Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium Program Methodology document. To understand the methodology used for the Premium program, it is important to review the entire methodology. There are two measurements applied for the evaluation of cost efficiency: patient total cost measurement and patient episode cost measurement. Listed below by measurement are the conditions and procedures used to evaluate physicians in the Pediatrics specialty. For further information regarding patient and episode attribution, please refer to the Attribution Methods document in the Methodology section of the Premium Methodology page. Cardiology Conditions/Procedures Arterial Inflammation Atrial Fibrillation & Flutter Cardiac Infection Cardiomyopathy Cardiovascular Diseases Signs & Symptoms Congestive Heart Failure Disorders of Lymphatic Channels Embolism & Thrombosis of Veins Heart Failure, Diastolic Hypertension Ischemic Heart Disease Non-Cerebral, Non-Coronary Atherosclerosis Other Conduction Disorders Other Diseases of Veins Other Non-Inflammatory Arterial Diseases Phlebitis & Thrombophlebitis of Veins Pulmonary Heart Disease Valvular Disorder Varicose Veins of Lower Extremity Dermatology Conditions/Procedures Acne* Bacterial Infection of Skin Chronic Skin Ulcers Contact Dermatitis Dermatological Signs & Symptoms Fungal Skin Infection Malignant Neoplasm of Skin, Major Non-Malignant Neoplasm of Skin Other Inflammation of Skin Other Skin Disorders Parasitic Skin Infection* Psoriasis* Skin Trauma, except Burn & Open Wound - Elbow & Upper Arm Skin Trauma, except Burn & Open Wound - Foot & Ankle 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 1
Dermatology Conditions/Procedures (continued) Skin Trauma, except Burn & Open Wound - Hand & Forearm Skin Trauma, except Burn & Open Wound - Head & Face Skin Trauma, except Burn & Open Wound - Hip & Thigh Skin Trauma, except Burn & Open Wound - Lower Leg Skin Trauma, except Burn & Open Wound - Other Skin Trauma, except Burn & Open Wound - Shoulder Skin Trauma, except Burn & Open Wound - Trunk Skin Trauma, except Burn & Open Wound - Unspecified Viral Skin Infection Endocrinology Conditions/Procedures Dehydration Diabetes* Endocrine Disease Signs & Symptoms Female Sex Gland Disorders Gout* Hyper-Functioning Adrenal Gland Hyper-Functioning Parathyroid Gland Hyper-Functioning Thyroid Gland Hyperlipidemia, Other* Hypo-Functioning Adrenal Gland Hypo-Functioning Parathyroid Gland* Hypo-Functioning Thyroid Gland Lipidoses (Gauchers Disease, Fabry Disease, Mucolipidosis I-Ill) Male Sex Gland Disorders* Malignant Neoplasm of Thyroid Gland Non-Malignant Neoplasm of Adrenal Gland Non-Malignant Neoplasm of Pituitary Gland Non-Malignant Neoplasm of Thyroid Gland Non-Toxic Goiter Nutritional Deficiency Obesity Other Diseases of Thyroid Gland Other Metabolic Disorders Gastroenterology Conditions/Procedures Diverticulitis & Diverticulosis Gastritis &/or Duodenitis Gastroenterology Diseases Signs & Symptoms Hemorrhoids Hernias, except Hiatal Hiatal Hernia Infection of Rectum or Anus Infection of Stomach & Esophagus 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 2
Gastroenterology Conditions/Procedures (continued) Inflammation of Esophagus Inflammation of Rectum or Anus Inflammatory Bowel Disease* Irritable Bowel Syndrome Malignant Neoplasm of Large Intestine Malignant Neoplasm of Rectum or Anus Malignant Neoplasm of Stomach & Esophagus Non-Malignant Neoplasm of Intestines & Abdomen Non-Malignant Neoplasm of Rectum or Anus Other Diseases & Disorders of Rectum & Anus Other Infectious Diseases of Intestines & Abdomen Other Inflammation of Intestines & Abdomen Ulcer Gynecology Conditions/Procedures Conditions Associated with Menstruation Endometriosis Gynecological Signs & Symptoms Infection of Cervix Infection of Ovary &/or Fallopian Tubes Infection of Vagina, except Monilial Inflammatory Condition of Female Genital Tract, except Endometriosis Malignant Neoplasm of Breast Malignant Neoplasm of Cervix Malignant Neoplasm of Ovaries Malignant Neoplasm of Uterus Monilial Infection of Vagina (Yeast) Non-Malignant Neoplasm of Breast Non-Malignant Neoplasm of Female Genital Tract Other Disorders of Breast Hematology Conditions/Procedures Agranulocytosis Hematology Signs & Symptoms Iron Deficiency Anemia Leukemia Lymphoma* Sickle-Cell Anemia Thrombocytopenia Hepatology Conditions/Procedures Acute Pancreatitis Cholelithiasis 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 3
Hepatology Conditions/Procedures (continued) Chronic Pancreatitis Cirrhosis* Hepatology Diseases Signs & Symptoms Infectious Hepatitis* Non-Infectious Hepatitis Other Diseases of Hepatobiliary System Infectious Diseases Conditions/Procedures Immunodeficiencies* Infectious Diseases Signs & Symptoms Other Infectious Diseases Septicemia Late Effects; Environmental Trauma & Poisonings Conditions/Procedures Environmental Trauma Neonatology Conditions/Procedures Always Include Include if Involved Medical Surgical Chromosomal Anomalies Other Neonatal Disorders, Perinatal origin Uncomplicated Neonatal Management Nephrology Conditions/Procedures Acute Renal Failure Acute Renal Inflammation Chronic Renal Failure Nephrology Diseases Signs & Symptoms Neurology Conditions/Procedures Alzheimer's Disease Brain Trauma Carpal Tunnel Syndrome Cerebral Vascular Disease Congenital Disorders of Central Nervous System Congenital Disorders of Peripheral Nerves* Epilepsy Hereditary & Degenerative Diseases of Central Nervous System, Other Inflammation of Central Nervous System, Other Inflammation of Cranial Nerves Inflammation of Non-Cranial Nerves, except Carpal Tunnel* Malignant Neoplasm of Central Nervous System 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 4
Neurology Conditions/Procedures (continued) Migraine Headache Multiple Sclerosis* Neurological Diseases Signs & Symptoms Parkinson's Disease Ophthalmology Conditions/Procedures Cataract Conjunctivitis External Eye Infection, except Conjunctivitis Glaucoma Inflammatory Eye Disease Other & Unspecified Diseases & Disorders of Eye & Adnexa Trauma of Eye Visual Disturbances Orthopedics & Rheumatology Conditions/Procedures Adult Rheumatoid Arthritis* Autoimmune Rheumatologic Diseases, except Lupus* Bursitis & Tendinitis - Elbow & Upper Arm Bursitis & Tendinitis - Foot & Ankle Bursitis & Tendinitis - Hand, Wrist & Forearm Bursitis & Tendinitis - Knee & Lower Leg Bursitis & Tendinitis - Shoulder Bursitis & Tendinitis - Thigh, Hip & Pelvis Bursitis & Tendinitis - Unspecified Joint Degeneration, Localized - Back Joint Degeneration, Localized - Elbow & Upper Arm Joint Degeneration, Localized - Foot & Ankle Joint Degeneration, Localized - Hand, Wrist & Forearm Joint Degeneration, Localized - Knee & Lower Leg Joint Degeneration, Localized - Neck Joint Degeneration, Localized - Shoulder Joint Degeneration, Localized - Thigh, Hip & Pelvis Joint Degeneration, Localized - Unspecified Lupus* Major Joint Inflammation - Back Major Joint Inflammation - Hand, Wrist & Forearm Major Joint Inflammation - Knee & Lower Leg Major Joint Inflammation - Other Major Joint Inflammation - Unspecified Malignant Neoplasm of Bone & Connective Tissue, Other than Head & Neck Minor Orthopedic Trauma - Back Minor Orthopedic Trauma - Elbow & Upper Arm Minor Orthopedic Trauma - Foot & Ankle 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 5
Orthopedics & Rheumatology (continued) Minor Orthopedic Trauma - Hand, Wrist & Forearm Minor Orthopedic Trauma - Knee & Lower Leg Minor Orthopedic Trauma - Neck Minor Orthopedic Trauma - Shoulder Minor Orthopedic Trauma - Thigh, Hip & Pelvis Minor Orthopedic Trauma - Trunk Minor Orthopedic Trauma - Unspecified Orthopedic Signs & Symptoms - Back Orthopedic Signs & Symptoms - Elbow & Upper Arm Orthopedic Signs & Symptoms - Foot & Ankle Orthopedic Signs & Symptoms - Hand, Wrist & Forearm Orthopedic Signs & Symptoms - Knee & Lower Leg Orthopedic Signs & Symptoms - Neck Orthopedic Signs & Symptoms - Shoulder Orthopedic Signs & Symptoms - Thigh, Hip & Pelvis Orthopedic Signs & Symptoms - Unspecified Osteoporosis* Other Minor Orthopedic Disorders - Back Other Minor Orthopedic Disorders - Foot & Ankle Other Minor Orthopedic Disorders - Hand, Wrist & Forearm Other Minor Orthopedic Disorders - Knee & Lower Leg Other Minor Orthopedic Disorders - Neck Other Minor Orthopedic Disorders - Shoulder Other Minor Orthopedic Disorders - Thigh, Hip & Pelvis Other Minor Orthopedic Disorders - Unspecified Otolaryngology Conditions/Procedures Acute Sinusitis Allergic Rhinitis Chronic Sinusitis Congenital & Acquired Anomalies of Ear/Nose/Throat Hearing Disorders Infections of Oral Cavity Inflammation of Oral Cavity Malignant Neoplasm of Ear/Nose/Throat Other Infections of Ear/Nose/Throat Other Inflammatory Conditions of Ear/Nose/Throat Otitis Media Otolaryngology Diseases Signs & Symptoms Tonsillitis, Adenoiditis or Pharyngitis Trauma to Ear/Nose/Throat Preventive & Administrative Conditions/Procedures Exposure to Infectious Diseases 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures Page 6
Psychiatry Conditions/Procedures Dementia Pulmonology Conditions/Procedures Acute Bronchitis Asthma* Bacterial Lung Infections Chronic Obstructive Pulmonary Disease Malignant Neoplasm of Pulmonary System Minor Infectious Pulmonary Diseases, Other than Acute Bronchitis Occupational & Environmental Pulmonary Diseases Other Inflammatory Lung Diseases Pulmonary Embolism Pulmonary Tuberculosis Pulmonology Diseases Signs & Symptoms Viral Pneumonia Urology Conditions/Procedures Patient Total Cost Patient Episode Cost Medical Surgical Infection of Lower Genitourinary System, Not Sexually Transmitted Infection of Upper Genitourinary System Inflammation of Genitourinary System, except Kidney Stones Kidney Stones Malignant Neoplasm of Genitourinary System, except Prostate Malignant Neoplasm of Prostate Non-Malignant Neoplasm of Genitourinary System, except Prostate Non-Malignant Neoplasm of Prostate Sexually Transmitted Diseases, Disseminated Sexually Transmitted Diseases, Primary Urinary Incontinence Urological Diseases Signs & Symptoms *Episodes for these conditions are excluded from cost efficiency measurement for patients whose pharmacy cost data is not available. 2018-2019 UnitedHealth Premium Designation Program Cost Efficiency Conditions and Procedures