Episodes of Care Risk Adjustment

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1 Episodes of Care Risk Adjustment Episode Types Wave 1 Asthma Acute Exacerbation Perinatal Total Joint Replacement Wave 2 Acute Percutaneous Coronary Intervention COPD Acute Exacerbation Non-acute Percutaneous Coronary Intervention Outpatient and Non-acute Inpatient Cholecystectomy Screening and Surveillance Colonoscopy Wave 3 Esophagogastroduodenoscopy Gastrointestinal Hemorrhage Inpatient Urinary Tract Infection Outpatient Urinary Tract Infection Pneumonia Respiratory Infection Wave 4 Attention Deficit and Hyperactivity Disorder Bariatric Surgery Congestive Heart Failure Acute Exacerbation Coronary Artery Bypass Graft Heart Valve Replacement or Repair Oppositional Defiant Disorder Wave 5 Anxiety Breast Biopsy Non-Emergent Depression Otitis Media Tonsillectomy Wave 6 Acute Diabetes Exacerbation HIV Infection Pancreatitis Skin and Soft Tissue Infections Appendix 1

2 Factors and Weights Acute Diabetes Exacerbation Female Male Bacterial infection Other infections; including parasitic Fluid and electrolyte disorders Anemia Diseases of white blood cells Developmental disorders Other nervous system disorders Hypertension Diseases of the heart Respiratory failure; insufficiency; arrest (adult) Other lower respiratory disease Biliary tract disease Liver disease Diseases of the urinary system Genitourinary congenital anomalies Acute Percutaneous Coronary Intervention Age (per year) Female Male Fluid and electrolyte disorders Diseases of the blood and blood-forming organs Coagulation and hemorrhagic disorders Pleurisy; pneumothorax; pulmonary collapse Respiratory failure; insufficiency; arrest (adult) Anxiety Female Male Adjustment disorders Alcohol-related disorders Substance-related disorders Anxiety disorders Attention deficit conduct and disruptive behavior disorders Developmental disorders Disorders usually diagnosed in infancy childhood or adolescence Impulse control disorders not elsewhere classified Mood disorders Personality disorders Administrative/social admission

3 Asthma Acute Exacerbation Age (per year) Female Male Line of Business BlueCare Line of Business TennCare Select Line of Business CoverKids Bacterial infection Endocrine; nutritional; and metabolic diseases and immunity disorders Hereditary and degenerative nervous system conditions Paralysis Diseases of the circulatory system Pneumonia (except that caused by TB or STD) Chronic obstructive pulmonary disease and bronchiectasis Respiratory failure; insufficiency; arrest (adult) Diseases of the digestive system Attention Deficit and Hyperactivity Disorder Female Male Adjustment disorders Screening and history of mental health and substance abuse codes Miscellaneous mental disorders Oppositional defiant disorder Developmental disorders Disorders usually diagnosed in infancy childhood or adolescence Mood disorders Personality disorders Diseases of the nervous system and sense organs Epilepsy; convulsions Eye disorders Congenital anomalies Bariatric Surgery Age (per year) Female Male Diseases of the blood and blood-forming organs Noninfectious gastroenteritis Lower gastrointestinal disorders Pancreatic disorders (not diabetes) Other pancreatic disorders Breast Biopsy Female Male

4 2.12 Secondary malignancies Cancer of breast Substance-related disorders Screening and history of mental health and substance abuse codes Contraceptive and procreative management Nonmalignant breast conditions Congestive Heart Failure Acute Exacerbation Female Male Infectious and parasitic diseases Cardiac and circulatory congenital anomalies Certain conditions originating in the perinatal period Anemia Coagulation and hemorrhagic disorders Peri-; endo-; and myocarditis; cardiomyopathy (except that caused by TB or STD) Diseases of veins and lymphatics Liver disease COPD Acute Exacerbation Age (per year) Acute and unspecified renal failure Injury and poisoning Bacterial infection Neoplasms Other nutritional; endocrine; and metabolic disorders Diabetes mellitus without complication Fluid and electrolyte disorders Diseases of the blood and blood-forming organs Coagulation and hemorrhagic disorders Diseases of the heart Acute cerebrovascular disease Pleurisy; pneumothorax; pulmonary collapse Respiratory failure; insufficiency; arrest (adult) Coronary Artery Bypass Graft Female Male Injury and poisoning Bacterial infection Coagulation and hemorrhagic disorders Diseases of the nervous system and sense organs Hypertension with complications and secondary hypertension Cardiac arrest and ventricular fibrillation Diseases of arteries; arterioles; and capillaries

5 Esophagogastroduodenoscopy Female Male Line of Business Fully-Insured Line of Business Self-Insured Line of Business State Diseases of the genitourinary system Congenital anomalies Endocrine; nutritional; and metabolic diseases and immunity disorders Diseases of the blood and blood-forming organs Coagulation and hemorrhagic disorders Diseases of the respiratory system Noninfectious gastroenteritis Other gastrointestinal disorders Lower gastrointestinal disorders Biliary tract disease [149.] Gastrointestinal Hemorrhage Age (per year) Other gastrointestinal cancer Fluid and electrolyte disorders Anemia Respiratory failure; insufficiency; arrest (adult) Upper gastrointestinal disorders Lower gastrointestinal disorders Heart Valve Replacement or Repair Female Male HIV Infection Female Male Bacterial infection Mycoses Other infections; including parasitic Thyroid disorders Nutritional deficiencies Fluid and electrolyte disorders Anemia Diseases of white blood cells Other hematologic conditions Alcohol-related disorders Substance-related disorders Miscellaneous mental disorders Attention deficit conduct and disruptive behavior disorders

6 5.4 Delirium dementia and amnestic and other cognitive disorders Hereditary and degenerative nervous system conditions Cerebrovascular disease Diseases of mouth; excluding dental Biliary tract disease Pancreatic disorders (not diabetes) Diseases of the urinary system Chronic ulcer of skin Infective arthritis and osteomyelitis (except that caused by TB or STD) Other bone disease and musculoskeletal deformities Nervous system congenital anomalies Joint disorders and dislocations; trauma-related Other viral infections Inpatient Urinary Tract Infection Age (per year) Diseases of the genitourinary system Nervous system congenital anomalies Bacterial infection Fluid and electrolyte disorders Diseases of the blood and blood-forming organs Delirium dementia and amnestic and other cognitive disorders Coma; stupor; and brain damage Non-acute Percutaneous Coronary Intervention Female Male Endocrine; nutritional; and metabolic diseases and immunity disorders Diseases of the respiratory system Non-Emergent Depression Female Male Obesity Substance-related disorders Suicide and intentional self-inflicted injury Screening and history of mental health and substance abuse codes Attention deficit conduct and disruptive behavior disorders Developmental disorders Disorders usually diagnosed in infancy childhood or adolescence [655] Mood disorders Diseases of the heart Complications of pregnancy; childbirth; and the puerperium Abortion-related disorders Administrative/social admission

7 Oppositional Defiant Disorder Female Male Screening and history of mental health and substance abuse codes Attention deficit disorder and Attention deficit hyperactivity disorder Developmental disorders Disorders usually diagnosed in infancy childhood or adolescence Mood disorders Otitis Media Female Male Viral infection Immunity disorders Fluid and electrolyte disorders Diseases of white blood cells Developmental disorders Disorders usually diagnosed in infancy childhood or adolescence Central nervous system infection Hereditary and degenerative nervous system conditions Headache; including migraine Other nervous system disorders Cerebrovascular disease Diseases of arteries; arterioles; and capillaries Respiratory infections Chronic obstructive pulmonary disease and bronchiectasis Asthma Other lower respiratory disease Disorders of teeth and jaw Diseases of mouth; excluding dental Upper gastrointestinal disorders Other skin disorders Other congenital anomalies Other perinatal conditions Allergic reactions Conditions associated with dizziness or vertigo Other ear and sense organ disorders Outpatient and Non-acute Inpatient Cholecystectomy Female Male Gout and other crystal arthropathies Fluid and electrolyte disorders Anemia Mental Illness Substance-related disorders Diseases of the heart

8 7.4 Diseases of arteries; arterioles; and capillaries Lower gastrointestinal disorders Liver disease Pancreatic disorders (not diabetes) Outpatient Urinary Tract Infection Female Male Calculus of urinary tract Other diseases of kidney and ureters Other diseases of bladder and urethra Genitourinary symptoms and ill-defined conditions Diseases of female genital organs Complications of pregnancy; childbirth; and the puerperium Bacterial infection Diabetes mellitus with complications Fluid and electrolyte disorders Diseases of the blood and blood-forming organs Diseases of white blood cells Mental Illness Paralysis Coma; stupor; and brain damage Other nervous system disorders Pancreatitis Female Male Bacterial infection Nutritional deficiencies Fluid and electrolyte disorders Coagulation and hemorrhagic disorders Other hematologic conditions Cerebrovascular disease Pleurisy; pneumothorax; pulmonary collapse Biliary tract disease Digestive congenital anomalies Perinatal Age (per year) Line of Business CoverKids Line of Business TennCare Select Diseases of the genitourinary system Diseases of the urinary system Complications mainly related to pregnancy Indications for care in pregnancy; labor; and delivery Other complications of birth; puerperium affecting management of mother Endocrine; nutritional; and metabolic diseases and immunity disorders

9 3.9 Cystic fibrosis Mental Illness Diseases of the nervous system and sense organs Paralysis Pneumonia Age (per year) Line of Business BlueCare Line of Business CoverKids Line of Business TennCare Select Bacterial infection Endocrine; nutritional; and metabolic diseases and immunity disorders Diabetes mellitus with complications Fluid and electrolyte disorders Anemia Diseases of white blood cells Hereditary and degenerative nervous system conditions Diseases of the circulatory system Chronic obstructive pulmonary disease and bronchiectasis Asthma Pleurisy; pneumothorax; pulmonary collapse Liver disease Respiratory Infection Age (per year) Female Male Infectious and parasitic diseases Candidiasis of the mouth (thrush) Endocrine; nutritional; and metabolic diseases and immunity disorders Diabetes mellitus without complication Diabetes mellitus with complications Diseases of the blood and blood-forming organs Diseases of white blood cells Diseases of the nervous system and sense organs Hereditary and degenerative nervous system conditions Paralysis Diseases of the heart Asthma Esophageal disorders Gastritis and duodenitis Screening and Surveillance Colonoscopy Female Male Benign neoplasms Other nutritional; endocrine; and metabolic disorders

10 3.2 Diabetes mellitus without complication Diabetes mellitus with complications Diseases of the blood and blood-forming organs Thrombocytopenia Diseases of the circulatory system Diseases of the heart Hemorrhoids Diseases of the digestive system Gastrointestinal hemorrhage Noninfectious gastroenteritis Upper gastrointestinal disorders Regional enteritis and ulcerative colitis Intestinal obstruction without hernia Anal and rectal conditions Peritonitis and intestinal abscess Skin and Soft Tissue Infections Age (per year) Female Male Bacterial infection Other infections; including parasitic Colorectal cancer Cancer of lymphatic and hematopoietic tissue Maintenance chemotherapy; radiotherapy Other gastrointestinal cancer Cancer of bronchus; lung Immunity disorders Other nutritional; endocrine; and metabolic disorders Fluid and electrolyte disorders Cystic fibrosis Anemia Coagulation and hemorrhagic disorders Diseases of white blood cells Substance-related disorders Mood disorders Central nervous system infection Paralysis Other nervous system disorders Hypertension Diseases of the heart Diseases of arteries; arterioles; and capillaries Diseases of veins and lymphatics Pleurisy; pneumothorax; pulmonary collapse Diseases of mouth; excluding dental Lower gastrointestinal disorders Liver disease Pancreatic disorders (not diabetes) Complications mainly related to pregnancy

11 11.7 Normal pregnancy and/or delivery Skin and subcutaneous tissue infections Other inflammatory condition of skin Chronic ulcer of skin Other skin disorders Infective arthritis and osteomyelitis (except that caused by TB or STD) Non-traumatic joint disorders Other connective tissue disease Joint disorders and dislocations; trauma-related Other injuries and conditions due to external causes Spinal cord injury Open wounds Superficial injury; contusion Burns Tonsillectomy Female Male Immunity disorders Other nutritional; endocrine; and metabolic disorders Nutritional deficiencies Fluid and electrolyte disorders Anemia Coagulation and hemorrhagic disorders Other hematologic conditions Paralysis Epilepsy; convulsions Ear conditions Other nervous system disorders Diseases of the circulatory system Chronic obstructive pulmonary disease and bronchiectasis Asthma Respiratory failure; insufficiency; arrest (adult) Upper gastrointestinal disorders Cardiac and circulatory congenital anomalies Digestive congenital anomalies Nervous system congenital anomalies Other perinatal conditions Total Joint Replacement Age (per year) Female Male Acute and unspecified renal failure Chronic kidney disease Obesity Diabetes mellitus without complication Mental Illness

12 7.2.1 Heart valve disorders Acute myocardial infarction Systemic lupus erythematosus and connective tissue disorders Congenital hip deformity Acute cerebrovascular disease Transient cerebral ischemia Emphysema Chronic airway obstruction; not otherwise specified Other venous embolism and thrombosis Congestive heart failure; nonhypertensive

13 Appendix Developed at the Agency for Healthcare Research and Quality (AHRQ), the Clinical Classifications Software (CCS) is a hierarchical tool for clustering patient diagnoses into a manageable number of clinically meaningful categories. These categories map directly to ICD-9 and ICD-10 codes. Because the clinical classification is hierarchical, each level of factors includes the clinical categories lower in the hierarchy. More information including an overview, complete mapping, and technical specifications for the CCS tool can be found at the following link: Clinical Classifications Software (CCS) for ICD-10-CM/PCS. 13

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