Large Claimant Report

Transcription

1 Description Group(s) LUBBOCK INDEPENDENT SCHOOL DISTRICT Date Run 10/4/20 Claim Source: Non Rx Claims Table - Medical Threshold: Large Claimant Report Period Paid: 1/20-10/20 Fill: 1/20-10/20 Large Claimant % Of Overall Plan Spent % Large Claimant $ Sum $2,502, Large Claimant # 14 DSS Member Id Name Plan Spent $ Total Plan Spent By ICD Code ICD Code Version ICD Code ICD Code Description EDC Concurrent Risk Prospective Risk Management Category Last Enroll Month Claimant 1 $443, $439, Z5111 Administrative concerns $1, C50411 Malig neoplm of upper-outer quadrant of right female breast $1, C50919 Malignant neoplasm of unsp site of female breast $ J209 Acute bronchitis, $ I10 Essential (primary) hypertension $ R739 Hyperglycemia, breast breast Hypertension, w/o major Administrative concerns $ M25561 Pain in right knee signs $ J45901 Unspecified asthma with (acute) exacerbation Asthma, w/o status asthmaticus Claimant 2 $295, $78, N059 Unsp nephritic syndrome with morphologic changes $76, N049 Nephrotic syndrome with morphologic changes $74, N048 Nephrotic syndrome with other morphologic changes $62, N040 Nephrotic syndrome with minor glomerular abnormality Nephritis, nephrosis Nephritis, nephrosis Nephritis, nephrosis Nephritis, nephrosis $ R601 Generalized edema Edema $ Z452 Surgical aftercare

2 $ R0602 Shortness of breath Respiratory signs and $ J020 Streptococcal pharyngitis $ R946 Abnormal results of thyroid function studies Acute upper respiratory Other endocrine disorders $ E782 Mixed hyperlipidemia Disorders of lipid metabolism $ N051 Unsp neph syndrome w focal and segmental glomerular lesions Nephritis, nephrosis $ Z208 Administrative concerns $ I10 Essential (primary) hypertension Hypertension, w/o major $ R310 Gross hematuria Urinary $ M7989 Other specified soft tissue disorders Bursitis, synovitis, tenosynovitis $ N390 Urinary, site specified Urinary s Claimant 3 $238, $172, Z5111 Administrative concerns Sep $28, C7989 Secondary malignant neoplasm of other specified sites $17, C4361 Malignant melanoma of right upper limb, including shoulder High impact malignant neoplasms Malignant neoplasms of the skin Sep Sep $12, Z510 Administrative concerns Sep $1, C799 Secondary malignant neoplasm of site $1, M20091 Other deformity of right finger(s) High impact malignant neoplasms Sep Sep $ T8132XD Adverse events from medical/surgical procedures Sep $ R0789 Other chest pain Chest pain Sep $ Z483 Surgical aftercare Sep $ T8131XD Adverse events from medical/surgical procedures $ Z0 Administrative concerns Sep Sep $ D4989 Neoplasm of behavior of other specified sites $ C439 Malignant melanoma of skin, $ C4371 Malignant melanoma of right lower limb, Low impact malignant neoplasms Malignant neoplasms of the skin Malignant neoplasms of the skin Sep Sep Sep

3 including hip $ R590 Localized enlarged lymph nodes Lymphadenopathy Sep $ D0361 Melanoma in situ of right upper limb, including shoulder Malignant neoplasms of the skin Sep $ Z2239 Administrative concerns Sep $ M231 Other specified acquired deformities of right forearm Sep $ A488 Other specified bacterial diseases $ B950 Streptococcus, group A, causing diseases classd elswhr Infections, other Sep Infections, other Sep $ Z208 Administrative concerns $ Z22330 Administrative concerns Sep Sep $ R6889 Other general and signs $ I259 Chronic ischemic heart disease, Ischemic heart disease (excluding acute myocardial infarction) Sep Sep $ E038 Other specified hypothyroidism Hypothyroidism Sep $ C801 Malignant (primary) neoplasm, High impact malignant neoplasms Sep $ R339 Retention of urine, Urinary Sep $ D509 Iron deficiency anemia, $ E119 Type 2 diabetes mellitus without $ R2231 Localized swelling, mass and lump, right upper limb Iron deficiency, other deficiency anemias Type 2 diabetes, w/o Dermatologic signs and Sep Sep Sep Claimant 4 $ Z5112 Administrative concerns $227, $139, Z5111 Administrative concerns Sep $36, C7951 Secondary malignant neoplasm of bone High impact malignant neoplasms $32, Z510 Administrative concerns $7, G893 Neoplasm related pain (acute) (chronic) $4, R1013 Epigastric pain Abdominal pain $3, C61 Malignant neoplasm of prostate prostate $1, R9431 Abnormal Cardiovascular signs

4 electrocardiogram [ECG] [EKG] $1, R1084 Generalized abdominal pain $ R1011 Right upper quadrant pain Abdominal pain Abdominal pain $ Z0000 Preventive care $ Z23 Preventive care $ E784 Other hyperlipidemia Disorders of lipid metabolism $ Z452 Surgical aftercare Claimant 5 $217, $139, M86142 Other acute osteomyelitis, left hand Sep $43, M869 Osteomyelitis, Sep $19, L0390 Cellulitis, Nonfungal infections of skin and subcutaneous tissue Sep $2, Z4789 Surgical aftercare Sep $1, R9 Other nonspecific abnormal finding of lung field $1, G894 Chronic pain syndrome Respiratory signs and Sep Sep $1, R531 Weakness Debility and undue fatigue Sep $1, M064 Inflammatory polyarthropathy Rheumatoid arthritis Sep $ M545 Low back pain Low back pain Sep $ R911 Solitary pulmonary nodule Respiratory signs and Sep $ A419 Sepsis, organism Septicemia Sep $ R6889 Other general and signs Sep $ M069 Rheumatoid arthritis, Rheumatoid arthritis Sep $ J9 Pneumonia, organism $ M2550 Pain in joint signs Sep Sep $ Z452 Surgical aftercare Sep $ Z79891 Preventive care Sep $ I82629 Acute embolism and thrombosis of deep vn unsp up extrem Deep vein thrombosis Sep $ M79642 Pain in left hand Neurologic signs and Sep $ M0609 Rheumatoid arthritis w/o rheumatoid factor, multiple sites Rheumatoid arthritis Sep

5 $ Z79899 Preventive care Sep $ M7989 Other specified soft tissue disorders $ L932 Other local lupus erythematosus $ E871 Hypo-osmolality and hyponatremia Bursitis, synovitis, tenosynovitis Autoimmune and connective tissue diseases Fluid/electrolyte disturbances Sep Sep Sep $ M79641 Pain in right hand Neurologic signs and Sep $ R198 Oth and signs involving the dgstv sys and abdomen Gastrointestinal signs Sep $ R569 Unspecified convulsions $ G40909 Epilepsy, unsp, not intractable, without status epilepticus $ M130 Polyarthritis, Seizure disorder Sep Seizure disorder Sep Arthropathy Sep $ M868X8 Other osteomyelitis, other site Sep $ D72810 Lymphocytopenia Disorders of the immune system $ M25561 Pain in right knee signs $ M25562 Pain in left knee signs $ M79671 Pain in right foot Neurologic signs and $ M79672 Pain in left foot Neurologic signs and Sep Sep Sep Sep Sep $ M86141 Other acute osteomyelitis, right hand $ M86 Other acute osteomyelitis, other site Sep Sep $ M79601 Pain in right arm Neurologic signs and Sep $ M009 Pyogenic arthritis, $ I80293 Phlebitis and thombophlb of deep vessels of low extrm, bi Arthropathy Sep Thrombophlebitis Sep Claimant 6 $170, $138, Z3800 Newborn status, uncomplicated $13, Q211 Atrial septal defect Congenital heart disease $6, P251 Pneumothorax originating in the perinatal $3, P2889 Other specified respiratory conditions of newborn Disorders of newborn Disorders of newborn

6 $3, P278 Oth chronic resp diseases origin in the perinatal Disorders of newborn $2, P2912 Neonatal bradycardia Disorders of newborn $ Z00129 Preventive care $ R6889 Other general and signs $ R0681 Apnea, not elsewhere classified Respiratory signs and $ R633 Feeding difficulties Failure to thrive $ R6812 Fussy infant (baby) $ P229 Respiratory distress of newborn, Disorders of newborn $ R620 Delayed milestone in childhood Developmental disorder $ P7883 Newborn esophageal reflux Disorders of newborn $ P0717 Other low birth weight newborn, grams Low birth weight Claimant 7 $165, $165, G35 Multiple sclerosis Multiple sclerosis Sep $ L820 Inflamed seborrheic keratosis Skin keratoses Sep $ D485 Neoplasm of uncertain behavior of skin Benign and neoplasm Sep Claimant 8 $154, $153, D3A8 Other benign neuroendocrine tumors Benign and neoplasm Sep $ N3001 Acute cystitis with hematuria Urinary s Sep $ R51 Headache Headaches Sep $ Z01419 Preventive care Sep $ R300 Dysuria Urinary Sep $ K34 Gastroparesis Peptic ulcer disease Sep $ R6889 Other general and signs Sep $ R002 Palpitations Cardiovascular signs Sep $ N6099 Unspecified benign mammary dysplasia of breast Chronic cystic disease of the breast Sep $ N644 Mastodynia Other breast disorders Sep $ Z428 Surgical aftercare Sep $ M25562 Pain in left knee signs Sep $ R079 Chest pain, Chest pain Sep

7 Claimant 9 $117, $116, H905 Unspecified sensorineural hearing loss $ H9191 Unspecified hearing loss, right ear Deafness, hearing loss Sep Deafness, hearing loss Sep $ J0380 Acute tonsillitis due to other specified organisms Acute upper respiratory Sep $ H903 Sensorineural hearing loss, bilateral Deafness, hearing loss Sep $ Z9621 Deafness, hearing loss Sep Claimant 10 $109, $88, Z5112 Administrative concerns Sep $7, L930 Discoid lupus erythematosus Autoimmune and connective tissue diseases Sep $6, G360 Neuromyelitis optica [Devic] Multiple sclerosis Sep $4, M6281 Muscle weakness (generalized) $ M329 Systemic lupus erythematosus, Acute sprains and strains Autoimmune and connective tissue diseases Sep Sep $ R109 Unspecified abdominal pain Abdominal pain Sep $ R202 Paresthesia of skin Dermatologic signs and Sep $ M3210 Systemic lupus erythematosus, organ or system involv unsp $ M25571 Pain in right ankle and joints of right foot Autoimmune and connective tissue diseases signs Sep Sep $ M549 Dorsalgia, Sep $ Z79899 Preventive care Sep $ L03115 Cellulitis of right lower limb Nonfungal infections of skin and subcutaneous tissue Sep $ R748 Abnormal levels of other serum enzymes Administrative concerns Sep $ R5382 Chronic fatigue, Debility and undue fatigue Sep Claimant 11 $101, $100, M3390 Dermatopolymyositis, unsp, organ involvement Autoimmune and connective tissue diseases $ J9 Pneumonia, organism $ Z79899 Preventive care $ Z0000 Preventive care $ R0789 Other chest pain Chest pain $ R05 Cough Cough

8 $ E785 Hyperlipidemia, Disorders of lipid metabolism $ Z8701 Administrative concerns $ J101 Flu due to oth ident influenza virus w oth resp manifest Acute upper respiratory Claimant 12 $ J209 Acute bronchitis, $92, $71, Z510 Administrative concerns $5, R42 Dizziness and giddiness Vertiginous syndromes $5, C210 Malignant neoplasm of anus, $4, C20 Malignant neoplasm of rectum $2, C211 Malignant neoplasm of anal canal colorectal colorectal colorectal $ Z1231 Preventive care $ R7989 Other specified abnormal findings of blood chemistry Administrative concerns $ R52 Pain, $ Z452 Surgical aftercare $ Z23 Preventive care $ K5730 Dvrtclos of lg int w/o perforation or abscess w/o bleeding Diverticular disease of colon $ Z0000 Preventive care $ I2510 Athscl heart disease of native coronary artery w/o ang pctrs Ischemic heart disease (excluding acute myocardial infarction) $ Z0 Administrative concerns $ M25551 Pain in right hip signs $ I10 Essential (primary) hypertension $ C2 Malig neoplasm of ovrlp sites of rectum, anus and anal canal Hypertension, w/o major colorectal $ K625 Hemorrhage of anus and rectum Anorectal conditions $ K6389 Other specified diseases of intestine Gastrointestinal/hepatic $ K642 Third degree hemorrhoids $ K645 Perianal venous thrombosis Anorectal conditions Anorectal conditions

9 Claimant 13 $ K921 Melena Gastrointestinal signs $92, $86, A49 Other specified sepsis Septicemia Sep $2, J869 Pyothorax without fistula $ E109 Type 1 diabetes mellitus without $ D473 Essential (hemorrhagic) thrombocythemia $ J1100 Flu due to unidentified flu virus w unsp type of pneumonia $ J1 Lobar pneumonia, organism $ J9 Pneumonia, organism Respiratory disorders, other Type 1 diabetes, w/o Benign and neoplasm Aspiration and bacterial pneumonias Sep Sep Sep Sep Sep Sep $ J9601 Acute respiratory failure with hypoxia Acute respiratory failure Sep $ D72829 Elevated white blood cell count, $ E1310 Oth diabetes mellitus with ketoacidosis without coma Disorders of the immune system Type 2 diabetes, w/o Sep Sep $ R0781 Pleurodynia Chest pain Sep $ E039 Hypothyroidism, $ A419 Sepsis, organism Hypothyroidism Sep Septicemia Sep $ I517 Cardiomegaly Cardiovascular signs Sep $ Z3009 Contraception Sep $ Z3200 Pregnancy and delivery, uncomplicated Sep $ J90 Pleural effusion, not elsewhere classified $ R6889 Other general and signs Respiratory disorders, other Sep Sep $ Z09 Administrative concerns $ R091 Pleurisy Respiratory disorders, other Sep Sep Claimant 14 $ R05 Cough Cough Sep $74, $56, A419 Sepsis, organism Septicemia Sep $6, J9 Pneumonia, organism $2, G5601 Carpal tunnel syndrome, right upper limb Peripheral neuropathy, neuritis Sep Sep $2, E860 Dehydration Fluid/electrolyte disturbances Sep

10 $1, K811 Chronic cholecystitis Cholelithiasis, cholecystitis $1, K810 Acute cholecystitis Cholelithiasis, cholecystitis Sep Sep $ E1065 Type 1 diabetes mellitus with hyperglycemia $ J154 Pneumonia due to other streptococci Type 1 diabetes, w/o Aspiration and bacterial pneumonias Sep Sep $ Z452 Surgical aftercare Sep $ J984 Other disorders of lung $ M654 Radial styloid tenosynovitis [de Quervain] $ E109 Type 1 diabetes mellitus without $ M65322 Trigger finger, left index finger $ M65321 Trigger finger, right index finger Respiratory disorders, other Bursitis, synovitis, tenosynovitis Type 1 diabetes, w/o Bursitis, synovitis, tenosynovitis Bursitis, synovitis, tenosynovitis Sep Sep Sep Sep Sep $ N179 Acute kidney failure, Acute renal failure Sep $ R0602 Shortness of breath Respiratory signs and Sep $ R109 Unspecified abdominal pain Abdominal pain Sep $ J1 Lobar pneumonia, organism Aspiration and bacterial pneumonias Sep $ Z01411 Preventive care Sep $ R1011 Right upper quadrant pain Abdominal pain Sep $ E119 Type 2 diabetes mellitus without $ J14 Pneumonia due to Hemophilus influenzae Type 2 diabetes, w/o Aspiration and bacterial pneumonias Sep Sep $ T9XXA Gastrointestinal/hepatic Sep $ J111 Flu due to unidentified influenza virus w oth resp manifest Sep $ Z01419 Preventive care Sep $ R6882 Decreased libido Sep $ R9 Other nonspecific abnormal finding of lung field Respiratory signs and Sep $ L309 Dermatitis, Dermatitis and eczema Sep