Diabetes mellitus without mention of complication, Type I (juvenile type), not Determine first whether case has RF05 Diabetes present …
2008 Leapfrog Hospital Survey
Resource-Based Efficiency Measure
Severity-Adjustment Risk Factor Definitions
RF03 — Site of infarction: anterior or anteriolateral
applies to AMI,PCI
Principal diagnosis ICD-9-CM Diagnosis Codes
|41001|Anterolateral wall, acute myocardial infarction-initial episode |
|41011|Other anterior wall, acute myocardial infarction-initial episode |
RF04 — Site of infarction: subendocardial
applies to AMI,PCI
Principal diagnosis ICD-9-CM Diagnosis Codes
|41071|Subendocardial, acute myocardial infarction |
RF05 — Diabetes
applies to AMI, CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|25001|Diabetes mellitus without mention of complication, Type I | |
| |juvenile type, not stated as uncontrolled | |
|25003|Diabetes mellitus without mention of complication, Type I | |
| |juvenile type, uncontrolled | |
|2501x|Diabetes w/ ketoacidosis |v1|
| | |2 |
|2502x|Diabetes w/ hyperosmolar coma
|v1|
| | |2 |
|2503x|Diabetes w/ coma |v1|
| | |2 |
|2504x|Diabetes w/ renal manifestestations |v1|
| | |2 |
|2505x|Diabetes w/ ophthalmic manifestations |v1|
| | |2 |
|2506x|Diabetes w/ neurologic manifestations |v1|
| | |2 |
|2507x|Diabetes w/ circulatory disease |v1|
| | |2 |
|2508x|Diabetes with other specified manifestations |v1|
| | |2 |
|2509x|Diabetes with unspecified complication |v1|
| | |2 |
|64800|Diabetes mellitus in pregnancy
| |
|to | | |
|64804| | |
|64881|Abnormal glucose tolerance of mother, with delivery | |
RF06 — Cancer
applies to AMI, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|1400 |Malignant neoplasms |
|to | |
|2089 | |
RF07 — Chronic cerebrovascular disease
applies to AMI,CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|437x |Other cerebrovascular disease |
|438x |Late effects of cerebrovascular disease |
RF08 — Chronic renal disease
applies to AMI,CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|40300|Hypertensive chronic kidney disease, malignant, without mention of |
| |renal failure |
|40301|Hypertensive chronic kidney disease, malignant, with renal failure |
|40310|Hypertensive chronic kidney disease,
benign, without mention of |
| |renal failure |
|40311|Hypertensive chronic kidney disease, benign, with renal failure |
|40390|Hypertensive chronic kidney disease, unspecified, without mention |
| |of renal failure |
|40391|Hypertensive chronic kidney disease, unspecified, with renal |
| |failure |
|40400|Hypertensive heart and chronic kidney disease, malignant |
| | |
|to | |
|40403| |
|40410|Hypertensive heart and chronic kidney disease, benign |
| | |
|to | |
|40413| |
|40490|Hypertensive heart and chronic kidney disease, unspecified |
| |
|
|to | |
|40493| |
|582 |Chronic nephritis |
|583 |Nephritis NOS |
|585 |Chronic kidney disease |
|to |Renal failure, unspecified |
|587 |Renal sclerosis, unspecified |
RF09 — Chronic liver disease
applies to AMI, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|571x |Chronic liver disease/cirrhosis |
|5721 |Portal pyemia |
|5722 |Hepatic coma |
|5723 |Portal hypertension |
|5724 |Hepatorenal syndrome |
|5728 |Other sequelae of chronic liver disease |
RF10 — Obesity
applies to AMI, PCI
Any diagnosis ICD-9-CM
Diagnosis Codes
|27800|Obesity, unspecified |
|27801|Morbid obesity |
RF11 — COPD
applies to AMI, CABG, PCI WARNING: Definition differs from
RF36 — COPD
Any diagnosis ICD-9-CM Diagnosis Codes
|49121|Obstructive chronic bronchitis, with acute exacerbation |
|49320|Chronic obstructive asthma without mention of status asthmaticus or|
| |acute exacerbation or unspecified |
|49321|Chronic obstructive asthma, with status asthmaticus |
|496 |Chronic airway obstruction, not elsewhere classified |
RF12 — Cardiomyopathy
applies to AMI, CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|425x |Cardiomyopathy |
RF13 — Chronic cardiac conditions
applies to AMI, CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|39890|Rheumatic heart disease, unspecified | |
|39891|Rheumatic heart failure congestive | |
|39899|Other rheumatic heart diseases | |
|402xx|Hypertensive
heart disease |v12|
|4148 |Other specified forms of chronic ischemic heart disease | |
|4149 |Chronic ischemic heart disease, unspecified | |
|416x |Chronic pulmonary heart disease |v12|
|4291 |Myocardial degeneration | |
|4292 |Cardiovascular disease, unspecified | |
|4293 |Cardiomegaly | |
|44381|Peripheral angiopathy in diseases classified elsewhere | |
|44389|Other unspecified peripheral vascular disease | |
|4439 |Peripheral vascular disease, unspecified | |
|V1250|Unspecified circulatory disease history | |
|V151 |Surgery to heart and great vessels history | |
RF14 — History of PTCA
applies to PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|V4582|Percutaneous transluminal coronary angioplasty status |
RF15 — Atherosclerosis and lipid disorders
applies to AMI,CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|272x |Diseases of lipoid metabolism
|
|41400|Coronary atherosclerosis |
|41401|Coronary atherosclerosis of native coronary vessel |
|41402|Coronary atherosclerosis of autologous vein bypass graft |
|41403|Coronary atherosclerosis of nonautologous biological bypass graft |
|41404|Coronary atherosclerosis of artery bypass graft |
|41405|Coronary atherosclerosis of unspecified type of bypass graft |
|440x |Atherosclerosis |
RF16 — PCI
applies to AMI, CABG
Any procedure
ICD-9-CM Procedure Codes
|0066 |Percutaneous transluminal coronary angioplasty PTCA or |
| |coronary artherectomy |
|Other codes indicate single/multiple vessels 0040-0043 or stenting |
|0045-0048, 3606, 3607 but are SECONDARY to this code and should not |
|be used to identify a PCI |
or
CPT-4 Procedure Codes
|92982 |Percutaneous transluminal coronary balloon angioplasty, single |
| |vessel |
|92984
|Percutaneous transluminal coronary balloon angioplasty, additional |
| |vessels |
|92995 |Percutaneous transluminal coronary arthrectomy w/wo balloon, single|
| |vessel |
|92996 |Percutaneous transluminal coronary arthrectomy w/wo balloon, |
| |additional vessels |
|92980 |Trancatheter placement of intracoronary stents, percutaneous, |
| |single vessel |
|92981 |Trancatheter placement of intracoronary stents, percutaneous, |
| |additional vessels |
RF17 — CABG
applies to AMI, PCI
Any procedure
ICD-9-CM Procedure Codes
|3610 |Bypass anasthamosis for heart revascularization |
|to | |
|3619 | |
|362 |Heart revascularization by arterial implant |
or
CPT-4 Procedure Codes
|33510 |Coronary artery
bypass graft |
|to | |
|33523 | |
|33533 |Coronary artery bypass graft |
|to | |
|33536 | |
RF18 — Musculoskeletal conditions
applies to CABG, PCI
Any diagnosis ICD-9-CM Diagnosis Codes
|715x |Osteoarthrosis and allied disorders |
|7200 |Ankylosing spondylitis |
|72190|Spondylosis of unspecified site without mention of myelopathy |
|7140x|Rheumatoid arthritis |
| | |
|to | |
|71433| |
RF19 - AMI
applies to CABG, PCI
Principal diagnosis ICD-9-CM Diagnosis Codes
|41001|Acute myocardial infarction, of anterolateral
wall, initial episode|
| |of care |
|41011|Acute myocardial infarction, of other anterior wall, initial |
| |episode of care |
|41021|Acute myocardial infarction, of inferolateral wall, initial episode|
| |of care |
|41031|Acute myocardial infarction, of inferoposterior wall, initial |
| |episode of care |
|41041|Acute myocardial infarction, of other inferior wall, initial |
| |episode of care |
|41051|Acute myocardial infarction, of other lateral wall, initial episode|
| |of care |
|41061|Acute myocardial infarction, true posterior wall infarction, |
| |initial episode of care |
|41071|Acute myocardial infarction, subendocardial infarction, initial |
| |episode of care |
|41081|Acute myocardial
infarction, of other specified sites, initial |
| |episode of care |
|41091|Acute myocardial infarction, unspecified site, initial episode of |
| |care |
RF20 - Coronary Artery Disease without prior CABG
applies to CABG
Any diagnosis ICD-9-CM Diagnosis Codes
|410xx|AMI / Ischemic heart disease |
|to | |
|41407| |
|41410|Aneurysm and dissection of heart |
| | |
|to | |
|41419| |
|4148 |Chronic ischemic heart disease |
|to | |
|4149 | |
but EXCLUDE if
Any diagnosis ICD-9-CM
Diagnosis Codes
|V4581|Aortocoronary bypass status |
|99603|Mechanical complication of cardiac device, implant, and graft due |
| |to coronary bypass graft |
RF21 — Coronary Artery Disease with prior CABG
applies to AMI, CABG
Any diagnosis ICD-9-CM Diagnosis Codes Group A
|410xx|AMI / Ischemic heart disease |
|to | |
|41407| |
|41410|Aneurysm and dissection of heart |
| | |
|to | |
|41419| |
AND
Any diagnosis ICD-9-CM Diagnosis Codes Group B
|V4581|Aortocoronary bypass status |
|99603|Mechanical complication of cardiac device, implant, and graft due |
| |to coronary bypass graft |
Must have at least
one diagnosis from Group A and at least one diagnosis
from Group B
RF22 - Diabetes AND Obesity
applies to AMI
IMPORTANT:
Determine first whether case has RF05 - Diabetes present
Determine first whether case has RF10 - Obesity present
|RF05 - Diabetes is present see table RF05 |
AND
|RF10 - Obesity is present see table RF10 |
If both RF05 and RF10 factors are present for the case, then RF22 is
present for the case
RF30 — Any cancer except basal or squamous-cell skin cancer
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|1400 to 1719 |
|1740 to 1991 |
|2000 to 20891 |
|2330 to 2349 |
RF31 — Cirrhosis or chronic hepatitis
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|5712 |Alcoholic cirrhosis of liver |
|5714 |Chronic hepatitis |
|5715 |Cirrhosis of liver without
mention of alcohol |
|5716 |Biliary cirrhosis |
RF32 — Stroke or transient ischemic attack
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|430x |Subarachnoid hemorrhage |
|431x |Intracerebral hemorrhage |
|432x |Intracranial hem nec/nos |
|433×1|Cerebral infarction |
|434×1|Cerebral infarction |
|435x |Transient cerebral ischemia |
|436x |Acute, but ill-defined, cerebrovascular disease |
RF33 — Congestive heart failure
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|428x |Heart failure |
|40201|Hypertensive heart disease, malignant, with heart failure |
|40211|Hypertensive heart disease, benign, with heart failure |
|40291|Hypertensive heart disease, unspecified, with heart failure |
|40401|Hypertensive heart and renal disease,
malignant, with congestive |
| |heart failure |
|40403|Hypertensive heart and renal disease, malignant, with congestive |
| |heart failure and renal failure |
|40411|Hypertensive heart and renal disease, benign, with congestive heart|
| |failure |
|40413|Hypertensive heart and renal disease, benign, with congestive heart|
| |failure and renal failure |
|40491|Hypertensive heart and renal disease, unspecified, with congestive |
| |heart failure |
|40493|Hypertensive heart and renal disease, unspecified, with congestive |
| |heart failure and renal failure |
RF34 — Kidney disease
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|580x |Acute nephritis |
|581x |Nephrotic syndrome |
|582x |Chronic nephritis |
|583x
|Nephritis NOS |
|584x |Acute renal failure |
|585x |Chronic renal failure |
|586x |Renal failure, unspecified |
|587x |Renal sclerosis, unspecified |
|588x |Impaired renal function |
|589x |Small kidney |
|590x |Kidney infection |
|591x |Hydronephrosis |
|592x |Renal/ureteral calculus |
|593x |Other renal ureteral disease |
|403xx|Hypertensive renal disease |
|404xx|Hypertensive heart/renal disease |
RF35 — Suspected or documented HIV
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|042x |Human immunodeficiency virus HIV disease |
|V08x |Asymptomatic human immunodeficiciency
virus HIV infection status |
|79571|Non-specific serologic evidence of human immunodeficiency virus |
RF36 - COPD
applies to Pneumonia WARNING: Definition differs from
RF11 — COPD
Any diagnosis ICD-9-CM Diagnosis Codes
|496x |Chronic airway obstruction, not elsewhere classified |
|4912 |Obstructive chronic bronchitis |
|4918 |Other chronic bronchitis |
|4919 |Unspecified chronic bronchitis |
ALREADY IDENTIFIED AS NOT BEING FEASIBLE WITH ADMINISTRATIVE DATA
RF37 — Inability to take oral medications
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|7872 |Dysphagia |
ALREADY IDENTIFIED AS NOT BEING FEASIBLE WITH ADMINISTRATIVE DATA
RF38 — Temperature below 35C 95F or above 40C 104F
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|7806 |Fever |
|7807 |Malaise and fatigue |
|7808 |Hyperhidrosis
|
|7809 |Other general symptoms |
ALREADY IDENTIFIED AS NOT BEING FEASIBLE WITH ADMINISTRATIVE DATA
RF39 — Altered mental status
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|7800 |Alteration of consciousness |
|78093|Memory loss |
RF41 — Sodium below 130 mEq/L
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|2761 |Hyposmolality and/or hyponatremia |
RF42 — Hematocrit less than 30
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|2859 |Anemia, unspecified |
RF43 — Pleural effusion
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|5119 |Unspecified pleural effusion |
RF44 — Septicemia
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|0380 |Septicemia | |
|03810|Staphylococcal septicemia, unspecified | |
|03811|Staphylococcus aureus septicemia |
|
|03819|Other staphylococcal septicemia | |
|0382 |Pneumococcal septicemia | |
|0383 |Septicemia due to anaerobes | |
|03840|Septicemia due to gram-negative organism, unspecified |v12 |
|03841|Septicemia due to hemophilus influenzae h influenzae | |
|03842|Septicemia due to escherichia coli e coli | |
|03843|Septicemia due to pseudomonas | |
|03844|Septicemia due to serratia | |
|03849|Other septicemia due to gram-negative organisms | |
|0388 |Other specified septicemias | |
|0389 |Unspecified septicemia | |
RF45 — Respiratory failure
applies to Pneumonia
Any diagnosis ICD-9-CM Diagnosis Codes
|51881|Acute respiratory failure |
|51884|Acute and chronic respiratory failure |
Source:familiesusa.org
