bundled episode payment and gainsharing …page 1 bundled episode payment and gainsharing...

©2016 Integrated Healthcare Association. All Rights Reserved.

Bundled Episode Payment and Gainsharing Demonstration*

Cardiovascular Episode Definitions

Episode Definitions

1. Angioplasty with Stents

2. Diagnostic Cardiac Catheterization

* This project was supported by grant number R18HS020098 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

©2016 Integrated Healthcare Association. All Rights Reserved. Page 1

Bundled Episode Payment and Gainsharing Demonstration* Angioplasty with Stents Definition

Component Clinical/Payment

Summary Description

This definition covers a 30-day period of treatment for a qualified patient that begins with a scheduled angioplasty with drug-eluting stent or bare metal stent in one vessel or two vessels as an outcome of the diagnostic catheterization. The episode includes:

Professional and facility charges for angioplasty with drug eluting or bare metal stent(s) in one or two vessels (the index procedure) and for any observation stay.

Routine follow-up care during the episode period provided by the interventional cardiologist (or his cardiology group) during the episode period

Professional and facility charges for outpatient treatment of patient complications arising during the index procedure

Episode price will vary by whether stents are placed in one or two vessels, but not by the type or number of stents per cardiac vessel (Medicare billing definition). The definition excludes patients treated with stents in more than two vessels or who proceed to a coronary artery bypass graft as the recommended treatment following the diagnostic catheterization. This definition requires that an episode rate adjustment be assessed in the event any of a number of defined complications occurs. An episode rate adjustment is an amount that the provider team reimburses the health plan when defined complications occur during the episode period. The amount of the episode rate adjustment is negotiated between the health plan and the primary provider contractor for the episode and may vary by the type of complication; the complications are defined in Attachment B.

Episode Period 0 to 30; Episode begins on date for first index procedure and ends 30 days after the procedure date.

Dx, DRG and procedure codes for standard episodes

See Attachment A

Services

Services expected within the episode period (may not be separately billed), include:

Facility Charges—all services rendered on the same day as the index procedure and during any observational stay following the procedure,

Professional Charges—All services provided by Cardiologists, Interventional Cardiologists, Anesthesiologists, Radiologists, Hospitalists, Other consultants (e.g., internist) on the same day as the index procedure, or during an observational stay following the procedure.

Charges for x-rays or imaging performed on the same day as the index procedure, or during an observational stay following the procedure

Services which, if they occur within the episode period, may not be separately billed:

Professional fees for treatment of complications during episode period

Outpatient facility charges for treatment of complications during episode period

Professional and facility charges for repeat procedure within episode period

Charges for specified cardiac procedures (see Attachment C)

Services excluded from Standard Definition, may be separately billed:

OP Rx

Patient Qualification

For inclusion in the pilot, patient must be:

Covered by participating health plan on date of procedure

Over age 18 and under age 65

Delivery Case Rate Definition


Patients are excluded from the pilot if:

Covered by Medicare as primary payer

Admitted to the cath lab from an inpatient setting

Admitted to the cath lab from an emergency department

Diagnosis in any position equals one of the following:

Description ICD-9-CM Diagnosis

Acute Myocardial Infarction

410, 410.x, 410.xx,

429.5, 429.6, 429.7, 429.71, 429.79

Cardiac Trauma 423.0, 861.0, 861.00-861.03,

861.1, 861.10-861.13

Cardiac Congenital Disorder

425.1, 425.2, 745.0-745.9,

745.10-745.12, 745.19, 745.60, 745.61, 745.69, 746, 746.0-746.9, 746.00-746.02, 746.09, 746.81-746.89, 747, 747.0-747.5, 747.8, 747.9, 747.20-747.22, 747.29, 747.40-747.42, 747.49, 747.83, 747.89

Heart Transplant V42.1

Cancer 140-209, 230-239

HIV 042

BMI>=40 V85.4

Chronic Kidney Disease: Stage III, GFR 30-59

585.3

Chronic Kidney Disease: Stage IV, GFR 15-29

585.4

Chronic Kidney Disease: Stage V, GFR <15

585.5

Acute Congestive Heart Failure

428.21, 428.23, 428.31, 428.33, 428.41, 428.43

Outliers No clinical definition (that is, all patients are inliers).

Inpatient Complications

An episode rate adjustment applies if complications result in a CABG or in a related ED visit or inpatient stay within the episode period. See Attachment B.

Outpatient Complications

The episode includes all professional and facility charges to treat complications if the primary diagnosis code is one of the cardiac complication codes listed in Attachment B.

Other Outpatient Services

The definition includes all charges for services provided by the cardiologist or his cardiology group for follow-up care related to the procedure during the episode period and all charges (professional, facility, imaging center, etc) for the procedures identified in Attachment C.

Repeat Procedures

All charges for repeat procedures that are performed between the 1st and 30th day following the index procedure are included in the episode period (may not be separately billed). A repeat procedure is defined according the criteria in Attachment A.



Attachment A: Codes: Angioplasty with Stents

Index Procedure Code: One of these procedures must exist to trigger the episode. Angioplasty with Drug-Eluting or Non Drug Eluting Stent Stents in one vessel Drug Eluting : CPT: G0290 - Transcatheter placement of a drug eluting

intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel

ICD-9 Procedure Code:

36.07 - Insertion of drug-eluting coronary artery stent(s)

Non Drug Eluting: CPT: 92980 - Transcatheter placement of an intracoronary

stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel

Stents in two vessels Drug Eluting : CPT: G0291 - Transcatheter placement of a drug eluting

intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel

92981 - Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel

ICD-9 Procedure Code: 36.07 - Insertion of drug-eluting coronary artery stent(s)

Diagnosis Inclusions: Post-procedure diagnosis (any position) for the anchor procedure equals one of the following:

411 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE*

411 POSTMYOCARDIAL INFARCTION SYNDROME

411.1 INTERMEDIATE CORONARY SYNDROME

411.8 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE*

411.81 ACUTE COR OCCLUSION WITHOUT MYOCARDIAL INFARCT

411.89 OTHER ACUTE&SUBACUTE FORM ISCHEMIC HEART DISEASE

412 OLD MYOCARDIAL INFARCTION

413 ANGINA PECTORIS*

413 ANGINA DECUBITUS

413.1 PRINZMETAL ANGINA

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS

414 OTHER FORMS OF CHRONIC ISCHEMIC HEART DISEASE*

414.0x-414.07

CORONARY ATHEROSCLEROSIS

414.1 ANEURYSM AND DISSECTION OF HEART*

414.1 ANEURYSM OF HEART

414.11 ANEURYSM OF CORONARY VESSELS

414.12 DISSECTION OF CORONARY ARTERY

414.19 OTHER ANEURYSM OF HEART

414.8 OTHER SPEC FORMS CHRONIC ISCHEMIC HEART DISEASE

414.9 UNSPECIFIED CHRONIC ISCHEMIC HEART DISEASE






414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY

414.3 CORONARY ATHEROSCLEROSIS D/T LIPID RICH PLAQUE



428 HEART FAILURE*

428.1 LEFT HEART FAILURE

428.2 SYSTOLIC HEART FAILURE*

428.2 UNSPECIFIED SYSTOLIC HEART FAILURE

428.22 CHRONIC SYSTOLIC HEART FAILURE

428.3 DIASTOLIC HEART FAILURE*

428.3 UNSPECIFIED DIASTOLIC HEART FAILURE

428.32 CHRONIC DIASTOLIC HEART FAILURE



428.4 COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE*

428.4 UNSPEC COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE

428.42 CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAILURE

428.9 UNSPECIFIED HEART FAILURE

429.5 RUPTURE OF CHORDAE TENDINEAE

429.6 RUPTURE OF PAPILLARY MUSCLE

429.7 CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NEC*

429.71 ACQUIRED CARDIAC SEPTAL DEFECT

429.79 OTHER CERTAIN SEQUELAE MYOCARDIAL INFARCTION NEC



Attachment B: Complications that result in an episode rate adjustment

Regardless of the provider used, a repeat procedure during the episode period will generate a financial penalty. Regardless of the provider used, if a patient receives angioplasty with stent(s) and subsequently receives CABG between the 1st and the 30th day following the index procedure, CABG is assumed to have resulted from a complication and will generate an episode rate adjustment An acute admission is any admission during the episode period beyond a 23 hour and 59 minute observation stay following the index procedure. Regardless of the provider or site of service, any ED visit or acute admission that begins between the 1st and the 30th day following the index procedure, and carries a diagnosis contained in the table below will result in an episode rate adjustment.

ICD-9 Dx Code Diagnosis Code Description ETG Description

410 ACUTE MYOCARDIAL INFARCTION* Ischemic heart disease

410.0 ACUTE MYOCARDIAL INFARCTION ANTEROLATERAL WALL* Ischemic heart disease

410.00 ACUT MI ANTEROLAT WALL EPIS CARE UNS Ischemic heart disease

410.01 ACUT MI ANTEROLAT WALL INIT EPIS CARE Ischemic heart disease

410.02 ACUT MI ANTEROLAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.1 ACUTE MYOCARDIAL INFARCTION OTHER ANTERIOR WALL* Ischemic heart disease

410.10 ACUT MYOCARD INFARCT OTH ANT WALL EPIS CARE UNS Ischemic heart disease

410.11 ACUT MYOCARD INFARCT OTH ANT WALL INIT EPIS CARE Ischemic heart disease

410.12 ACUT MI OTH ANT WALL SUBSQT EPIS CARE Ischemic heart disease

410.2 ACUTE MYOCARDIAL INFARCTION INFEROLATERAL WALL* Ischemic heart disease

410.20 ACUT MI INFEROLAT WALL EPIS CARE UNS Ischemic heart disease

410.21 ACUT MI INFEROLAT WALL INIT EPIS CARE Ischemic heart disease

410.22 ACUT MI INFEROLAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.3 ACUTE MYOCARDIAL INFARCTION INFEROPOSTERIOR WALL* Ischemic heart disease

410.30 ACUT MI INFEROPOST WALL EPIS CARE UNS Ischemic heart disease

410.31 ACUT MI INFEROPOST WALL INIT EPIS CARE Ischemic heart disease

410.32 ACUT MI INFEROPOST WALL SUBSQT EPIS CARE Ischemic heart disease

410.4 ACUTE MYOCARDIAL INFARCTION OTHER INFERIOR WALL* Ischemic heart disease

410.40 ACUT MYOCARD INFARCT OTH INF WALL EPIS CARE UNS Ischemic heart disease

410.41 ACUT MYOCARD INFARCT OTH INF WALL INIT EPIS CARE Ischemic heart disease

410.42 ACUT MI OTH INF WALL SUBSQT EPIS CARE Ischemic heart disease

410.5 ACUTE MYOCARDIAL INFARCTION OTHER LATERAL WALL* Ischemic heart disease

410.50 ACUT MYOCARD INFARCT OTH LAT WALL EPIS CARE UNS Ischemic heart disease

410.51 ACUT MYOCARD INFARCT OTH LAT WALL INIT EPIS CARE Ischemic heart disease

410.52 ACUT MI OTH LAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.6 ACUTE MYOCARD INFARCT TRUE POST WALL INFARCT* Ischemic heart disease

410.60 ACUT MI TRUE POST WALL INFARCT EPIS CARE UNS Ischemic heart disease

410.61 ACUT MI TRUE POST WALL INFARCT INIT EPIS CARE Ischemic heart disease

410.62 ACUT MI TRUE POST WALL INFARCT SUBSQT EPIS CARE Ischemic heart disease

410.7 ACUTE MYOCARDIAL INFARCT SUBENDOCARDIAL INFARCT* Ischemic heart disease

410.70 ACUT MI SUBENDOCARDIAL INFARCT EPIS CARE UNS Ischemic heart disease

410.71 ACUT MI SUBENDOCARDIAL INFARCT INIT EPIS CARE Ischemic heart disease

410.72 ACUT MI SUBENDOCARDIAL INFARCT SUBSQT EPIS CARE Ischemic heart disease

410.8 ACUTE MYOCARDIAL INFARCTION OTHER SPEC SITES* Ischemic heart disease

410.80 ACUT MYOCARD INFARCT OTH SPEC SITE EPIS CARE UNS Ischemic heart disease

410.81 ACUT MYOCARD INFARCT OTH SITE INIT EPIS CARE Ischemic heart disease



410.82 ACUT MYOCARD INFARCT OTH SITE SUBSQT EPIS CARE Ischemic heart disease

410.9 ACUTE MYOCARDIAL INFARCTION UNSPECIFIED SITE* Ischemic heart disease

410.90 ACUT MYOCARD INFARCT UNS SITE EPIS CARE UNS Ischemic heart disease

410.91 ACUTE MYOCARD INFARCT UNSPEC SITE INIT EPIS CARE Ischemic heart disease

410.92 ACUT MYOCARD INFARCT UNS SITE SUBSQT EPIS CARE Ischemic heart disease

411 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE* Ischemic heart disease

411.0 POSTMYOCARDIAL INFARCTION SYNDROME Ischemic heart disease

411.1 INTERMEDIATE CORONARY SYNDROME Ischemic heart disease

411.8 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE* Ischemic heart disease

411.81 ACUTE COR OCCLUSION WITHOUT MYOCARDIAL INFARCT Ischemic heart disease

411.89 OTHER ACUTE&SUBACUTE FORM ISCHEMIC HEART DISEASE Ischemic heart disease

412 OLD MYOCARDIAL INFARCTION Ischemic heart disease

413 ANGINA PECTORIS* Ischemic heart disease

413.0 ANGINA DECUBITUS Ischemic heart disease

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS Ischemic heart disease

414.0 CORONARY ATHEROSCLEROSIS* Ischemic heart disease

414.00 COR ATHEROSLERO UNSPEC TYPE VESSEL NATIVE/GRAFT Ischemic heart disease

414.01 CORONARY ATHEROSCLEROSIS NATIVE CORONARY ARTERY Ischemic heart disease

414.02 CORONARY ATHEROSLERO AUTOL VEIN BYPASS GRAFT Ischemic heart disease

414.03 COR ATHEROSLERO NONAUTOL BIOLOGICAL BYPS GRAFT Ischemic heart disease

414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT Ischemic heart disease

414.05 CORONARY ATHEROSLERO UNSPEC TYPE BYPASS GRAFT Ischemic heart disease

414.06 COR ATHEROSLERO COR ART TRANSPLANTED HEART Ischemic heart disease

414.07 COR ATHEROSLERO BYPS GRAFT TRANSPLANTED HEART Ischemic heart disease

414.1 ANEURYSM AND DISSECTION OF HEART* Ischemic heart disease

414.10 ANEURYSM OF HEART Ischemic heart disease

414.11 ANEURYSM OF CORONARY VESSELS Ischemic heart disease

414.12 DISSECTION OF CORONARY ARTERY Ischemic heart disease

414.19 OTHER ANEURYSM OF HEART Ischemic heart disease

414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY Ischemic heart disease

414.3 CORONARY ATHEROSCLEROSIS D/T LIPID RICH PLAQUE Ischemic heart disease

414.8 OTHER SPEC FORMS CHRONIC ISCHEMIC HEART DISEASE Ischemic heart disease

414.9 UNSPECIFIED CHRONIC ISCHEMIC HEART DISEASE Ischemic heart disease

415.1 PULMONARY EMBOLISM AND INFARCTION* Pulmonary embolism

415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION Pulmonary embolism

415.12 SEPTIC PULMONARY EMBOLISM Pulmonary embolism

415.19 OTHER PULMONARY EMBOLISM AND INFARCTION Pulmonary embolism

416.2 CHRONIC PULMONARY EMBOLISM Pulmonary embolism

423.0 HEMOPERICARDIUM Cardiac trauma

423.3 CARDIAC TAMPONADE Cardiovascular diseases signs & symptoms

428 HEART FAILURE* Congestive heart failure

428.0 CONGESTIVE HEART FAILURE UNSPECIFIED Congestive heart failure

428.1 LEFT HEART FAILURE Congestive heart failure

428.2 SYSTOLIC HEART FAILURE* Congestive heart failure

428.20 UNSPECIFIED SYSTOLIC HEART FAILURE Congestive heart failure

428.21 ACUTE SYSTOLIC HEART FAILURE Congestive heart failure

428.22 CHRONIC SYSTOLIC HEART FAILURE Congestive heart failure

428.23 ACUTE ON CHRONIC SYSTOLIC HEART FAILURE Congestive heart failure

428.4 COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE* Congestive heart failure

428.40 UNSPEC COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure



428.41 ACUTE COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure

428.42 CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure

428.43 ACUTE CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAIL Congestive heart failure

428.9 UNSPECIFIED HEART FAILURE Congestive heart failure

444 ARTERIAL EMBOLISM AND THROMBOSIS* Arterial embolism/thrombosis

444.0 EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA Arterial embolism/thrombosis

444.1 EMBOLISM AND THROMBOSIS OF THORACIC AORTA Arterial embolism/thrombosis

444.2 EMBOLISM&THROMBOSIS ARTERIES THE EXTREMITIES* Arterial embolism/thrombosis

444.21 EMBOLISM&THROMBOSIS ARTERIES UPPER EXTREMITY Arterial embolism/thrombosis

444.22 EMBOLISM&THROMBOSIS ARTERIES LOWER EXTREMITY Arterial embolism/thrombosis

444.8 EMBOLISM&THROMBOSIS OF OTHER SPECIFIED ARTERY* Arterial embolism/thrombosis

444.81 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY Arterial embolism/thrombosis

444.89 EMBOLISM&THROMBOSIS OF OTHER SPECIFIED ARTERY Arterial embolism/thrombosis

444.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY Arterial embolism/thrombosis

445 ATHEROEMBOLISM* Arterial embolism/thrombosis

445.0 ATHEROEMBOLISM OF EXTREMITIES* Arterial embolism/thrombosis

445.01 ATHEROEMBOLISM OF UPPER EXTREMITY Arterial embolism/thrombosis

445.02 ATHEROEMBOLISM OF LOWER EXTREMITY Arterial embolism/thrombosis

445.8 ATHEROEMBOLISM OF OTHER SITES* Arterial embolism/thrombosis

445.81 ATHEROEMBOLISM OF KIDNEY Arterial embolism/thrombosis

445.89 ATHEROEMBOLISM OF OTHER SITE Arterial embolism/thrombosis

447.2 RUPTURE OF ARTERY Arterial embolism/thrombosis

451.0 PHLEBITIS&THROMBOPHLEB SUP VESSELS LOWER EXTREM Phlebitis & thrombophlebitis of veins

451.1 PHLEBITIS&THROMBOPHLEB DEEP VEINS LOWER EXTREM* Phlebitis & thrombophlebitis of veins

451.11 PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN Phlebitis & thrombophlebitis of veins

451.19 PHLEBITIS&THROMBOPHLEB OTH DEEP VES LOWER EXTREM Phlebitis & thrombophlebitis of veins

451.2 PHLEBITIS&THROMBOPHLEBITIS LOWER EXTREM UNSPEC Phlebitis & thrombophlebitis of veins

451.81 PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN Phlebitis & thrombophlebitis of veins

453.4 AC VNUS EMB&THRMB DP VES LWR EXTREM Embolism & thrombosis of veins

453.40 AC VNUS EMB&THRMB UNS DP VES LW EXT Embolism & thrombosis of veins

453.41 AC VNUS EMB&THRMB DP VES PRX LW EXT Embolism & thrombosis of veins

453.42 AC VNUS EMB&THRMB DP VES DST LW EXT Embolism & thrombosis of veins

453.5 CHRON VENOUS EMB & THROMBO DEEP VES LOWR EXTREM Embolism & thrombosis of veins

453.50 CHRON VNUS EMB & THROMB UNSPEC DEEP VES LOWR EXT Embolism & thrombosis of veins

453.51 CHRN VNUS EMB & THROMB DEEP VES PROX LOWR EXTREM Embolism & thrombosis of veins

453.52 CHRN VNUS EMBO & THROMB DP VES DISTL LOWR EXTREM Embolism & thrombosis of veins

453.6 VENOUS EMBO & THROMB SUPERFICIAL VES LOWR EXTREM Embolism & thrombosis of veins

785.51 CARDIOGENIC SHOCK Cardiovascular diseases signs & symptoms

786.5 CHEST PAIN* Cardiovascular diseases signs & symptoms

786.50 CHEST PAIN UNSPECIFIED Cardiovascular diseases signs & symptoms

786.51 PRECORDIAL PAIN Cardiovascular diseases signs & symptoms

786.59 OTHER CHEST PAIN Cardiovascular diseases signs & symptoms

794.3 NONSPECIFIC ABNORMAL RESULTS CV FUNCTION STUDY* Cardiovascular diseases signs & symptoms

794.30 NONSPECIFIC ABNORMAL UNSPEC CV FUNCTION STUDY Cardiovascular diseases signs & symptoms

794.31 NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM Cardiovascular diseases signs & symptoms

794.39 OTH NONSPECIFIC ABNORM CV SYSTEM FUNCTION STUDY Cardiovascular diseases signs & symptoms

861.0 HRT INJURY WITHOUT MENTION OPEN WOUND INTO THOR* Cardiac trauma

861.00 UNSPEC INJURY HRT W/O MENTION OPEN WOUND IN THOR Cardiac trauma

861.01 HRT CONTUS WITHOUT MENTION OPEN WOUND INTO THOR Cardiac trauma



861.03 HEART LACERATION W/PENETRATION OF CHAMBERS Cardiac trauma

902.0 ABDOMINAL AORTA INJURY Arterial trauma

902.53 ILIAC ARTERY INJURY Arterial trauma

904.0 COMMON FEMORAL ARTERY INJURY Arterial trauma

904.1 SUPERFICIAL FEMORAL ARTERY INJURY Arterial trauma



Attachment C: Cardiac Procedure Codes: Outpatient Services

All services billed by the interventional cardiologist (or others within the cardiology group) within the episode period are included in the episode definition and may not be separately billed. Other Charges All charges associated with the procedures below are included in the episode definition and may not be separately billed when performed with the episode period.

Procedure Group Description Proc Code Procedure Description

CARDIAC COMPUTED TOMOGRAPHY

0144T Computed tomography, heart, without contrast material, including image postprocessing and quantitative evaluation of coronary calcium


0145T Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology


0146T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary


0147T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; computed tomographic angiography of coronary arteries (including native and anomalous coronary arteries, coronary


0148T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and


0149T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology and computed tomographic angiography of coronary arteries (including native and


0150T Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing; cardiac structure and morphology in congenital heart disease


0151T

Computed tomography, heart, with contrast material(s), including noncontrast images, if performed, cardiac gating and 3D image postprocessing, function evaluation (left and right ventricular function, ejection-fraction and segmental wall motion) (List sep


75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium


75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)


75573

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation


75574

Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation



CARDIAC MAGNETIC RESONANCE IMAGING

75552 Cardiac magnetic resonance imaging for morphology; without contrast material


75553 Cardiac magnetic resonance imaging for morphology; with contrast material


75554 Cardiac magnetic resonance imaging for function, with or without morphology; complete study


75555 Cardiac magnetic resonance imaging for function, with or without morphology; limited study


75556 Cardiac magnetic resonance imaging for velocity flow mapping


75557 Cardiac magnetic resonance imaging for morphology and function without contrast material;


75558 Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification


75559 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging


75560 Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification and stress


75561 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;


75562 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification


75563 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging


75564 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress


75565 Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure)

ECHOCARDIOGRAPHY 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete

ECHOCARDIOGRAPHY 93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study

ECHOCARDIOGRAPHY 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

ECHOCARDIOGRAPHY 93307 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography

ECHOCARDIOGRAPHY 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study

ECHOCARDIOGRAPHY C8929

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler

EKG 0178T Electrocardiogram, 64 leads or greater, with graphic presentation and analysis; with interpretation and report

EKG 0179T Electrocardiogram, 64 leads or greater, with graphic presentation and analysis; tracing and graphics only, without interpretation and report

EKG 0180T Electrocardiogram, 64 leads or greater, with graphic presentation and analysis; interpretation and report only

EKG 0206T Algorithmic analysis, remote, of electrocardiographic-derived data with computer



probability assessment, including report

EKG 3120F 12-Lead ECG Performed (EM)

EKG 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

EKG 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

EKG 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

EKG 93040 Rhythm ECG, 1-3 leads; with interpretation and report

EKG 93041 Rhythm ECG, 1-3 leads; tracing only without interpretation and report

EKG 93042 Rhythm ECG, 1-3 leads; interpretation and report only

EKG C8921 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete

EKG C8922 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study

EKG C8923 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D) with or without M-mode recording; complete

EKG C8924 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D) with or without M-mode recording; follow-up or limited study

EKG C8925

Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report

EKG C8926 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report

EKG C8928

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), with or without M-mode recording, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pha

EKG G0366 Ecg at least 12 leads; i&r cmpnt init prev pe

EKG G0367 Ecg =/>12 leads; tracing only cmpnt init prev pe

EKG G0368 Ecg =/> 12 leads; i&r only cmpnt init prev pe

EKG G8350 Pt doc to have had 12-lead ecg performed

EKG G8356 Pt doc to have had ecg performed

EKG G8397 Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy

EXERCISE STRESS TEST 93015 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report

EXERCISE STRESS TEST 93016 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report

EXERCISE STRESS TEST 93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report

EXERCISE STRESS TEST 93018 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only

CARDIAC PERFUSION IMAGING AT REST ONLY

78451 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or



gated technique, additional quantification, when performed); single study, at rest or stress (


78452

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or


78453 Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)


78454

Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) an


78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation


78460 Myocardial perfusion imaging; (planar) single study, at rest or stress (exercise and/or pharmacologic), with or without quantification


78461 Myocardial perfusion imaging; multiple studies (planar), at rest and/or stress (exercise and/or pharmacologic), and redistribution and/or rest injection, with or without quantification


78464 Myocardial perfusion imaging; tomographic (SPECT), single study (including attenuation correction when performed), at rest or stress (exercise and/or pharmacologic), with or without quantification


78465

Myocardial perfusion imaging; tomographic (SPECT), multiple studies (including attenuation correction when performed), at rest and/or stress (exercise and/or pharmacologic) and redistribution and/or rest injection, with or without quantification


78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative


78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique


78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification


78472 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing


78478 Myocardial perfusion study with wall motion, qualitative or quantitative study (List separately in addition to code for primary procedure)


78480 Myocardial perfusion study with ejection fraction (List separately in addition to code for primary procedure)


78481 Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification


78491 Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress


78492 Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest and/or stress


78494 Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing


78496 Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure)

CARDIAC PERFUSION IMAGING AT 78499 Unlisted cardiovascular procedure, diagnostic nuclear medicine



REST ONLY

CARDIAC IMAGING WITH EXERCISE

78473 Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or without additional quantification


78483 Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification


93350

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation


93351

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation


A9500 Technetium tc-99m sestamibi, diagnostic, per study dose


A9505 Thallium Tl-201 thallous chloride, diagnostic, per millicurie


C8930

Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise

TRANS-ESOPHAGEAL ECHOCARDIOGRAPHY

93312 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report


93314 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only


93315 Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report


93317 Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only

*This project was supported by grant number R18HS020098 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.


Bundled Episode Payment and Gainsharing Demonstration* Diagnostic Cardiac Catheterization Definition

Component

Clinical/Payment

Summary Description

This definition covers a 30-day period of treatment for a qualified patient that begins with a scheduled cardiac catheterization. The episode includes:

Professional and facility charges for a diagnostic catheterization (index procedure) and for any observation stay.

Routine follow-up care provided by the interventional cardiologist (or her cardiology group) during the episode period

Professional and facility charges for outpatient treatment of patient complications arising during the index procedure

A separate definition and episode price applies to the patient who is treated with an angioplasty with stents in one or two vessels. The definition excludes patients who are treated with stents in more than two vessels or who proceed to a coronary artery bypass graft as the recommended treatment following the diagnostic catheterization. This definition requires that an episode rate adjustment be assessed in the event a defined complication occurs. An episode rate adjustment is an amount that the provider team reimburses the health plan when defined complications occur. The amount of the episode rate adjustment may vary by the type of complication; the complications are defined in Attachment B.

Episode Period

0 to 30; Episode begins on date for index procedure and ends 30 days after the procedure date.

Dx, DRG and procedure codes for standard episodes

See Attachment A

Services

Services expected within the episode period (may not be separately billed), include:

Facility Charges—all services rendered on the same day as the index procedure, or during an observational stay following the procedure.

Professional Charges: All services provided by Cardiologists, Interventional Cardiologists, Anesthesiologists, Radiologists, Hospitalists, Other consultants (e.g., internist) on the same day as the index procedure, or during an observational stay following the procedure.

Charges for x-rays or imaging performed on the same day as the index procedure, or during an observational stay following the procedure.

Services which, if they occur within the episode period, may not be separately billed:

Charges billed by the treating cardiology group and associated facility for outpatient treatment of complications during episode period

Services excluded from Standard Definition, may be separately billed:

OP Rx

Patient Qualification

For inclusion in the pilot, patient must be:

Covered by participating health plan on date of procedure

Over age 18 and under age 65



Patients are excluded from the pilot if:

Covered by Medicare as primary payer

Admitted to the cath lab from an inpatient setting

Admitted to the cath lab from an emergency department

Diagnosis in any position equals one of the following:

Description ICD-9-CM Diagnosis

Acute Myocardial Infarction

410, 410.x, 410.xx,

429.5, 429.6, 429.7, 429.71, 429.79

Cardiac Trauma 423.0, 861.0, 861.00-861.03, 861.1, 861.10-861.13

Cardiac Congenital Disorder

425.1, 425.2, 745.0-745.9,

745.10-745.12, 745.19, 745.60, 745.61, 745.69, 746, 746.0-746.9, 746.00-746.02, 746.09,

746.81-746.89, 747, 747.0-747.5, 747.8, 747.9, 747.20-747.22, 747.29, 747.40-747.42,

747.49, 747.83, 747.89

Heart Transplant V42.1

Cancer 140-209, 230-239

HIV 042

BMI>=40 V85.4

Chronic Kidney Disease: Stage III, GFR 30-59

585.3

Chronic Kidney Disease: Stage IV, GFR 15-29

585.4

Chronic Kidney Disease: Stage V, GFR <15

585.5

Acute Congestive Heart Failure

428.21, 428.23, 428.31, 428.33, 428.41, 428.43

Additional Exclusions

CABG: Patients who are scheduled to undergo CABG (codes S2205-S2209, 33510-33516, 33533-33536) as appropriate treatment of their disease are excluded from this definition.

If an intervention of angioplasty with drug or non-drug eluting stent occurs, then this bundle is superseded by the bundle for the intervention:

Outliers

No clinical definition (that is, all patients are inliers).

Inpatient Complications

An episode rate adjustment applies if complications result in a CABG or in a related ED visit or inpatient stay within the episode period. See Attachment B.

Outpatient Complications

All services provided by the cardiologist (or his cardiology group) to treat outpatient complications that begin during the episode period are included in the episode, as well as facility charges from the facility where the index procedure was performed.



Attachment A:

Procedure and Diagnosis Codes Defining Diagnostic Catheterization Procedure

Index Procedure Code: One of these procedures must exist to trigger the episode. Diagnostic catheterization Note that there were several CPT code modifications for diagnostic catheterization effective 1/1/2011. Therefore the code sets used for the retrospective analyses (for services incurred through 12/31/10) will differ from those used for the prospective definition. CPT (for prospective definition): 93451—Right heart catheterization 93452—Left heart catheterization 93453—Combined right and left heart

catheterization 93454-93461—Catheter placement in

coronary artery(s) 93563-93568—Injection procedure during

cardiac cath CPT (for retrospective analyses): 93508—Catheter placement in coronary

artery(s) 93510-93511—Left heart catheterization 93524—Combined transseptal and

retrograde left heart catheterization 93526-93529; 93531-93533—Combined

right and left heart catheterization 93539, 93540, 93543, 93545—Injection

procedure during cardiac cath 93556--Imaging supervision,

interpretation and report for injection procedure(s) during cardiac catheterization

Diagnosis Inclusions: Post-procedure diagnosis (any position) for the anchor procedure must equal one of the following:

411 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE*

411 POSTMYOCARDIAL INFARCTION SYNDROME

411.1 INTERMEDIATE CORONARY SYNDROME

411.8 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE*

411.81 ACUTE COR OCCLUSION WITHOUT MYOCARDIAL INFARCT

411.89 OTHER ACUTE&SUBACUTE FORM ISCHEMIC HEART DISEASE

412 OLD MYOCARDIAL INFARCTION

413 ANGINA PECTORIS*

413 ANGINA DECUBITUS

413.1 PRINZMETAL ANGINA

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS

414 OTHER FORMS OF CHRONIC ISCHEMIC HEART DISEASE*

414.0x-414.07 CORONARY ATHEROSCLEROSIS













414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY

414.3 CORONARY ATHEROSCLEROSIS D/T LIPID RICH PLAQUE



428 HEART FAILURE*



428.1 LEFT HEART FAILURE

428.2 SYSTOLIC HEART FAILURE*

428.2 UNSPECIFIED SYSTOLIC HEART FAILURE

428.22 CHRONIC SYSTOLIC HEART FAILURE

428.3 DIASTOLIC HEART FAILURE*

428.3 UNSPECIFIED DIASTOLIC HEART FAILURE

428.32 CHRONIC DIASTOLIC HEART FAILURE

428.4 COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE*

428.4 UNSPEC COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE

428.42 CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAILURE

428.9 UNSPECIFIED HEART FAILURE

429.5 RUPTURE OF CHORDAE TENDINEAE

429.6 RUPTURE OF PAPILLARY MUSCLE

429.7 CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NEC*

429.71 ACQUIRED CARDIAC SEPTAL DEFECT

429.79 OTHER CERTAIN SEQUELAE MYOCARDIAL INFARCTION NEC



Attachment B:

Complications that result in an episode rate adjustment A CABG performed as a result of complications from diagnostic cath results in an episode rate adjustment. An acute admission is any admission during the episode period beyond a 23 hour and 59 minute observation stay following the index procedure. Regardless of the provider or site of service, any ED visit or acute admission that begins between the 1st and the 30th day following the index procedure, and carries a diagnosis contained in the table below will result in an episode rate adjustment.

ICD-9 Dx Code Diagnosis Code Description ETG Description

410 ACUTE MYOCARDIAL INFARCTION* Ischemic heart disease

410.0 ACUTE MYOCARDIAL INFARCTION ANTEROLATERAL WALL* Ischemic heart disease

410.00 ACUT MI ANTEROLAT WALL EPIS CARE UNS Ischemic heart disease

410.01 ACUT MI ANTEROLAT WALL INIT EPIS CARE Ischemic heart disease

410.02 ACUT MI ANTEROLAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.1 ACUTE MYOCARDIAL INFARCTION OTHER ANTERIOR WALL* Ischemic heart disease

410.10 ACUT MYOCARD INFARCT OTH ANT WALL EPIS CARE UNS Ischemic heart disease

410.11 ACUT MYOCARD INFARCT OTH ANT WALL INIT EPIS CARE Ischemic heart disease

410.12 ACUT MI OTH ANT WALL SUBSQT EPIS CARE Ischemic heart disease

410.2 ACUTE MYOCARDIAL INFARCTION INFEROLATERAL WALL* Ischemic heart disease

410.20 ACUT MI INFEROLAT WALL EPIS CARE UNS Ischemic heart disease

410.21 ACUT MI INFEROLAT WALL INIT EPIS CARE Ischemic heart disease

410.22 ACUT MI INFEROLAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.3 ACUTE MYOCARDIAL INFARCTION INFEROPOSTERIOR WALL* Ischemic heart disease

410.30 ACUT MI INFEROPOST WALL EPIS CARE UNS Ischemic heart disease

410.31 ACUT MI INFEROPOST WALL INIT EPIS CARE Ischemic heart disease

410.32 ACUT MI INFEROPOST WALL SUBSQT EPIS CARE Ischemic heart disease

410.4 ACUTE MYOCARDIAL INFARCTION OTHER INFERIOR WALL* Ischemic heart disease

410.40 ACUT MYOCARD INFARCT OTH INF WALL EPIS CARE UNS Ischemic heart disease

410.41 ACUT MYOCARD INFARCT OTH INF WALL INIT EPIS CARE Ischemic heart disease

410.42 ACUT MI OTH INF WALL SUBSQT EPIS CARE Ischemic heart disease

410.5 ACUTE MYOCARDIAL INFARCTION OTHER LATERAL WALL* Ischemic heart disease

410.50 ACUT MYOCARD INFARCT OTH LAT WALL EPIS CARE UNS Ischemic heart disease

410.51 ACUT MYOCARD INFARCT OTH LAT WALL INIT EPIS CARE Ischemic heart disease

410.52 ACUT MI OTH LAT WALL SUBSQT EPIS CARE Ischemic heart disease

410.6 ACUTE MYOCARD INFARCT TRUE POST WALL INFARCT* Ischemic heart disease

410.60 ACUT MI TRUE POST WALL INFARCT EPIS CARE UNS Ischemic heart disease

410.61 ACUT MI TRUE POST WALL INFARCT INIT EPIS CARE Ischemic heart disease

410.62 ACUT MI TRUE POST WALL INFARCT SUBSQT EPIS CARE Ischemic heart disease

410.7 ACUTE MYOCARDIAL INFARCT SUBENDOCARDIAL INFARCT* Ischemic heart disease

410.70 ACUT MI SUBENDOCARDIAL INFARCT EPIS CARE UNS Ischemic heart disease

410.71 ACUT MI SUBENDOCARDIAL INFARCT INIT EPIS CARE Ischemic heart disease

410.72 ACUT MI SUBENDOCARDIAL INFARCT SUBSQT EPIS CARE Ischemic heart disease

410.8 ACUTE MYOCARDIAL INFARCTION OTHER SPEC SITES* Ischemic heart disease

410.80 ACUT MYOCARD INFARCT OTH SPEC SITE EPIS CARE UNS Ischemic heart disease

410.81 ACUT MYOCARD INFARCT OTH SITE INIT EPIS CARE Ischemic heart disease



410.82 ACUT MYOCARD INFARCT OTH SITE SUBSQT EPIS CARE Ischemic heart disease

410.9 ACUTE MYOCARDIAL INFARCTION UNSPECIFIED SITE* Ischemic heart disease

410.90 ACUT MYOCARD INFARCT UNS SITE EPIS CARE UNS Ischemic heart disease

410.91 ACUTE MYOCARD INFARCT UNSPEC SITE INIT EPIS CARE Ischemic heart disease

410.92 ACUT MYOCARD INFARCT UNS SITE SUBSQT EPIS CARE Ischemic heart disease

411 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE* Ischemic heart disease

411.0 POSTMYOCARDIAL INFARCTION SYNDROME Ischemic heart disease

411.1 INTERMEDIATE CORONARY SYNDROME Ischemic heart disease

411.8 OTH ACUTE&SUBACUTE FORMS ISCHEMIC HEART DISEASE* Ischemic heart disease

411.81 ACUTE COR OCCLUSION WITHOUT MYOCARDIAL INFARCT Ischemic heart disease

411.89 OTHER ACUTE&SUBACUTE FORM ISCHEMIC HEART DISEASE Ischemic heart disease

412 OLD MYOCARDIAL INFARCTION Ischemic heart disease

413 ANGINA PECTORIS* Ischemic heart disease

413.0 ANGINA DECUBITUS Ischemic heart disease

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS Ischemic heart disease

414.0 CORONARY ATHEROSCLEROSIS* Ischemic heart disease

414.00 COR ATHEROSLERO UNSPEC TYPE VESSEL NATIVE/GRAFT Ischemic heart disease

414.01 CORONARY ATHEROSCLEROSIS NATIVE CORONARY ARTERY Ischemic heart disease

414.02 CORONARY ATHEROSLERO AUTOL VEIN BYPASS GRAFT Ischemic heart disease

414.03 COR ATHEROSLERO NONAUTOL BIOLOGICAL BYPS GRAFT Ischemic heart disease

414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT Ischemic heart disease

414.05 CORONARY ATHEROSLERO UNSPEC TYPE BYPASS GRAFT Ischemic heart disease

414.06 COR ATHEROSLERO COR ART TRANSPLANTED HEART Ischemic heart disease

414.07 COR ATHEROSLERO BYPS GRAFT TRANSPLANTED HEART Ischemic heart disease

414.1 ANEURYSM AND DISSECTION OF HEART* Ischemic heart disease

414.10 ANEURYSM OF HEART Ischemic heart disease

414.11 ANEURYSM OF CORONARY VESSELS Ischemic heart disease

414.12 DISSECTION OF CORONARY ARTERY Ischemic heart disease

414.19 OTHER ANEURYSM OF HEART Ischemic heart disease

414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY Ischemic heart disease

414.3 CORONARY ATHEROSCLEROSIS D/T LIPID RICH PLAQUE Ischemic heart disease

414.8 OTHER SPEC FORMS CHRONIC ISCHEMIC HEART DISEASE Ischemic heart disease

414.9 UNSPECIFIED CHRONIC ISCHEMIC HEART DISEASE Ischemic heart disease

415.1 PULMONARY EMBOLISM AND INFARCTION* Pulmonary embolism

415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION Pulmonary embolism

415.12 SEPTIC PULMONARY EMBOLISM Pulmonary embolism

415.19 OTHER PULMONARY EMBOLISM AND INFARCTION Pulmonary embolism

416.2 CHRONIC PULMONARY EMBOLISM Pulmonary embolism

423.0 HEMOPERICARDIUM Cardiac trauma

423.3 CARDIAC TAMPONADE Cardiovascular diseases signs & symptoms

428 HEART FAILURE* Congestive heart failure

428.0 CONGESTIVE HEART FAILURE UNSPECIFIED Congestive heart failure

428.1 LEFT HEART FAILURE Congestive heart failure

428.2 SYSTOLIC HEART FAILURE* Congestive heart failure

428.20 UNSPECIFIED SYSTOLIC HEART FAILURE Congestive heart failure

428.21 ACUTE SYSTOLIC HEART FAILURE Congestive heart failure

428.22 CHRONIC SYSTOLIC HEART FAILURE Congestive heart failure

428.23 ACUTE ON CHRONIC SYSTOLIC HEART FAILURE Congestive heart failure

428.4 COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE* Congestive heart failure

428.40 UNSPEC COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure



428.41 ACUTE COMBINED SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure

428.42 CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAILURE Congestive heart failure

428.43 ACUTE CHRONIC COMB SYSTOLIC&DIASTOLIC HEART FAIL Congestive heart failure

428.9 UNSPECIFIED HEART FAILURE Congestive heart failure

444 ARTERIAL EMBOLISM AND THROMBOSIS* Arterial embolism/thrombosis

444.0 EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA Arterial embolism/thrombosis

444.1 EMBOLISM AND THROMBOSIS OF THORACIC AORTA Arterial embolism/thrombosis

444.2 EMBOLISM&THROMBOSIS ARTERIES THE EXTREMITIES* Arterial embolism/thrombosis

444.21 EMBOLISM&THROMBOSIS ARTERIES UPPER EXTREMITY Arterial embolism/thrombosis

444.22 EMBOLISM&THROMBOSIS ARTERIES LOWER EXTREMITY Arterial embolism/thrombosis

444.8 EMBOLISM&THROMBOSIS OF OTHER SPECIFIED ARTERY* Arterial embolism/thrombosis

444.81 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY Arterial embolism/thrombosis

444.89 EMBOLISM&THROMBOSIS OF OTHER SPECIFIED ARTERY Arterial embolism/thrombosis

444.9 EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY Arterial embolism/thrombosis

445 ATHEROEMBOLISM* Arterial embolism/thrombosis

445.0 ATHEROEMBOLISM OF EXTREMITIES* Arterial embolism/thrombosis

445.01 ATHEROEMBOLISM OF UPPER EXTREMITY Arterial embolism/thrombosis

445.02 ATHEROEMBOLISM OF LOWER EXTREMITY Arterial embolism/thrombosis

445.8 ATHEROEMBOLISM OF OTHER SITES* Arterial embolism/thrombosis

445.81 ATHEROEMBOLISM OF KIDNEY Arterial embolism/thrombosis

445.89 ATHEROEMBOLISM OF OTHER SITE Arterial embolism/thrombosis

447.2 RUPTURE OF ARTERY Arterial embolism/thrombosis

451.0 PHLEBITIS&THROMBOPHLEB SUP VESSELS LOWER EXTREM Phlebitis & thrombophlebitis of veins

451.1 PHLEBITIS&THROMBOPHLEB DEEP VEINS LOWER EXTREM* Phlebitis & thrombophlebitis of veins

451.11 PHLEBITIS AND THROMBOPHLEBITIS OF FEMORAL VEIN Phlebitis & thrombophlebitis of veins

451.19 PHLEBITIS&THROMBOPHLEB OTH DEEP VES LOWER EXTREM Phlebitis & thrombophlebitis of veins

451.2 PHLEBITIS&THROMBOPHLEBITIS LOWER EXTREM UNSPEC Phlebitis & thrombophlebitis of veins

451.81 PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN Phlebitis & thrombophlebitis of veins

453.4 AC VNUS EMB&THRMB DP VES LWR EXTREM Embolism & thrombosis of veins

453.40 AC VNUS EMB&THRMB UNS DP VES LW EXT Embolism & thrombosis of veins

453.41 AC VNUS EMB&THRMB DP VES PRX LW EXT Embolism & thrombosis of veins

453.42 AC VNUS EMB&THRMB DP VES DST LW EXT Embolism & thrombosis of veins

453.5 CHRON VENOUS EMB & THROMBO DEEP VES LOWR EXTREM Embolism & thrombosis of veins

453.50 CHRON VNUS EMB & THROMB UNSPEC DEEP VES LOWR EXT Embolism & thrombosis of veins

453.51 CHRN VNUS EMB & THROMB DEEP VES PROX LOWR EXTREM Embolism & thrombosis of veins

453.52 CHRN VNUS EMBO & THROMB DP VES DISTL LOWR EXTREM Embolism & thrombosis of veins

453.6 VENOUS EMBO & THROMB SUPERFICIAL VES LOWR EXTREM Embolism & thrombosis of veins

785.51 CARDIOGENIC SHOCK Cardiovascular diseases signs & symptoms

786.5 CHEST PAIN* Cardiovascular diseases signs & symptoms

786.50 CHEST PAIN UNSPECIFIED Cardiovascular diseases signs & symptoms

786.51 PRECORDIAL PAIN Cardiovascular diseases signs & symptoms

786.59 OTHER CHEST PAIN Cardiovascular diseases signs & symptoms

794.3 NONSPECIFIC ABNORMAL RESULTS CV FUNCTION STUDY* Cardiovascular diseases signs & symptoms

794.30 NONSPECIFIC ABNORMAL UNSPEC CV FUNCTION STUDY Cardiovascular diseases signs & symptoms

794.31 NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM Cardiovascular diseases signs & symptoms

794.39 OTH NONSPECIFIC ABNORM CV SYSTEM FUNCTION STUDY Cardiovascular diseases signs & symptoms

861.0 HRT INJURY WITHOUT MENTION OPEN WOUND INTO THOR* Cardiac trauma

861.00 UNSPEC INJURY HRT W/O MENTION OPEN WOUND IN THOR Cardiac trauma



861.01 HRT CONTUS WITHOUT MENTION OPEN WOUND INTO THOR Cardiac trauma

861.03 HEART LACERATION W/PENETRATION OF CHAMBERS Cardiac trauma

902.0 ABDOMINAL AORTA INJURY Arterial trauma

902.53 ILIAC ARTERY INJURY Arterial trauma

904.0 COMMON FEMORAL ARTERY INJURY Arterial trauma

904.1 SUPERFICIAL FEMORAL ARTERY INJURY Arterial trauma

* This project was supported by grant number R18HS020098 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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