The impact of anesthesia providers on major morbidity following screening colonoscopies

Figures & data

Table 1 Baseline demographic and clinical characteristics in whole population

Characteristics	Whole population N=63,750
Sex, N (%)
Male	26,945 (42.27)
Female	36,805 (57.73)
Age group, N (%)
50–<55	12,209 (19.15)
55–<60	10,283 (16.13)
60–<65	7,527 (11.81)
65–<70	9,851 (15.45)
70–<75	10,367 (16.26)
75–<80	7,895 (12.38)
80+	5,618 (8.81)
Age, mean (SD)	65.80 (10.11)
Type of insurance, N (%)
Commercial
HMO	12,084 (18.96)
PPO	16,954 (26.59)
Medicare ADV
HMO	25,972 (40.74)
PFFS	8,061 (12.64)
PPO	679 (1.07)
Geographic region, N (%)
West	3,669 (5.76)
South	42,183 (66.17)
Northeast	259 (0.41)
Midwest	17,639 (27.67)
Charlson comorbidity,a N (%)
Myocardial infarction (score =1)	1,527 (2.40)
Congestive heart failure (score =1)	2,432 (3.81)
Peripheral vascular disease (score =1)	3,127 (4.91)
Cerebrovascular disease (score =1)	2,401 (3.77)
Dementia (score =1)	237 (0.37)
Chronic pulmonary disease (score =1)	6,057 (9.50)
Connective tissue disease–rheumatic disease (score =1)	1,330 (2.09)
Peptic ulcer disease (score =1)	558 (0.88)
Mild liver disease (score =1)	1,331 (2.09)
Diabetes without complications (score =1)	11,570 (18.15)
Diabetes with complications (score =2)	2,841 (4.46)
Paraplegia and hemiplegia (score =2)	160 (0.25)
Renal disease (score =2)	1,833 (2.88)
Cancer (score =2)	4,361 (6.84)
Moderate or severe liver disease (score =3)	87 (0.14)
Metastatic carcinoma (score =6)	293 (0.46)
AIDS/HIV (score =6)	68 (0.11)
Charlson comorbidity score,a mean (SD)	0.81 (1.43)
Incomplete colonoscopy procedure,b N (%)	810 (1.27)
Service site,b N (%)
Ambulatory surgical center	31,396 (49.25)
Hospital outpatient	27,229 (42.71)
Physician office	4,524 (7.10)
Hospital inpatient	576 (0.90)
Other provider	25 (0.04)
Presence of anesthesia provider,c N (%)	16,243 (25.48)
Personal history of colonic polyps,d N (%)	3,693 (5.79)
ASA status,e N (%)
P1	344 (0.54)
P2	1,587 (2.49)
P3	2,085 (3.27)
P4	136 (0.21)
P5	4 (0.01)
RCRI factors,f N (%)
0	46,825 (73.45)
1	11,844 (18.58)
2	3,709 (5.82)
3	1,079 (1.69)
4	257 (0.40)
5	36 (0.06)

Notes:

a Charlson comorbidity was calculated using medical claims 365 days prior to index date;

b incomplete procedure (CPT modifiers 52, 53, and 74), provider specialty, service site were defined by using medical claims containing the indexed colonoscopy procedure;

c presence of anesthesia provider was defined by the presence of CPT codes 00810 within any medical claim on index date.

d Personal history of colonic polyps was defined as follows: ICD-9 codes 211.3, 211.4, and V12.72 within 365 days prior to index date, or V12.72 on index date;

e CPT modifiers from medical claims within 1 year prior to index date (including) were used to defined patients’ ASA status. If a patient had different ASA statuses within this period, the latest one was used;

f RCRI factors were defined using medical claims within 365 days prior to index date: 1) history of ischemic heart disease: 410.xx, 411.xx, 412.xx, 413.xx, 414.xx 2) history of congestive heart failure: 428.xx 3) history of cerebrovascular disease: 43.

Abbreviations: ADV, Advantage; ASA, American Society of Anesthesiologists; CPT, Current Procedural Terminology; HMO, health maintenance organization; ICD-9, International Classification of Diseases Ninth revision; PPO, preferred provider organization; RCRI, Revised Cardiac Risk Index; SD, standard deviation; PFFS, private fee-for-service.

Table 2 Baseline demographic and clinical characteristics after propensity score matching (N=14,006)

Characteristics	Colonoscopy without anesthesia provider N=7,003	Colonoscopy with anesthesia provider N=7,003	P-value
Sex, N (%)
Male	2,755 (39.34)	2,732 (40.01)
Female	4,248 (60.66)	4,271 (60.99)	0.6905a
Age, mean (SD)	65.57 (9.96)	65.39 (10.05)	0.2925b
Type of insurance, N (%)
Commercial
HMO	1,172 (16.74)	1,254 (17.91)	0.1190a
PPO	1,952 (27.87)	1,982 (28.30)
Medicare ADV
HMO	3,149 (44.97)	3,112 (44.44)
PFFS	674 (9.62)	607 (8.67)
PPO	56 (0.80)	48 (0.69)
Geographic region, N (%)
West	237 (3.38)	208 (2.97)	0.1415a
South	5,936 (84.76)	6,030 (86.11)
Northeast	19 (0.27)	20 (0.29)
Midwest	811 (11.58)	745 (10.64)
Charlson comorbidity score, mean (SD)	0.68 (1.32)	0.67 (1.32)	0.5103b
Service site, N (%)
Ambulatory surgical center	4,390 (62.69)	4,298 (61.37)	0.2178a
Hospital outpatient	2,166 (30.93)	2,206 (31.50)
Physician office	407 (5.81)	465 (6.64)
Hospital inpatient	37 (0.53)	32 (0.46)
Other provider	3 (0.04)	2 (0.03)
Personal history of colonic polyps, N (%)
Yes	260 (3.71)	234 (3.34)	0.2337a
RCRI risk group, N (%)
High	430 (6.14)	444 (6.34)	0.6248a
RCRI factors, N (%)
Ischemic heart disease (yes)	1,049 (14.98)	1,070 (15.28)	0.6205a
Congestive heart failure (yes)	239 (3.41)	257 (3.67)	0.4105a
Cerebrovascular disease (yes)	437 (6.24)	484 (6.91)	0.1091a
Renal insufficiency (yes)	257 (3.67)	205 (2.93)	0.0139a
Diabetes with insulin therapy (yes)	176 (2.51)	147 (2.10)	0.1026a
Hyperlipidemia, N (%)
Yes	4,686 (66.91)	4,648 (66.37)	0.4959a
Hypertension, N (%)
Yes	4,156 (59.35)	4,204 (60.03)	0.4083a
Obesity, N (%)
Yes	404 (5.77)	443 (6.33)	0.1668a

Notes:

a P-value for comparison between anesthesia without provider and with provider, calculated by chi-square test;

b P-value for comparison between anesthesia without provider and with provider, calculated by t-test with equal variance.

Abbreviations: ADV, Advantage; HMO, health maintenance organization; PFFS, private fee-for-service; PPO, preferred provider organization; RCRI, Revised Cardiac Risk Index; SD, standard deviation.

Table 3 Comparison of colonoscopy outcomes

Outcomes	Colonoscopy without anesthesia provider	Colonoscopy with anesthesia provider	Unadjusted			Adjusted*
	N=7,003	N=7,003	OR	95% CI	P-value	OR	95% CI	P-value
Completed colonoscopy on index day, N (%)	6,906 (98.61)	6,923 (98.86)	1.22	0.90–1.64	0.2020	1.23	0.91–1.66	0.1797
Repeated colonoscopy within 180 days post-index day, N (%)**	168 (2.40)	125 (1.78)	0.74	0.59–0.93	0.0114	0.75	0.59–0.96	0.0195
Colorectal cancer identified on index day and within 180 days post-index day, N (%)	119 (1.7)	142 (2.03)	1.20	0.94–1.53	0.1487	1.21	0.95–1.55	0.1266
Colon	104 (1.49)	128 (1.83)	1.24	0.95–1.60	0.1110	1.25	0.96–1.63	0.0942
Rectum and anus	72 (1.03)	94 (1.34)	1.31	0.96–1.78	0.0867	1.33	0.97–1.81	0.0761
Hospital admission on index day and within 7 days post-index day, N (%)	58 (0.83)	49 (0.70)	0.97	0.86–1.09	0.6205	0.97	0.86–1.09	0.5848

Notes:

* For MI, adjusting for age, sex, and previous history of MI. For stroke, adjusting for age, sex, and previous history of cerebrovascular disease. For other outcomes, adjusting for variables used for propensity score matching (age, sex, geographic region, RCRI group, etc) and status of colonoscopy procedure (not used for completed colonoscopy outcome). GEE analysis was performed to adjust for correlation within matched pairs;

** all types of colonoscopy procedures defined in Table 4.

Abbreviations: CI, confidence interval; GEE, generalized estimating equations; MI, myocardial infarction; OR, odds ratio; RCRI, Revised Cardiac Risk Index.

Table 4 Comparison of cardiovascular outcomes

Outcomes	Colonoscopy without anesthesia provider	Colonoscopy with anesthesia provider	Unadjusted			Adjusted*
	N=7,003	N=7,003	OR	95% CI	P-value	OR	95% CI	P-value
MI on index day and within 7 days post-index day, N (%)	4 (0.06)	13 (0.19)	3.25	1.06–9.99	0.0392	3.20	1.03–9.90	0.0442
MI (primary diagnosis) on index day and within 7 days post-index day, N (%)	3 (0.04)	7 (0.10)	2.33	0.60–9.04	0.2195	2.25	0.58–8.77	0.2422
Stroke on index day and within 7 days post-index day, N (%)	10 (0.14)	10 (0.14)	1.00	0.42–2.41	1.0000	0.90	0.38–2.18	0.8234
Stroke (primary diagnosis) on index day and within 7 days post-index day, N (%)	5 (0.07)	4 (0.06)	0.80	0.21–2.98	0.7394	0.76	0.20–2.81	0.6765

Notes:

* For MI, adjusting for age, sex, and previous history of MI. For stroke, adjusting for age, sex, and previous history of cerebrovascular disease. GEE analysis was performed to adjust for correlation within matched pairs.

Abbreviations: CI, confidence interval; GEE, generalized estimating equations; MI, myocardial infarction; OR, odds ratio.

Table 5 Baseline demographic and clinical characteristics (N=63,750)

Characteristics	Colonoscopy without anesthesia provider N=47,507	Colonoscopy with anesthesia provider N=16,243	P-value
Sex, N (%)
Male	20,425 (42.99)	6,520 (40.14)
Female	27,082 (57.01)	9,723 (59.86)	<0.0001a
Age, mean (SD)	65.28 (10.10)	67.31 (9.99)	<0.0001b
Type of insurance, N (%)
Commercial
HMO	9,278 (19.53)	2,806 (17.28)	<0.0001a
PPO	14,019 (29.51)	2,935 (18.07)
Medicare ADV
HMO	16,885 (35.54)	9,087 (55.94)
PFFS	6,803 (14.32)	1,258 (7.74)
PPO	522 (1.10)	157 (0.97)
Geographic region, N (%)
West	3,339 (7.03)	330 (2.03)	<0.0001a
South	27,454 (57.79)	14,729 (90.68)
Northeast	115 (0.24)	144 (0.89)
Midwest	16,599 (34.94)	1,040 (6.40)
Charlson comorbidity score, mean (SD)	0.76 (1.40)	0.93 (1.52)	<0.0001c
Service site, N (%)
Ambulatory surgical center	19,717 (41.50)	11,679 (71.90)	<0.0001a
Hospital outpatient	23,568 (49.61)	3,661 (22.54)
Physician office	3,693 (7.77)	831 (5.12)
Hospital inpatient	507 (1.07)	69 (0.42)
Other provider	22 (0.05)	3 (0.02)
Personal history of colonic polyps, N (%)
Yes	1,990 (4.19)	1,703 (10.48)	<0.0001a
RCRI risk group, N (%)
High	3,568 (7.51)	1,513 (9.31)	<0.0001a
RCRI factors, N (%)
Ischemic heart disease (yes)	7,666 (16.14)	3,449 (21.23)	<0.0001a
Congestive heart failure (yes)	2,161 (4.55)	791 (4.87)	0.0929a
Cerebrovascular disease (yes)	3,551 (7.47)	1,544 (9.51)	<0.0001a
Renal insufficiency (yes)	1,835 (3.86)	788 (4.85)	<0.0001a
Diabetes with insulin therapy (yes)	1,422 (2.99)	500 (3.08)	0.5844a
Hyperlipidemia, N (%)
Yes	28,902 (60.84)	11,353 (69.89)	<0.0001a
Hypertension, N (%)
Yes	27,665 (58.23)	10,514 (64.73)	<0.0001a
Obesity, N (%)
Yes	2,971 (6.25)	1,295 (7.97)	<0.0001a

Notes:

a P-value for comparison between colonoscopy without anesthesia provider and with anesthesia provider, calculated by chi-square test;

b P-value for comparison between colonoscopy without anesthesia provider and with anesthesia provider, calculated by t-test with equal variance;

c P-value for comparison between colonoscopy without anesthesia provider and with anesthesia provider, calculated by t-test with unequal variance.

Abbreviations: ADV, Advantage; HMO, health maintenance organization; PFFS, private fee-for-service; PPO, preferred provider organization; RCRI, Revised Cardiac Risk Index; SD, standard deviation.

Table

CPT code	Description
00810	Presence of anesthesia provider
45355	Colonoscopy, rigid or flexible, transabdominal via colostomy, single or multiple
45378	Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression
45380	Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
Modifier 52	Incomplete procedure
Modifier 53	Incomplete procedure
Modifier 74	Incomplete procedure
Modifier P1	Normal healthy patient
Modifier P2	Patient with mild systemic disease
Modifier P3	Patient with severe systemic disease
Modifier P4	Patient with severe systemic disease that is a constant threat to life
Modifier P5	Moribund patient who is not expected to survive without the operation
G code
G0121	Colorectal screening; colonoscopy on individual not meeting criteria for high risk
G0105	Colorectal screening; colonoscopy on individual meeting criteria for high risk
V code
V10.05	Personal history of malignant neoplasm of large intestine
V10.06	Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus
ICD-9 code
153	Malignant neoplasm of colon
153.0	Malignant neoplasm of hepatic flexure
153.1	Malignant neoplasm of transverse colon
153.2	Malignant neoplasm of descending colon
153.3	Malignant neoplasm of sigmoid colon
153.4	Malignant neoplasm of cecum
153.5	Malignant neoplasm of appendix
153.6	Malignant neoplasm of ascending colon
153.7	Malignant neoplasm of splenic flexure
153.8	Malignant neoplasm of other specified sites of large intestine
153.9	Malignant neoplasm of colon, unspecified site
154	Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.0	Malignant neoplasm of rectosigmoid junction
154.1	Malignant neoplasm of rectum
154.2	Malignant neoplasm of anal canal
154.3	Malignant neoplasm of anus, unspecified site
154.8	Malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus
ICD-9 code
230.3	Carcinoma in situ of colon
230.6	Carcinoma in situ of rectum
230.7	Carcinoma in situ of anal canal
230.8	Carcinoma in situ of anus, unspecified
235.2	Neo uncertain behavior
239.0	Neo unspecified
555	Regional enteritis
555.1	Regional enteritis, large intestine
555.2	Regional enteritis, small intestine with large intestine
555.9	Regional enteritis, unspecified site
556	Ulcerative colitis
556.0	Ulcerative (chronic) enterocolitis
556.1	Ulcerative (chronic) ileocolitis
556.2	Ulcerative (chronic) proctitis
556.3	Ulcerative (chronic) proctosigmoiditis
556.4	Pseudopolyposis of colon
556.5	Left-sided ulcerative (chronic) colitis
556.6	Universal ulcerative (chronic) colitis
556.8	Other ulcerative colitis
556.9	Ulcerative colitis, unspecified
410	Acute myocardial infarction
410.0	Acute myocardial infarction of anterolateral wall
410.00	Acute myocardial infarction of anterolateral wall, episode of care unspecified
410.01	Acute myocardial infarction of anterolateral wall, initial episode of care
410.02	Acute myocardial infarction of anterolateral wall, subsequent episode of care
410.1	Acute myocardial infarction of other anterior wall
410.0	Acute myocardial infarction of other anterior wall, episode of care unspecified
410.11	Acute myocardial infarction of other anterior wall, initial episode of care
410.12	Acute myocardial infarction of other anterior wall, subsequent episode of care
410.2	Acute myocardial infarction of inferolateral wall
410.20	Acute myocardial infarction of inferolateral wall, episode of care unspecified
410.21	Acute myocardial infarction of inferolateral wall, initial episode of care
410.22	Acute myocardial infarction of inferolateral wall, subsequent episode of care
410.3	Acute myocardial infarction of inferoposterior wall
410.30	Acute myocardial infarction of inferoposterior wall, episode of care unspecified
410.31	Acute myocardial infarction of inferoposterior wall, initial episode of care
410.32	Acute myocardial infarction of inferoposterior wall, subsequent episode of care
410.4	Acute myocardial infarction of other inferior wall
410.40	Acute myocardial infarction of other inferior wall, episode of care unspecified
410.41	Acute myocardial infarction of other inferior wall, initial episode of care
ICD-9 code
410.42	Acute myocardial infarction of other inferior wall, subsequent episode of care
410.5	Acute myocardial infarction of other lateral wall
410.50	Acute myocardial infarction of other lateral wall, episode of care unspecified
410.51	Acute myocardial infarction of other lateral wall, initial episode of care
410.52	Acute myocardial infarction of other lateral wall, subsequent episode of care
410.6	Acute myocardial infarction, true posterior wall infarction
410.60	Acute myocardial infarction, true posterior wall infarction, episode of care unspecified
410.61	Acute myocardial infarction, true posterior wall infarction, initial episode of care
410.62	Acute myocardial infarction, true posterior wall infarction, subsequent episode of care
410.7	Acute myocardial infarction, subendocardial infarction
410.70	Acute myocardial infarction, subendocardial infarction, episode of care unspecified
410.71	Acute myocardial infarction, subendocardial infarction, initial episode of care
410.72	Acute myocardial infarction, subendocardial infarction, subsequent episode of care
410.8	Acute myocardial infarction of other specified sites
410.80	Acute myocardial infarction of other specified sites, episode of care unspecified
410.81	Acute myocardial infarction of other specified sites, initial episode of care
410.82	Acute myocardial infarction of other specified sites, subsequent episode of care
410.9	Acute myocardial infarction, unspecified site
410.90	Acute myocardial infarction, unspecified site, episode of care unspecified
410.91	Acute myocardial infarction, unspecified site, initial episode of care
410.92	Acute myocardial infarction, unspecified site, subsequent episode of care
411	Other acute and subacute forms of ischemic heart disease
411.0	Postmyocardial infarction syndrome
411.1	Intermediate coronary syndrome
411.8	Other acute and subacute forms of ischemic heart disease
411.81	Acute coronary occlusion without myocardial infarction
411.89	Other acute and subacute form of ischemic heart disease
412	Old myocardial infarction
413	Angina pectoris
413.0	Angina decubitus
413.1	Prinzmetal angina
413.9	Other and unspecified angina pectoris
414	Other forms of chronic ischemic heart disease
414.0	Coronary atherosclerosis
414.00	Coronary atherosclerosis of unspecified type of vessel, native, or graft
414.01	Coronary atherosclerosis of native coronary artery
414.02	Coronary atherosclerosis of autologous vein bypass graft
414.03	Coronary atherosclerosis of nonautologous biological bypass graft
414.04	Coronary atherosclerosis of artery bypass graft
414.05	Coronary atherosclerosis of unspecified type of bypass graft
ICD-9 code
414.06	Coronary atherosclerosis, of native coronary artery of transplanted heart
414.07	Coronary atherosclerosis, of bypass graft (artery) (vein) of transplanted heart
414.1	Aneurysm and dissection of heart
414.10	Aneurysm of heart
414.11	Aneurysm of coronary vessels
414.12	Dissection of coronary artery
414.19	Other aneurysm of heart
414.2	Chronic total occlusion of coronary artery
414.8	Other specified forms of chronic ischemic heart disease
414.9	Unspecified chronic ischemic heart disease
430	Subarachnoid hemorrhage
431	Intracerebral hemorrhage
432	Other and unspecified intracranial hemorrhage
432.0	Nontraumatic extradural hemorrhage
432.1	Subdural hemorrhage
432.9	Unspecified intracranial hemorrhage
433	Occlusion and stenosis of precerebral arteries
433.0	Occlusion and stenosis of basilar artery
433.00	Occlusion and stenosis of basilar artery without mention of cerebral infarction
433.01	Occlusion and stenosis of basilar artery with cerebral infarction
433.1	Occlusion and stenosis of carotid artery
433.10	Occlusion and stenosis of carotid artery without mention of cerebral infarction
433.11	Occlusion and stenosis of carotid artery with cerebral infarction
433.2	Occlusion and stenosis of vertebral artery
433.20	Occlusion and stenosis of vertebral artery without mention of cerebral infarction
433.21	Occlusion and stenosis of vertebral artery with cerebral infarction
433.3	Occlusion and stenosis of multiple and bilateral precerebral arteries
433.30	Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction
433.31	Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction
433.8	Occlusion and stenosis of other specified precerebral artery
433.80	Occlusion and stenosis of other specified precerebral artery without mention of cerebral infarction
433.81	Occlusion and stenosis of other specified precerebral artery with cerebral infarction
433.9	Occlusion and stenosis of unspecified precerebral artery
433.90	Occlusion and stenosis of unspecified precerebral artery without mention of cerebral infarction
433.91	Occlusion and stenosis of unspecified precerebral artery with cerebral infarction
434	Occlusion of cerebral arteries
434.0	Cerebral thrombosis
434.00	Cerebral thrombosis without mention of cerebral infarction
434.01	Cerebral thrombosis with cerebral infarction
ICD-9 code
434.1	Cerebral embolism
434.10	Cerebral embolism without mention of cerebral infarction
434.11	Cerebral embolism with cerebral infarction
434.9	Unspecified cerebral artery occlusion
434.90	Unspecified cerebral artery occlusion without mention of cerebral infarction
434.91	Unspecified cerebral artery occlusion with cerebral infarction
435	Transient cerebral ischemia
435.0	Basilar artery syndrome
435.1	Vertebral artery syndrome
435.2	Subclavian steal syndrome
435.3	Vertebrobasilar artery syndrome
435.8	Other specified transient cerebral ischemias
435.9	Unspecified transient cerebral ischemia
436	Acute, but ill-defined, cerebrovascular disease
437	Other and ill-defined cerebrovascular disease
437.0	Cerebral atherosclerosis
437.1	Other generalized ischemic cerebrovascular disease
437.2	Hypertensive encephalopathy
437.3	Cerebral aneurysm, nonruptured
437.4	Cerebral arteritis
437.5	Moyamoya disease
437.6	Nonpyogenic thrombosis of intracranial venous sinus
437.7	Transient global amnesia
437.8	Other ill-defined cerebrovascular disease
437.9	Unspecified cerebrovascular disease
438	Late effects of cerebrovascular disease
438.0	Cognitive deficits due to cerebrovascular disease
438.1	Speech and language deficits due to cerebrovascular disease
439.10	Unspecified speech and language deficit due to cerebrovascular disease
438.11	Aphasia due to cerebrovascular disease
438.12	Dysphasia due to cerebrovascular disease
438.19	Other speech and language deficits due to cerebrovascular disease
438.2	Hemiplegia/hemiparesis due to cerebrovascular disease
438.20	Hemiplegia affecting unspecified side due to cerebrovascular disease
438.21	Hemiplegia affecting dominant side due to cerebrovascular disease
438.22	Hemiplegia affecting nondominant side due to cerebrovascular disease
438.3	Monoplegia of upper limb due to cerebrovascular disease
438.30	Monoplegia of upper limb affecting unspecified side due to cerebrovascular disease
438.31	Monoplegia of upper limb affecting dominant side due to cerebrovascular disease
438.32	Monoplegia of upper limb affecting nondominant side due to cerebrovascular disease
ICD-9 code
438.4	Monoplegia of lower limb due to cerebrovascular disease
438.40	Monoplegia of lower limb affecting unspecified side due to cerebrovascular disease
438.41	Monoplegia of lower limb affecting dominant side due to cerebrovascular disease
438.42	Monoplegia of lower limb affecting nondominant side due to cerebrovascular disease
438.5	Other paralytic syndrome due to cerebrovascular disease
438.50	Other paralytic syndrome affecting unspecified side due to cerebrovascular disease
438.51	Other paralytic syndrome affecting dominant side due to cerebrovascular disease
438.52	Other paralytic syndrome affecting nondominant side due to cerebrovascular disease
438.6	Alteration of sensations as late effect of cerebrovascular disease
438.7	Disturbance of vision as late effect of cerebrovascular disease
438.8	Other late effects of cerebrovascular disease due to cerebrovascular disease
438.81	Apraxia due to cerebrovascular disease
438.82	Dysphagia due to cerebrovascular disease
438.83	Facial weakness as late effect of cerebrovascular disease
438.84	Ataxia as late effect of cerebrovascular disease
438.85	Vertigo as late effect of cerebrovascular disease
438.89	Other late effects of cerebrovascular disease
438.9	Unspecified late effects of cerebrovascular disease due to cerebrovascular disease
428	Heart failure
428.0	Congestive heart failure, unspecified
428.1	Left heart failure
428.2	Systolic heart failure
428.20	Unspecified systolic heart failure
428.21	Acute systolic heart failure
428.22	Chronic systolic heart failure
428.23	Acute on chronic systolic heart failure
428.3	Diastolic heart failure
428.30	Unspecified diastolic heart failure
428.31	Acute diastolic heart failure
428.32	Chronic diastolic heart failure
428.33	Acute on chronic diastolic heart failure
428.4	Combined systolic and diastolic heart failure
428.40	Unspecified combined systolic and diastolic heart failure
428.41	Acute combined systolic and diastolic heart failure
428.42	Chronic combined systolic and diastolic heart failure
428.43	Acute on chronic combined systolic and diastolic heart failure
428.9	Unspecified heart failure
250	Diabetes mellitus
250.0	Diabetes mellitus without mention of complication
ICD-9 code
250.00	Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
250.01	Diabetes mellitus without mention of complication, type I (juvenile type), not stated as uncontrolled
250.02	Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
250.03	Diabetes mellitus without mention of complication, type I (juvenile type), uncontrolled
250.1	Diabetes with ketoacidosis
250.10	Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
250.11	Diabetes with ketoacidosis, type I (juvenile type), not stated as uncontrolled
250.12	Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.13	Diabetes with ketoacidosis, type I (juvenile type), uncontrolled
250.2	Diabetes with hyperosmolarity
250.20	Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21	Diabetes with hyperosmolarity, type I (juvenile type), not stated as uncontrolled
250.22	Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23	Diabetes with hyperosmolarity, type I (juvenile type), uncontrolled
250.3	Diabetes with other coma
250.30	Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
250.31	Diabetes with other coma, type I (juvenile type), not stated as uncontrolled
250.32	Diabetes with other coma, type II or unspecified type, uncontrolled
250.33	Diabetes with other coma, type I (juvenile type), uncontrolled
250.4	Diabetes with renal manifestations
250.40	Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
250.41	Diabetes with renal manifestations, type I (juvenile type), not stated as uncontrolled
250.42	Diabetes with renal manifestations, type II or unspecified type, uncontrolled
250.43	Diabetes with renal manifestations, type I (juvenile type), uncontrolled
250.5	Diabetes with ophthalmic manifestations
250.50	Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled
250.51	Diabetes with ophthalmic manifestations, type I (juvenile type), not stated as uncontrolled
250.52	Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled
250.53	Diabetes with ophthalmic manifestations, type I (juvenile type), uncontrolled
250.6	Diabetes with neurological manifestations
250.60	Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
250.61	Diabetes with neurological manifestations, type I (juvenile type), not stated as uncontrolled
250.62	Diabetes with neurological manifestations, type II or unspecified type, uncontrolled
250.63	Diabetes with neurological manifestations, type I (juvenile type), uncontrolled
250.7	Diabetes with peripheral circulatory disorders
250.70	Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled
250.71	Diabetes with peripheral circulatory disorders, type I (juvenile type), not stated as uncontrolled
250.72	Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled
250.73	Diabetes with peripheral circulatory disorders, type I (juvenile type), uncontrolled
ICD-9 code
250.8	Diabetes with other specified manifestations
250.80	Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled
250.81	Diabetes with other specified manifestations, type I (juvenile type), not stated as uncontrolled
250.82	Diabetes with other specified manifestations, type II or unspecified type, uncontrolled
250.83	Diabetes with other specified manifestations, type I (juvenile type), uncontrolled
250.9	Diabetes with unspecified complication
250.90	Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled
250.91	Diabetes with unspecified complication, type I (juvenile type), not stated as uncontrolled
250.92	Diabetes with unspecified complication, type II or unspecified type, uncontrolled
250.93	Diabetes with unspecified complication, type I (juvenile type), uncontrolled
581	Nephrotic syndrome
581.0	Nephrotic syndrome with lesion of proliferative glomerulonephritis
581.1	Nephrotic syndrome with lesion of membranous glomerulonephritis
581.2	Nephrotic syndrome with lesion of membranoproliferative glomerulonephritis
581.3	Nephrotic syndrome with lesion of minimal change glomerulonephritis
581.8	Nephrotic syndrome with other specified pathological lesion in kidney
581.81	Nephrotic syndrome with other specified pathological lesion in kidney in diseases classified elsewhere
581.89	Other nephrotic syndrome with specified pathological lesion in kidney
581.9	Nephrotic syndrome with unspecified pathological lesion in kidney
582	Chronic glomerulonephritis
582.0	Chronic glomerulonephritis with lesion of proliferative glomerulonephritis
582.1	Chronic glomerulonephritis with lesion of membranous glomerulonephritis
582.2	Chronic glomerulonephritis with lesion of membranoproliferative glomerulonephritis
582.4	Chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis
582.8	Chronic glomerulonephritis with other specified pathological lesion in kidney
582.81	Chronic glomerulonephritis with other specified pathological lesion in kidney in diseases classified elsewhere
582.89	Other chronic glomerulonephritis with specified pathological lesion in kidney
582.9	Chronic glomerulonephritis with unspecified pathological lesion in kidney
585	Chronic renal failure
585.1	Chronic kidney disease, Stage I
585.2	Chronic kidney disease, Stage II (mild)
585.3	Chronic kidney disease, Stage III (moderate)
585.4	Chronic kidney disease, Stage IV (severe)
585.5	Chronic kidney disease, Stage V
585.6	End stage renal disease
585.9	Chronic kidney disease, unspecified
587	Unspecified renal sclerosis
588	Disorders resulting from impaired renal function
588.0	Renal osteodystrophy
ICD-9 code
588.1	Nephrogenic diabetes insipidus
588.8	Other specified disorder resulting from impaired renal function
588.89	Other specified disorders resulting from impaired renal function
588.9	Unspecified disorder resulting from impaired renal function
GPI code
2710101000	Insulin (Regular) Inj 100 Unit/ML
2710101000	Insulin (Regular) Inj 80 Unit/ML
2710101000	Insulin (Regular) Inj 40 Unit/ML
2710102000	Insulin Isophane Inj 40 Unit/ML
2710102000	Insulin Isophane Inj 100 Unit/ML
2710102000	Insulin Isophane Inj 80 Unit/ML
2710103000	Insulin Protamine Zinc Inj 40 Unit/ML
2710103000	Insulin Protamine Zinc Inj 100 Unit/ML
2710104000	Insulin Zinc Inj 40 Unit/ML
2710104000	Insulin Zinc Inj 80 Unit/ML
2710104000	Insulin Zinc Inj 100 Unit/ML
2710105000	Insulin Zinc, Extended Inj 100 Unit/ML
2710105000	Insulin Zinc, Extended Inj 40 Unit/ML
2710106000	Insulin Zinc, Prompt Inj 100 Unit/ML
2710106000	Insulin Zinc, Prompt Inj 40 Unit/ML
2710201000	Insulin Regular (Beef) Inj 100 Unit/ML
2710202000	Insulin Isophane (Beef) Inj 100 Unit/ML
2710203000	Insulin Protamine Zinc (Beef) Inj 100 Unit/ML
2710204000	Insulin Zinc (Beef) Inj 100 Unit/ML
2710205000	Insulin Zinc, Extended (Beef) Inj 100 Unit/ML
2710206000	Insulin Zinc, Prompt (Beef) Inj 100 Unit/ML
2710301000	Insulin Regular (Pork) Inj 500 Unit/ML
2710301000	Insulin Regular (Pork) Inj 100 Unit/ML
2710301000	Insulin Regular (Pork) Inj 40 Unit/ML
2710302000	Insulin Isophane (Pork) Inj 100 Unit/ML
2710303000	Insulin Protamine Zinc (Pork) Inj 100 Unit/ML
2710304000	Insulin Zinc (Pork) Inj 100 Unit/ML
2710306000	Insulin Zinc, Prompt (Pork) Inj 100 Unit/ML
2710307000	Insulin Regular and Isophane (Pork) Inj 100 Unit/ML
2710400200	Insulin Aspart Inj 100 Unit/ML
2710400300	Insulin Glargine Inj 100 Unit/ML
2710400500	Insulin Lispro (Human) Inj 100 Unit/ML
2710401000	Insulin Regular (Human) Inj 100 Unit/ML
2710401500	Insulin Regular (Human) Inj Buffered 100 Unit/ML
GPI code
2710402000	Insulin Isophane (Human) Inj 100 Unit/ML
2710403000	Insulin Zinc (Human) Inj 100 Unit/ML
2710405000	Insulin Zinc, Extended (Human) Inj 100 Unit/ML
2710407000	Insulin Aspart Prot and Aspart (Human) Inj 100 Unit/ML (70–30)
2710408000	Insulin Lispro and Lispro Prot (Human) Inj 100 Unit/ML (25–75)
2710409000	Insulin Isophane and Regular (Human) Inj 100 Unit/ML (50–50)
2710409000	Insulin Isophane and Regular (Human) Inj 100 Unit/ML (70–30)
2710409000	Insulin Regular and Isophane (Human) Inj 100 Unit/ML (30–70)

Abbreviations: CPT, Current Procedural Terminology; GPI, Generic Product Identifier; ICD-9, International Classification of Diseases Ninth revision; Inj, injected.