Children's Health Alliance

Transcription

1 Children's Health Alliance Note: the table below is part of the (Cincinnati Children's) Children With Special Health Care Needs Identification Project (155 pediatricians/38 practices) which found that 30% of patients have at least one chronic condition when doing just (hospital and practice-based) data claims runs. Thinking this was an over-estimation of those needing focused care management, they reviewed the patients and refined the list based on 15 factors (such as multiple chronic conditions or one chronic condition that was not well-controlled). This resulted in an average of 15% of patient panel identified as needing care management. They divided list into two categories always included and conditional, meaning only conditional patients needed chart reviews. Status Diagnosis Codes Comments Include HIV Include CARCINOMA thru thru : Change (Hemangioma NOS) to Conditional. - Change (Skin/subcu- Hemangioma) to Exclude. - Change (Benign eyelid neoplasm) to Conditional (benign neoplasm) deleted Include NEUROFIBROMATOSIS Conditional HYPERTHYROIDISM Conditional HYPOTHYROIDISM Include DIABETES thru

2 Include SCHWACKMAN DIAMOND (SDS) Include CHRONIC ENDOCRINE thru thru Include PANHYPOPITUITARISM Include ADRENAL INSUFFICIENCY Conditional Sexual Precocity Added to conditional. Include RICKETS Include PKU Include CYSTIC FIBROSIS Include HUNTER/HURLERS Conditional OBESITY Include OBESITY : Change from Conditional to Auto Include Include IMMUNODEFICIENCY DISORDERS thru Include SICKLE CELL DISEASE Include HEMOPHILIA Include VON WILLEBRAND DISEASE Include PSYCHOSIS thru thru Include BIPOLAR DISORDER thru thru

3 Conditional DEPRESSION (ACUTE) Conditional DEPRESSION (RECURRENT) Include AUTISM Include ASPERGERS Conditional MENTAL DISORDERS thru thru * (Anorexia nervosa) is auto include. Rest of range is conditional. Conditional PANIC DISORDER Conditional ANXIETY DISORDER thru Conditional OBSESSIVE COMPULSIVE DISORDER Include ANOREXIA NERVOSA Conditional TIC Conditional TOURETTE DISEASE Conditional ADD Conditional ADHD Conditional SPECIFIC LEARNING DISABILITY / LEARNING DIFFICULTIES Conditional DYSLEXIA Conditional Conditional SPEECH/LANGUAGE DISORDER EXPRESSIVE SPEECH DELAY Conditional MENTAL RETARDATION Include MENTAL RETARDATION

4 Conditional ORGANIC SLEEP APNEA Include LEUKODYSTROPHY : (Obstructive Sleep Apnea) Added to Conditional Include CEREBREAL LIPIDOSIS (TAY SACHS) Added as auto include Include DRAVET'S SYNDROME Include WERDNIG-HOFFMAN Conditional CHRONIC HEADACHE Conditional CEREBRAL PALSY Include EPILEPSY (GENERAL.NON- CONCLUSIVE) thru Conditional CHRONIC HEADACHE - MIGRAINE Include Other Conditions of Brain Added to Auto Include (Compression of brain, compression brain (stem), Herniation brain (stem), Posterior fossa compression syndrome. To address Practice identification of chiari malformation type one. Include IPLE CRANIAL NERVE PA Added to Auto Include (Mobius Syndrome) Include MUSCULAR DYSTROPHY

5 Include Coats' Syndrome Added to Auto Include (Coats' Syndrome-Exudative Retinopathy) Include PIGMENTARY RETINAL DYSTROPHY Include VISION LOSS (SEVERE) thru Added as alato include Conditional NYSTAGMUS Include Include HEARING LOSS (SEVERE) CHRONIC CARDIAC DISORDER thru : and (Hearing loss codes) Excluded. Include ANEURYSM thru Conditional ALLERGIES * 995.3* : Delete IF this is the only DX for the patient. Conditional ASTHMA thru : Identification through asthma registry. Include CHRONIC RESPIRATORY DISORDER Include EOSINOPHILIC ESOPHAGITIS Added to list as Auto Include Include CROHN'S DISEASE

6 Include ULCERATIVE COLITIS Include CHRONIC LIVER thru DISORDER Include CELIAC DISEASE Include CHRONIC RENAL DISORDER Include RENAL INSUFFICIENFY thru Conditional Conditional VESICO-URETERAL REFLUX DERMATITISAND ECZEMA : Add as Conditional. (Exclude if this is their only DX) Include LUPUS/SLE Include DERMATOMYOSITIS : Added as Auto Include Include JUVENILE RHEUMATOID ARTHRITIS Conditional MYALGIA AND MYOSITIS, UNSECIFIED : Added as Conditional Conditional SCOLIOSIS (ACQUIRED POSTURAL) thru

7 Include CONGENITAL ANOMALIES thru thru Check with Keith to take out the C.A.s that may need to be conditional. & PDA :Exclude (undestended testis) & (retractile testis) : Change (Tongue anomaly NOS) to Conditional. - Change (Tongue tied) to Exclude - Change (Pectus excavatum) to Conditional. - Change (VSD) to Conditional (CHANGE BACK TO AUTO ON ) - Change (Genital organ anomal NOS) to Conditional - Change (Penile anomalies NEC )to Conditional.(Now, exclude on )- Change (Congenical hip deformity NEC) to Conditional - Change (Lower limb anomaly NOS) to Conditional - Change (Cong hip dislocunilat) to Conditional - Change (Hypospadias) to Conditional -

8 : (other anomolies of the lacrimal duct) & ( pes planus) deleted :752.42, (Imperfprate hymen) Excluded (torticollis) Excluded : (Congenital Eyelid anomoly) Change from Auto to Conditional) include SPINA BIFIDA Conditional COLOBOMA include SEPTO-OPTIC DYSPLASIA include TETRALOGY OF FALLOT include HYPOLASTIC LEFT HEART include CHD- CONGENITAL include AORTIC ATRESIA/STENOSIS Include CLEFT PALATE thru Include SCOLIOSIS (CONGENITAL) Include LARSEN SYNDROME

9 Conditional GOLDENHAR(*Auto Include. See comments) Code changed to conditional due to a varity of other conditions that don't warrant Auto Include - See above in Congenital Anomalies Include EHLER-DANLOS Include DOWNS SYNDROME Include VCF SYNDROME Include TURNER SYNDROME Include WILLIAMS SYNDROME Include MARFAN'S SYNDROME Include FRAGILE X Include CORNELIA DE LANGE SYNDROME Include BECKWITH WIEDEMANN Include CHARGE SYNDROME Include FETAL ALCOHOL SYNDROME Conditional PREMATURITY thru Conditional BRONCHOPULMON DYSPLASIA Conditional SEIZURE Conditional ABNORMAL WEIGHT GAIN : (Abnormal weight gain) Added as conditional Conditional DEVELOPMENTAL DELAY

10 Conditional GROSS MOTOR DELAY Conditional FAILURE TO THRIVE Include Conditional TRAUMATIC BRAIN INJURY-CONCUSSION TRAUMATIC BRAIN INJURY- CONCUSSION thru thru : excluded (Concussion without loss of consciousness) : (Concussion NOS) change from Auto to Conditional). Conditional LEAD POISONING Conditional CHILD ABUSE Conditional SEXUAL ABUSE NOTE: Hydrocephalis 331.3, 33.4,

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13 Deaths Attributed to Pediatric Complex Chronic Conditions Center for Infants and Children with Special Needs Care Coordination Toolkit (appendix 1, pg. 24) Cincinnati Children's Hospital Medical Center, 2004 Note: This list represents a modification of one used previously in a retrospective longitudinal study of mortality patterns in Washington State, which, in turn, had been based, in part, on studies of hospitalization patterns of children with costly illnesses and with congenital defects. The authors modified the list by including epilepsy and by expanding the range of ICD-9 codes for the subcategories of mental retardation, central nervous system degeneration and disease, and malignancy. Feudner, et al, content/107/6/399.full.html /CareCoordinationToolkit06.pdf Note: These codes were contributed by the providers who participated in Carl Cooley's 2001 learning collaborative, Buliding a Medical Home: Improvement Strategies in Primary Care for Children Diagnosis Code Diagnosis Code Human immunodeficiency virus 42 HIV Malignancy Carcinoma Hyperthyroidism Diabetes

14 Bone and joint anomalies Amino acid metabolism Carbohydrate metabolism Lipid metabolism Other metabolic disorders PKU Cystic fibrosis 277 Cystic Fibrosis Other metabolic disorders 277.2, 277.4, 277.6, and Storage disorders and Obesity Hereditary immunodeficiency Immunodeficiency Disorders Hereditary Anemias Sickle cell disease Sickle Cell Disease Hemophilia Hereditary immunodeficiency Bipolar Disorder

15 Depression (Acute) Depression (Recurrent) Autism Panic Disorder Anxiety Disorder Obsessive Compulsive Disorder ` Mental Disorders Encorpresis (Non-Org. Origin) Tourette Disease Depression ADD ADHD Developmental Learning Difficulties Speech/Lang Disorder Mental Retardation Expressive Speech Delay

16 Central nervous system degeneration and disease TIC Wernig-Hoffman Infantile Cerebral Palsy Cerebral Palsy Epilepsy Epilepsy (General non-conclusive) Epileptic Convulsions Epilepsy (General non-conclusive) Muscular dystropies and myopathies Muscular Dystrophy

17 Vision Loss (Severe) Strabismus Nystagmus Chronic Serious Otitis Media Hearing Loss (Severe) Cardiomyopathies Conduction disorders and , dysrhythmias Cardiomyopathies Hereditary immunodeficiency Allergic Rhinitis Asthma Chronic Respiratory Disorder Gastroesophageal Reflux Diaphragm and abdominal wall Inflammatory bowel disease Chrohns Disease

18 Constipation Chronic liver disease and chirrosis Chronic Liver Disorder Chronic renal failure 585 Chronic Renal Disorder UTI Eczema Acne Juvenile Rheumatoid Arthritis Bone and joint disorders Scoliosis (Acquired Postural)

19 Brain and spinal cord malformations Congenital Anomolies

20 Coloboma Conginital Dacryostenosis Heart and great vessel malformations Respiratory malformations Congenital anomalies Congenital anomalies Congenital anomalies Congenital anomalies Scoliosis (Congenital)

21 Bone and joint anomolies Diaphragm and abdominal wall Chromosomal anomalies Other congenital anomalies Fetal Alcohol Syndrome Prematurity Chronic respiratory disease Bronchopulmon Dysplasia Cardio Neurogenic Syncope Febrile Seizure Seizure NOS Developmental Delay

22 Gross Motor Delay Failure to Thrive Dyslexia Encorpresis Fragile X Fracture Traumatic Brain Injury Head Trauma Lead Poisoning Bee Sting Allergy Allergies Child Abuse Sexual Abuse

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25 Adoption and Foster Care Analysis and Coding System: AFC New Codes as noted in Coding for Pediatrics, 16th Edition American Academy of Pediatrics AFCARS Disability/Special Needs Table (AFCARS does not utilize ICD-9. Like diagnoses are identified here with an "X") Note: this table lists several medical/emotional conditions that may be mapped to AFCARS data elements for foster care and adoption. It is not an exhaustive list of all conditions that states may use for reporting. Diagnosis Code Diagnosis des/07_summarytables.asp Code X Late Effects of Tuberculosis 137 X Note: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for 2011 identifies more than 150 new codes, revisions and deletions effective October, Below are some codes from (Symptoms, Signs, and Other Ill- Defined Conditions). Note: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for 2011 identifies more than 150 new codes, revisions and deletions effective October, Below are some codes from (Symptoms, Signs, and Other Ill-Defined Conditions). X

26 X x x x

27 x x X X x X X x X X X X X

28 X X X Retinal Detachment and Defects 361

29 Visual Disturbances 368 Blindness and Low Vision 369 Hearing Loss 389 X X

30 X

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32 X X

33 Down Syndrome, Klienefelter X Post Traumatic Seizures

34 ATTENTION OR CONCENTRATION DEFICIT COGNITIVE COMMUNICATION DEFICIT VISUOSPATIAL DEFICIT PSYCHOMOTOR DEFICIT FRONTAL LOBE AND EXECUTIVE FUNCTION DEFICIT OTHER SIGNS AND SYMPTOMS INVOLVING COGNITION * AFCARS also includes:

35 Borderline Intellectual functioning Hydrocephalus Microcephaly Cataracts Congenital anomaly of the eye Glaucoma Diabetic Retinopathy Arthritis Osteogenesis Imperfuctus Club Foot Diplegia Multiple Sclerosis Myasthenia Gravis Paralysis (para-quad-di) Poliomyelitis Adjustment Disorders Conduct Disorder Oppositional Defiant Disorder Agoraphobia Phobias PTSD Separation Anxiety Disorder Bulimia Impulse control Disorder Cyclothymic Disorder Dysthymic Disorder Personality Disorders (9) Reactive Attachment Disorder Psychotic Disorders (5) Somatoform Disorder Aplatic Anemia AIDS Blood disorder that requires hospitalization once a month

36 Childhood Disintegrative Disorder (PDD) Chronic Granulomatous Disease Coagulation Defects Congenital cystic lung Congenital heart anomaly Cushings snydrome Encephalopathy Fetal drug addiction Heart murmer, vigorous activity curtailed Heart disease Hemophilia Hypertension Other Human T-Cell Lymphotropic Viros-III Kidney Disease Leukemia Liver disease Lupus Misplaced Facial feature Organic Brain Syndrome Pancreatic Disease PDD-NOS Rett Disorder Sarcomas Shaken Infant Syndrome Nutritional deficiency