Appendix A. Patient Cohorts and Related ICD-9-CM Codes
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Hospital Report CardsTM Methodology 8
May not be reprinted or reproduced without permission from Health Grades, Inc.
Patient Cohort
ICD-9-CM Procedure/Diagnosis Codes and Criteria
Gastrointestinal Bleed
Principal Diagnoses Inclusions:
456.0, 456.20, 530.2, 530.21, 530.7, 530.82,
531.00, 531.01, 531.20, 531.21, 531.40, 531.41, 531.60, 531.61, 532.00, 532.01,
532.20, 532.21, 532.40, 532.41, 532.60, 532.61, 533.00, 533.01, 533.20, 533.21,
533.40, 533.41, 533.60, 533.61, 534.0, 534.00, 534.01, 534.20, 534.21, 534.40,
534.41, 534.60, 534.61, 535.01, 535.11, 535.21, 535.31, 535.41, 535.51, 535.61,
537.83, 537.84, 562.02, 562.03, 562.12, 562.13, 569.3, 569.82, 569.85, 569.86,
578, 578.0, 578.1, 578.9, 751.0
Procedures Exclusions:
37.5, 37.51, 37.52, 37.53, 37.54, 37.62, 37.63
Diagnoses Exclusions:
196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9,
197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2,
198.3, 198.4, 198.5, 198.6, 198.7, 198.8, 198.81, 198.82, 198.89, V66.7
Gastrointestinal Procedures
and Surgeries
APR-DRG:
220-224, 226, 229, 260, 261, 264
Heart Attack
Principal Diagnoses Inclusions:
410.01, 410.11, 410.21, 410.31, 410.41,
410.51, 410.61, 410.71, 410.81, 410.91
Procedures Exclusions:
37.5, 37.51, 37.52, 37.53, 37.54, 37.62, 37.63
Diagnoses Exclusions:
196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9,
197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2,
198.3, 198.4, 198.5, 198.6, 198.7, 198.8, 198.81, 198.82, 198.89, 414.06, 414.07,
V42.1, V66.7
Heart Failure
Principal Diagnoses Inclusions:
398.91, 402.01, 402.11, 402.91, 404.01,
404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.2, 428.20, 428.21,
428.22, 428.23, 428.3, 428.30, 428.31, 428.32, 428.33, 428.4, 428.40, 428.41,
428.42, 428.43, 428.9
Procedures Exclusions:
37.5, 37.51, 37.52, 37.53, 37.54, 37.62, 37.63, 39.95
Diagnoses Exclusions:
196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9,
197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2,
198.3, 198.4, 198.5, 198.6, 198.7, 198.8, 198.81, 198.82, 198.89, 414.06, 414.07,
V42.1, V66.7
Hip Fracture Repair
Principal Procedures Inclusions:
79.05, 79.15, 79.25, 79.35
Procedures Exclusions:
37.5, 37.51, 37.52, 37.53, 37.54, 78.65, 78.66, 78.67,
80.05, 80.06, 81.54, 81.55
Diagnoses Exclusions:
800.6, 820.10, 820.11, 820.12, 820.13, 820.19, 820.30,
820.31, 820.32, 820.9, 821.10, 821.11, 821.30, 821.31, 821.32, 821.33, 821.39,
996.4, V66.7
Pancreatitis
Principal Diagnoses Inclusions:
577.0, 577.1
Procedures Exclusions:
37.5, 37.51, 37.52, 37.53, 37.54, 37.62, 37.63
Diagnoses Exclusions:
196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9,
197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2,
198.3, 198.4, 198.5, 198.6, 198.7, 198.8, 198.81, 198.82, 198.89, V66.7
