 714, 715, 446, 710, 720, 274, 711, 712, 713, 716,

717, 718 719, 721, 725 to 729, 739

ICD-10-CA: M05, M06, M15 to M19, M07, M10, M11 to M14, M30 to M36, M00 to M03, M20 to M25, M65 to M79

Cardiac dysrhythmia [17]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 427

ICD-10-CA: I47, I48, I49

Congestive heart failure [18, 19]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9 code: 428

ICD-10-CA: I50

Chronic obstructive pulmonary disease [18]

One or more inpatient hospital separations with an ICD code in any diagnostic field or one or more physician billing claims with an ICD code.

ICD-9 code: 491, 492, 496

ICD-10-CA: J41, J42, J43, J44

Glaucoma [18]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician claims with an ICD code.

ICD-9 code: 365

ICD-10-CA: H40, H42

Hip fracture [20]

One or more inpatient hospital separations with an ICD code in the first diagnosis field.

ICD-9: 820

ICD-10-CA: S72.0, S72.1, S72.2

Hypertension [21, 22]

One or more inpatient hospital separations with an ICD code in any diagnosis field or two or more physician claims with an ICD code within two years.

ICD-9: 401 to 405

ICD-10-CA: I10 to I13, I15

Multiple sclerosis [15]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 340

ICD-10-CA: G35

Osteoporosis [23, 24]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 733.0 (hospital data) or 733 (physician data)

ICD-10-CA: M80, M81

Parkinson’s disease [15]

One or more inpatient hospital separations with an ICD code in any diagnosis field or one or more physician billing claims with an ICD code.

ICD-9: 332

ICD-10-CA: G20

Stroke/transient ischemic attack [25]

One or more inpatient hospital separations with an ICD code in the first diagnosis field.

ICD-9: 430, 431, 432, 433, 434, 435, 436, 437, or 438

ICD-10-CA: I60, I61, I62, I63 (excluding I63.6), I64, I65, I66, I67 (excluding I67.6), I68, I69, G45, G46, H34.

  1. Note: ICD-9 codes are used to ascertain cases in physician billing claims and in hospital records up to and including 2000/01 fiscal year; ICD-10-CA codes are used to ascertain cases in hospital records for 2001/02 onward and ICD-9 codes are used to ascertain cases in physician billing claims for 2001/02 onward.