Quality Indicators by wuzhenguang

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									Quality Indicators
As at 22 November 2011



Publish ID    Indicator                                       Count of   Numerator Filter                              Denominator Filter                           Comments                                                        Target
        006   Diabetics w Lipid profile test                  Member Activity.Code =Lipid Panel                  Diagnosis.Code=Diabetic
                                                                     OR
                                                                     Activity.Code=HDL AND LDL AND Triglycerides
                                                                     OR
                                                                     Activity.Code=HDL AND Total Cholesterol
                                                                     AND Triglycerides



        007   Diabetics w Renal test                          Member Activity.Code=Renal test                          Diagnosis.Code=Diabetic

        008   Diabetics w >1 HbA1c test                       Member Activity.Code=HbA1C test                          Diagnosis.Code=Diabetic

        020   Diabetics w Eye exam                            Member Activity.Code=Retinal/Eye exam                    Diagnosis.Code=Diabetic

        022   Episodes Diabetics w Microalbuminuria w/o       Member In any Episode:                                   (a) Microalbuminuria and treatment in one    10/1/11: Denominator to filter to ≥2 Episodes at 1 facility
              ACE/ARB                                                Activity.Code≠Microalbuminuria medication         episode                                      within 1 month, change to count of Member
                                                                                                                       Diagnosis.Code=Diabetic                      14/3/11: Approved for publication
                                                                                                                       AND                                          23/3/11: To be amended to w/o ACE/ARB for consistency
                                                                                                                       [Diagnosis.Code=Microalbuminuria list OR     (done in OLAP)
                                                                                                                       Observation.Code=Microalbumin observation,   18/11/11: Data not available in cube - #Value error
                                                                                                                       Observation.Value=>30,
                                                                                                                       Observation.ValueType=Mg/l]
                                                                                                                       AND
                                                                                                                       Activity.Code=Microalbuminuria medication
                                                                                                                       OR
                                                                                                                       (b) ≥2 Episodes at facility in 30 days w
                                                                                                                       Diabetic/Microalbuminuria 1st episode
                                                                                                                       ≥ 2 Episodes same FacilityID within 30days
                                                                                                                       (StartDate)
                                                                                                                       WHERE in 1st Episode:
                                                                                                                       Diagnosis.Code=Diabetic
                                                                                                                       AND
                                                                                                                       [Diagnosis.Code=Microalbuminuria list OR
                                                                                                                       Observation.Code=Microalbumin observation,
                                                                                                                       Observation.Value=>30,
                                                                                                                       Observation.ValueType=Mg/l]
        024   Diabetics latest LDL:HDL < 3.5                  Member [(Observation.Code=HDL) :                         Diagnosis.Code=Diabetic                      10/1/11: Approved for publication
                                                                     (Observation.Code=LDL List)]
                                                                     Observation.Value: LDL:HDL<=3.5
                                                                     Observation.ValueType=mmol/l
        025   Diabetics latest LDL:HDL > 3.5 w/o medication   Member Activity.Code≠Lipid modifying medication          Diagnosis.Code=Diabetic                      10/1/11: Approved for publication
                                                                                                                       AND                                          17/11/11: Methodology updated to 'without'
                                                                                                                       [(Observation.Code=HDL) :
                                                                                                                       (Observation.Code=LDL)]
                                                                                                                       Observation.Value: LDL:HDL>3.5
                                                                                                                       Observation.ValueType=mmol/l
        066   Diabetics w HbA1c observation & latest          Member Observation.Code=HbA1C observation                Diagnosis.Code=Diabetic                      10/1/11: New - under development
              HbA1c<7.5%                                              Observation.Value<7.5                            Observation.Code=HbA1C observation           14/3/11: Approved for publication
                                                                      Observation.ValueType=%                          Observation.ValueType=%
        067   Diabetics w HbA1c observation & latest          Member Observation.Code=HbA1C observation                Diagnosis.Code=Diabetic                      10/1/11: New - under development
              HbA1c<7%                                                Observation.Value<7                              Observation.Code=HbA1C observation           14/3/11: Approved for publication
                                                                      Observation.ValueType=%                          Observation.ValueType=%
        068   Diabetics w LDL:HDL observation & latest        Member [(Observation.Code=HDL) :                         Diagnosis.Code=Diabetic                      10/1/11: New - under development
              LDL:HDL < 3.5                                           (Observation.Code=LDL)]                          [Observation.Code=HDL) AND                   14/3/11: Approved for publication
                                                                      Observation.Value: LDL:HDL<=3.5                  (Observation.Code=LDL)]
                                                                      Observation.ValueType=mmol/l
        023a Diabetics latest HbA1c<7.5%                      Member Observation.Code=HbA1C observation                Diagnosis.Code=Diabetic
                                                                      Observation.Value<7.5
                                                                      Observation.ValueType=%
        023b Diabetics latest HbA1c<7%                        Member Observation.Code=HbA1C observation                Diagnosis.Code=Diabetic
                                                                      Observation.Value<7
                                                                      Observation.ValueType=%
        004   Episodes w Common Cold w Antibiotics (excl      Episode Activity.Code= Antibiotics                       Diagnosis.Type=Principal                     29/11: Filter all clinicians with 'NA' category
              Clin N/A)                                                                                                Diagnosis.Code=Common cold
                                                                                                                       Episode.Clinician.Category≠N/A

        013   Episodes Hypertensives w Treatment               Episode Activity.Code=Anti-hypertensives                Diagnosis.Code=Hypertension list             21/4/11: Approved for publication
                                                                       OR                                                                                           14/3/11: First round of data to be available 15/3/11
                                                                       Activity.Code=Lifestyle treatment                                                            21/2/11: Anti-hypertensive medication codes to be updated
                                                                                                                                                                    include C03 (Diuretics), C04 (Peripheral vasodilators), C07
                                                                                                                                                                    (Beta blocking agents), C08 (Calcium Channel blockers) and
                                                                                                                                                                    C09 (Agents acting on the renin-angiotensin system) in
                                                                                                                                                                    addition to C02 (Antihypertensives)
                                                                                                                                                                    21/11: Lifestyle treatments added, 'Secondary hypertension'
                                                                                                                                                                    diagnoses excluded from list of 'hypertension' diagnoses
                                                                                                                                                                    20/10: Additional indicator to be included 'How many times
                                                                                                                                                                    have patients with a primary diagnosis of hypertension been
                                                                                                                                                                    prescribed within past 12 months'



        014   Dental extraction (routine) w complication       Episode Diagnosis.Code=Dental complication              Activity.Code=Routine extraction             10/1/11: Approved for publication
                                                                       WHERE
                                                                       Activity.Start ≤ [Activity.Start(Routine
                                                                       extraction) +7 days]
        017   Thiqa Episodes Obese w Lifestyle or Drugs        Episode Activity.Code=Lifestyle treatment               Person.BirthDate=[Age >=18 years]            21/11:
                                                                       OR                                              Package.Group=Thiqa                          Denominator to filter to those with a Prinicipal Diagnosis of
                                                                       Activity.Code=Obesity medication                [Diagnosis.Code=Obesity AND                  obesity and Thiqa members only.
                                                                                                                       Diagnosis.Type=Principal]
                                                                                                                       OR
                                                                                                                       [Activity.Code=BMI>30 Adult]
        061   Drug-drug interactions - severe or life          Episode                                                 Claims with drugs (Dimensions)               20/2/11: Awaiting more data
              threatening/ contraindication

                                                                         DM1 (Severity level 4)



                                                                                                     DRAFT    11/27/2012 12:56 PM   Page 1
Publish ID    Indicator                                     Count of   Numerator Filter                         Denominator Filter                                 Comments                                                     Target
        062   Drug-disease interactions - Absolute/Direct    Episode DM2 (Severity level 2)                     Claims with drugs (Dimensions)                     20/2/11: Awaiting more data

        063   Duplicate generic drug prescribed              Episode                                                                                               20/2/11: Awaiting more data
                                                                                                                                                                   21/11: Contains duplicates
        064   Diagnosis error alerts                         Episode                                                                                               20/2/11: Awaiting more data
                                                                                                                                                                   21/11: Errors onsidered include patient age, gender, not
                                                                                                                                                                   primary diagnosis,
                                                                       DM10+DM11+DM12+DM13
        065   Inappropriate CPT alerts                       Episode                                                                                               20/2/11: Awaiting more data
                                                                                                                                                                   21/11: Includes age, gender and for Di cross-coding alerts

                                                                   DM5+DM7+DM8
        070   LDL:HDL observation & latest LDL:HDL < 3.5    Member [(Observation.Code=HDL) :                    [Observation.Code=HDL) AND                         8/8/11: Approved for publication
                                                                   (Observation.Code=LDL)]                      (Observation.Code=LDL)]                            17/11/11: Data not yet available. Pending Netcetera's
                                                                   Observation.Value: LDL:HDL<=3.5                                                                 removal of Diabetic filter deep in cube.
                                                                   Observation.ValueType=mmol/l
        073   Diabetics latest HbA1C>9%                     Member Observation.Code=HbA1C observation           Diagnosis.Code=Diabetic                            8/8/11: Approved for publication
                                                                   Observation.Value>9
                                                                   Observation.ValueType=%
        074   Diabetics w HbA1c observation & latest        Member Observation.Code=HbA1C observation           Diagnosis.Code=Diabetic                            8/8/11: Approved for publication
              HbA1C>9%                                             Observation.Value>9                          Observation.Code=HbA1C observation
                                                                   Observation.ValueType=%                      Observation.ValueType=%
        078   Episodes w Diabetics HbA1c>7.5% w/o           Member In any Episode:                              (a) HBA1C>7.5% and treatment in one episode        15/3/2011: New - under development (same as 001a but
              Medication                                           Activity.Code≠Diabetic medication            Episode w                                          medication only)
                                                                                                                Diagnosis.Code=Diabetic                            17/11/11: In Cube but incomplete mapping of
                                                                                                                Observation.Code= HbA1c                            greenrain:ATC codes in cube not yet addressed.
                                                                                                                Observation.Value>=7.5                             21/11/11: Approved for publication subject to ATC code
                                                                                                                Observation.ValueType=%                            update in cube.
                                                                                                                Activity.Code=Diabetic medication
                                                                                                                OR
                                                                                                                (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                Diabetic/HBA1C>7.5% in the first episode
                                                                                                                ≥ 2 Episodes same FacilityID within 30days
                                                                                                                (StartDate)
                                                                                                                WHERE in 1st Episode:
                                                                                                                Diagnosis.Code=Diabetic
                                                                                                                Observation.Code= HbA1c
                                                                                                                Observation.Value>=7.5
                                                                                                                Observation.ValueType=%


        079   Episodes w Diabetics HbA1c>7% w/o             Member In any Episode:                              (a) HBA1C>7.5% and treatment in one episode        15/3/2011: New - under development (same as 001b but
              Medication                                           Activity.Code≠Diabetic medication            Episode w                                          medication only)
                                                                                                                Diagnosis.Code=Diabetic                            17/11/11: In Cube but incomplete mapping of
                                                                                                                Observation.Code= HbA1c                            greenrain:ATC codes in cube not yet addressed.
                                                                                                                Observation.Value>=7                               21/11/11: Approved for publication subject to ATC code
                                                                                                                Observation.ValueType=%                            update in cube.
                                                                                                                Activity.Code=Diabetic medication
                                                                                                                OR
                                                                                                                (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                Diabetic/HBA1C>7.5% in the first episode
                                                                                                                ≥ 2 Episodes same FacilityID within 30days
                                                                                                                (StartDate)
                                                                                                                WHERE in 1st Episode:
                                                                                                                Diagnosis.Code=Diabetic
                                                                                                                Observation.Code= HbA1c
                                                                                                                Observation.Value>=7
                                                                                                                Observation.ValueType=%


        080   Episodes w Diabetics HbA1C>9% w/o             Member In any Episode:                              (a) HBA1C>9% and treatment in one episode          15/3/11: New - under development (same as 075 but
              Medication                                           Activity.Code≠Diabetic medication            Episode w                                          medication only)
                                                                                                                Diagnosis.Code=Diabetic                            17/11/11: In Cube but incomplete mapping of
                                                                                                                Observation.Code= HbA1c                            greenrain:ATC codes in cube not yet addressed.
                                                                                                                Observation.Value≥9                                18/11/11: Breakdown by provider name very slow.
                                                                                                                Observation.ValueType=%                            21/11/11: Approved for publication subject to ATC code
                                                                                                                Activity.Code=Diabetic medication                  update in cube.
                                                                                                                OR
                                                                                                                (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                Diabetic/HBA1C>7.5% in the first episode
                                                                                                                ≥ 2 Episodes same FacilityID within 30days
                                                                                                                (StartDate)
                                                                                                                WHERE in 1st Episode:
                                                                                                                Diagnosis.Code=Diabetic
                                                                                                                Observation.Code= HbA1c
                                                                                                                Observation.Value≥9
                                                                                                                Observation.ValueType=%


        075   Episodes w Diabetics HbA1C>9% w/o             Member In any Episode:                              (a) HBA1C>9% and treatment in one episode          21/2/11: New - under development
              Treatment                                            Activity.Code≠Lifestyle treatment            Episode w                                          17/11/11: In Cube but incomplete mapping of
                                                                   OR                                           Diagnosis.Code=Diabetic                            greenrain:ATC codes in cube not yet addressed.
                                                                   Activity.Code≠Diabetic medication            Observation.Code= HbA1c                            18/11/11: Breakdown by provider name very slow
                                                                                                                Observation.Value≥9                                21/11/11: Approved for publication subject to ATC code
                                                                                                                Observation.ValueType=%                            update in cube.
                                                                                                                Activity.Code=Lifestyle treatment
                                                                                                                OR Diabetic medication
                                                                                                                OR
                                                                                                                (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                Diabetic/HBA1C>7.5% in the first episode
                                                                                                                ≥ 2 Episodes same FacilityID within 30days
                                                                                                                (StartDate)
                                                                                                                WHERE in 1st Episode:
                                                                                                                Diagnosis.Code=Diabetic
                                                                                                                Observation.Code= HbA1c
                                                                                                                Observation.Value≥9
                                                                                                                Observation.ValueType=%




                                                                                              DRAFT    11/27/2012 12:56 PM   Page 2
Publish ID    Indicator                                     Count of    Numerator Filter                           Denominator Filter                                 Comments                                                        Target
        001a Episodes w Diabetics HbA1c>7.5% w/o            Member In any Episode:                                 (a) HBA1C>7.5% and treatment in one episode        10/1/11: Denominator to filter to ≥2 Episodes at 1 facility
             Treatment                                             Activity.Code≠Lifestyle treatment               Episode w                                          within 1 month, change to count of Member
                                                                   OR                                              Diagnosis.Code=Diabetic                            14/3/11: First data with 2 visit methodology
                                                                   Activity.Code≠Diabetic medication               Observation.Code= HbA1c                            15/3/11: Add indicator with medication only.
                                                                                                                   Observation.Value>=7.5                             17/11/11: In Cube but incomplete mapping of
                                                                                                                   Observation.ValueType=%                            greenrain:ATC codes in cube not yet addressed.
                                                                                                                   Activity.Code=Lifestyle treatment                  18/11/11: Methodoloy? Numbers not consisntent
                                                                                                                   OR Diabetic medication
                                                                                                                   OR
                                                                                                                   (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                   Diabetic/HBA1C>7.5% in the first episode
                                                                                                                   ≥ 2 Episodes same FacilityID within 30days
                                                                                                                   (StartDate)
                                                                                                                   WHERE in 1st Episode:
                                                                                                                   Diagnosis.Code=Diabetic
                                                                                                                   Observation.Code= HbA1c
                                                                                                                   Observation.Value>=7.5
                                                                                                                   Observation.ValueType=%


        001b Episodes w Diabetics HbA1c>7% w/o              Member In any Episode:                                 (a) HBA1C>7.5% and treatment in one episode        10/1/11: Denominator to filter to ≥2 Episodes at 1 facility
             Treatment                                             Activity.Code≠Lifestyle treatment               Episode w                                          within 1 month, change to count of Member
                                                                   OR                                              Diagnosis.Code=Diabetic                            14/3/11: First data with 2 visit methodology
                                                                   Activity.Code≠Diabetic medication               Observation.Code= HbA1c                            15/3/11: Add indicator with medication only.
                                                                                                                   Observation.Value>=7                               17/11/11: In Cube but incomplete mapping of
                                                                                                                   Observation.ValueType=%                            greenrain:ATC codes in cube not yet addressed.
                                                                                                                   Activity.Code=Lifestyle treatment                  18/11/11: Methodoloy? Numbers not consisntent
                                                                                                                   OR Diabetic medication
                                                                                                                   OR
                                                                                                                   (b) ≥2 Episodes at same facility in 30 days with
                                                                                                                   Diabetic/HBA1C>7.5% in the first episode
                                                                                                                   ≥ 2 Episodes same FacilityID within 30days
                                                                                                                   (StartDate)
                                                                                                                   WHERE in 1st Episode:
                                                                                                                   Diagnosis.Code=Diabetic
                                                                                                                   Observation.Code= HbA1c
                                                                                                                   Observation.Value>=7
                                                                                                                   Observation.ValueType=%


        069   Latest LDL:HDL < 3.5                          Member [(Observation.Code=HDL) :                       All members                                        21/2/11: New - under development (same as 024 but in
                                                                   (Observation.Code=LDL List)]                                                                       general population)
                                                                   Observation.Value: LDL:HDL<=3.5                                                                    17/11/11: Data not yet available. Pending Netcetera's
                                                                   Observation.ValueType=mmol/l                                                                       removal of Diabetic filter deep in cube.
        071   Latest LDL:HDL > 3.5 w/o medication           Member Activity.Code=Lipid modifying medication         [(Observation.Code=HDL) :                         21/2/11: New - under development (same as 025 but in
                                                                                                                    (Observation.Code=LDL List)]                      general population)
                                                                                                                    Observation.Value: LDL:HDL>3.5                    17/11/11: Data not yet available. Pending Netcetera's
                                                                                                                    Observation.ValueType=mmol/l                      removal of Diabetic filter deep in cube.
        081   Asthmatics ≥10 years w ≥1 spirometry in ≤ 2   Member      Activity.Code=Spirometry                    Diagnosis.Type=Principal                          2/5/11: Recommended by Asthma sub-group
              years                                                                                                 Diagnosis.Code=Asthma                             9/5/11: Agreed for development with 2 year period.
                                                                                                                    Member.Age≥10
                                                                                                                    Within 2 years
        082   Asthmatics 5-9 years w ≥1 spirometry in ≤ 2   Member      Activity.Code=Spirometry                    Diagnosis.Type=Principal                          2/5/11: Recommended by Asthma sub-group
              years                                                                                                 Diagnosis.Code=Asthma                             9/5/11: Agreed for development with 2 year period.
                                                                                                                    Member.Age≥5≤9
                                                                                                                    Within 2 years
        083   Uncontrolled asthmatics w/o controller        Member      Activity.Code≠Asthma controller medications 2x Episodes in ≤12months w                        2/5/11: Recommended by Asthma sub-group
              medications                                      and                                                  Diagnosis.Type=Principal                          9/5/11: Agreed for development with 2 visits in 12 months
                                                            Provider?                                               Diagnosis.Code=Acute Asthma                       as denominator filter.
                                                                                                                                                                      7/6/11: Asthma controller medications updated
                                                                                                                                                                      Potential additional indicator - asthmatics receiving long-
                                                                                                                                                                      acting-beta-agonists only (target low)

        087   Members with diagnosis of asthma              Member Diagnosis.code=Asthma                           Member count                                       9/5/11: Identified for development by CQP

        015   Females 40-69 w biennial Screening            Member ActivityCode=Screening Mammogram                MemberPersonAge≥40≤69 years. Over average of 20/10/10: Reporting of mammography screening to be
              Mammogram                                                                                            2 year period                                incorporated into single data point (KEH) - HAAD Head
                                                                                                                   MemberGender=Female                          Statistics & Modelling and HAAD Head Public Health &
                                                                                                                                                                Research
                                                                                                                                                                09/11 - Public Health: Should refer to screening
                                                                                                                                                                mammography and those eligible for insurance coverage
                                                                                                                                                                only [insurance NMC also]
                                                                                                                                                                Should exclude those with dx or tx for BC prior to the
                                                                                                                                                                reporting period. Reporting period should be 2 years
                                                                                                                                                                27/6/11: Amendments to previous filters
                                                                                                                                                                6/7/11: Dr Jalaa Taher - remove proposed exclusion criteria -
                                                                                                                                                                these are not made internationally.
                                                                                                                                                                As of 1 January 2011 screening mammography should be
                                                                                                                                                                reported via eClaims, from this date data should be in KEH
                                                                                                                                                                2 year methodology to be established
                                                                                                                                                                15/9/11: Self pay should be reported via eClaims but
                                                                                                                                                                providers not necessarily compliant. Only one MOH
                                                                                                                                                                Screening Centre remains in AD (Al Mushrif) and volume of
                                                                                                                                                                screening is low - 100/month.
                                                                                                                                                                21/11/11: Approved for development

        088   Females 40-69 w annual CBE                    Member ActivityCode=CBE                                MemberPersonAge≥40≤69 years                        6/7/11: Dr Jalaa Taher:
                                                                                                                   MemberGender=Female                                Remove proposed exclusion criteria - these exclusions are
                                                                                                                                                                      not made internationally.
                                                                                                                                                                      21/11/11: Approved for development
        089   Females 20-39 w triennial CBE                 Member ActivityCode=CBE                                MemberPersonAge≥20≤39 years over 3 year            6/7/11: Dr Jalaa Taher - remove proposed exclusion criteria -
                                                                                                                   period                                             these are not made internationally.
                                                                                                                   MemberGender=Female                                3 year methodology to be established
                                                                                                                                                                      21/11/11: Approved for development




                                                                                                  DRAFT   11/27/2012 12:56 PM   Page 3
Publish ID    Indicator                                           Count of   Numerator Filter                          Denominator Filter                              Comments                                                       Target
        090   Invasive cancer detection rate for females w         Episode DiagnosisCode= Invasive Breast Cancer.      MemberGender=Female                             6/7/11: Added
              screening mammogram                                                                                      ActivityCode=Screening Mammogram                21/11/11: Approved for development




        091   Recall rate for females w screening                  Episode ObservationCode=BIRADS 0 OR BIRADS 3 OR     MemberGender=Female                             6/7/11: Added
              mammogram                                                    BIRADS 4 OR BIRADS 5                        ActivityCode=Screening Mammogram                7/9/11: On Dr Jalaa's advice, amended to also include
                                                                                                                                                                       BIRADS 3, 4 & 5.
                                                                                                                                                                       9/7/11: Requires mandatory BIRADS code reporting issue to
                                                                                                                                                                       be resolved .
        092   Females w screening mammogram that are               Episode ObservationCode=BIRADS 3                    MemberGender=Female                             21/11/11: Approved for development
                                                                                                                                                                       6/7/11: Added
              subject to early recall (finding probably benign,                                                        ActivityCode=Screening Mammogram                9/7/11: Requires mandatory BIRADS code reporting issue to
              follow up)                                                                                                                                               be resolved.
                                                                                                                                                                       21/11/11: Approved for development
        093   Females w breast needle biopsy w image               Episode [ActivityCode=Image Guided Breast Biopsy]   MemberGender=Female                             21/11/11: Approved for development
              guidance                                                     OR                                          [ActivityCode=Image Guided Breast Biopsy]
                                                                           [ActivityCode=Image Guided Biopsy AND       OR
                                                                           DiagnosisCode=Breast Screen or Breast       [ActivityCode=Image Guided Biopsy AND
                                                                           Abnormality or Breast Cancer] .             DiagnosisCode=Breast Screen or Breast
                                                                                                                       Abnormality or Breast Cancer]
                                                                                                                       OR
                                                                                                                       [ActivityCode=Non-Image Guided Breast Biopsy]
                                                                                                                       OR
                                                                                                                       [ActivityCode=Non-Image Guided Biopsy AND
                                                                                                                       DiagnosisCode=Breast Screen or Breast
                                                                                                                       Abnormality or Breast Cancer]

        094   Females with breast cancer diagnosis                Member [ActivityCode=Image Guided Breast Biopsy]   MemberGender=Female                               21/11/11: Approved for development
              confirmed w pre-operative Fine Needle                      OR                                          DiagnosisCode=Breast Cancer (1st time)
              Aspiration or Core biopsy                                  [ActivityCode=Image Guided Biopsy AND
                                                                         DiagnosisCode=Breast Screen or Breast
                                                                         Abnormality or Breast Cancer] .
                                                                         OR
                                                                         [ActivityCode=Non-Image Guided Breast
                                                                         Biopsy]
                                                                         OR
                                                                         [ActivityCode=Non-Image Guided Biopsy AND
                                                                         DiagnosisCode=Breast Screen or Breast
                                                                         Abnormality or Breast Cancer]
                                                                         ActivityStartDate≤EncounterStartDate of 1st
                                                                         Breast Cancer Diagnosis

        095   Females w mammogram w image guided                   Episode [ActivityCode=Image Guided Breast Biopsy] MemberGender=Female                               6/7/11: Added.
              breast core biopsy                                           OR                                        ActivityCode=Screening Mammogram                  13/11/11: Amended following agreement with Dr Jalaa.
                                                                           [ActivityCode=Image Guided Biopsy AND                                                       21/11/11: Approved for development
                                                                           DiagnosisCode=Breast Screen or Breast
                                                                           Abnormality or Breast Cancer]
                                                                           OR
                                                                           [ActivityCode=Non-Image Guided Breast
                                                                           Biopsy]
                                                                           OR
                                                                           [ActivityCode=Non-Image Guided Biopsy AND
                                                                           DiagnosisCode=Breast Screen or Breast
                                                                           Abnormality or Breast Cancer]

        096   Females w mammogram w Benign open breast             Episode ActivityCode=Open Breast Biopsy             MemberGender=Female                             13/9/11: New - added by Dr Jalaa
              biopsy                                                       AND                                         ActivityCode=Screening Mammogram                15/9/11: Dr Jalaa - Not for further development as open
                                                                           DiagnosisCode≠ Breast cancer                                                                biopsies not recommended or widely used.
                                                                                                                                                                       13/11/11: Amended following agreement with Dr Jalaa.
                                                                                                                                                                       15/11/11: Amended to benign open biopsies on Dr Jalaa's
                                                                                                                                                                       advice.
                                                                                                                                                                       21/11/11: Approved for development

        097   Females w abnormal mammogram w follow up Member [ActivityCode=Image Guided Breast Biopsy]                MemberGender=Female                             6/7/11: For definition only if BIRADS mandatory for
              assessment ≤21 days                             OR                                                       Activity Code= Screening Mammogram              reporting
                                                              [ActivityCode=Image Guided Biopsy AND                                                                    9/7/11: Requires mandatory BIRADS code reporting issue to
                                                              DiagnosisCode=Breast Screen or Breast                                                                    be resolved before further progressing.
                                                              Abnormality or Breast Cancer]                                                                            14/9/11: Method amended to remove need for use of
                                                              OR                                                                                                       BIRADS.
                                                              [ActivityCode=Non-Image Guided Breast                                                                    21/11/11: Approved for development
                                                              Biopsy]
                                                              OR
                                                              [ActivityCode=Breast Ultrasound]
                                                              OR
                                                              [ActivityCode=Breast MRI]
                                                              OR
                                                              [ActivityCode=Diagnostic Mammogram]
                                                              ActivityStartDate≤ 21 Days of
                                                              ActivityStartDate where
                                                              ActivityCode=Screening Mammogram

        098   Females w treatment within 4 weeks of Breast        Member ActivityCode=Breast Cancer Surgery OR         MemberGender=Female                             6/7/11: Dr Jalaa Taher: Amend to 35 days as standard is that
              cancer diganosis                                           Chemotherapy OR Tamoxifen OR Aromtase         DiagnosisCode=Breast Cancer                     treatment commences in 5 weeks, not 15 days (15 days is
                                                                         Inhibtors OR Trastuzumab                                                                      for consultation).
                                                                         ActivityStartDate≤ 28 Days of                                                                 7/9/11: On advice from Dr Jalaa, radiotherapy removed as
                                                                         EncounterStartDate where                                                                      not 1st line treatment, Tamoxifen added AND amend to 42
                                                                         DiagnosisCode=Breast Cancer [1st time]                                                        days as 6 weeks is appropriate period of time for treatment
                                                                                                                                                                       to commence.
                                                                                                                                                                       26/10/11: Amended to 28 days (4 weeks) as advised by Dr
                                                                                                                                                                       Jalaa to align with HAAD BC Management Standard.
                                                                                                                                                                       15/11/11: Aromtase Inhibitors and Trastuzumab added as
                                                                                                                                                                       treatment formats on Dr Jalaa's advice.
                                                                                                                                                                       21/11/11: Approved for development

        099   Females w invasive breast cancer w single           Member ActivityCode=BreastCancerSurgery              MemberGender=Female                             26/10/11: New - added by Dr Jalaa
              breast surgery (excluding reconstruction)                  ActivtyQuantity=1                             DiagnosisCode=Invasive Breast Cancer            13/11/11: Edited as per Dr Jalaa's comments.
                                                                                                                                                                       21/11/11: Approved for development



                                                                                                      DRAFT   11/27/2012 12:56 PM   Page 4
Publish ID    Indicator                                  Count of   Numerator Filter                         Denominator Filter                    Comments                                               Target
        100   Females w breast cancer w breast surgery   Member [ActivityCode= Chemotherapy OR Breast        MemberGender=Female                   13/11/11: Added by Dr Jalaa. Amendments to Numerator
              treated w adjuvant chemotherapy or                Radiotherapy]                                DiagnosisCode=Breast Cancer Surgery   filter to reflect indicator name.
              radiotherapy within 31 days.                      OR                                                                                 21/11/11: Approved for development
                                                                [DiagosisCode=Breast Cancer AND
                                                                ActivityCode=Radiotherapy]
                                                                ActivityStartDate≤ 31 Days of
                                                                ActivityStartDate for ActivityCode=Breast
                                                                Cancer Surgery




                                                                                            DRAFT   11/27/2012 12:56 PM   Page 5
Name                  Type         Code    Code descriptor                                                                           2011 Compliant
Consultation          CPT         99201    OFFICE OUTPT NEW 10 MIN
Consultation          CPT         99202    OFFICE OUTPT NEW 20 MINUTES
Consultation          CPT         99203    OFFICE OUTPT NEW 30 MIN
Consultation          CPT         99204    OFFICE OUTPT NEW 45 MIN
Consultation          CPT         99205    OFFICE OUTPT NEW 60 MIN
Consultation          CPT         99211    OFFICE O/P EST 5 MIN
Consultation          CPT         99212    OFFICE OUTPT EST 10 MIN
Consultation          CPT         99213    OFFICE OUTPT EST15 MIN
Consultation          CPT         99214    OFFICE OUTPT EST 25 MIN
Consultation          CPT         99215    OFFICE OUTPT EST 40 MIN
Diabetic              ICD            250   DM without mention of complication, type II or unspecified type, not stated as
Diabetic              ICD        250.01    uncontrolledmention of complication, type I not stated as uncontrolled
                                           DM without
Diabetic              ICD        250.02    DM without mention of complication, type II or unspecified type uncontrolled
Diabetic              ICD        250.03    DM without mention of complication, type I uncontrolled
Diabetic              ICD          250.1   DM with ketoacidosis, type II or unspecified type, not stated as uncontrolled
Diabetic              ICD        250.11    DM with ketoacidosis, type I not stated as uncontrolled
Diabetic              ICD        250.12    DM with ketoacidosis, type II or unspecified type uncontrolled
Diabetic              ICD        250.13    DM with ketoacidosis, type I uncontrolled
Diabetic              ICD          250.2   DM with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
Diabetic              ICD        250.21    DM with hyperosmolarity, type I not stated as uncontrolled
Diabetic              ICD        250.22    DM with hyperosmolarity, type II or unspecified type uncontrolled
Diabetic              ICD        250.23    DM with hyperosmolarity, type I uncontrolled
Diabetic              ICD          250.3   DM with other coma, type II or unspecified type, not stated as uncontrolled
Diabetic              ICD        250.31    DM with other coma, type I not stated as uncontrolled
Diabetic              ICD        250.32    DM with other coma, type II or unspecified type uncontrolled
Diabetic              ICD        250.33    DM with other coma, type I uncontrolled
Diabetic              ICD          250.4   DM with renal manifestation, type II or unspecified type, not stated as uncontrolled
Diabetic              ICD        250.41    DM with renal manifestation, type I not stated as uncontrolled
Diabetic              ICD        250.42    DM with renal manifestation, type II or unspecified type uncontrolled
Diabetic              ICD        250.43    DM with renal manifestation, type I uncontrolled
Diabetic              ICD          250.5   DM with ophthalmic manifestations, type II or unspecified type, not stated as
Diabetic              ICD        250.51    uncontrolled
                                           DM with ophthalmic manifestations, type I not stated as uncontrolled
Diabetic              ICD        250.52    DM with ophthalmic manifestations, type II or unspecified type uncontrolled
Diabetic              ICD        250.53    DM with ophthalmic manifestations, type I uncontrolled
Diabetic              ICD          250.6   DM with neurological manifestations, type II or unspecified type, not stated as
Diabetic              ICD        250.61    uncontrolled
                                           DM with neurological manifestations, type I not stated as uncontrolled
Diabetic              ICD        250.62    DM with neurological manifestations, type II or unspecified type uncontrolled
Diabetic              ICD        250.63    DM with neurological manifestations, type I uncontrolled
Diabetic              ICD          250.7   DM with peripheral circulatory disorders, type II or unspecified type, not stated as
Diabetic              ICD        250.71    uncontrolled
                                           DM with peripheral circulatory disorders, type I not stated as uncontrolled
Diabetic              ICD        250.72    DM with peripheral circulatory disorders, type II or unspecified type uncontrolled
Diabetic              ICD        250.73    DM with peripheral circulatory disorders, type I uncontrolled
Diabetic              ICD          250.8   DM with other specified manifestations type II or unspecified type, not stated as
Diabetic              ICD        250.81    uncontrolled specified manifestations, type I not stated as uncontrolled
                                           DM with other
Diabetic              ICD        250.82    DM with other specified manifestations, type II or unspecified type uncontrolled
Diabetic              ICD        250.83    DM with other specified manifestations, type I uncontrolled
Diabetic              ICD          250.9   DM with unspecified complications type II or unspecified type, not stated as
Diabetic              ICD        250.91    uncontrolled
                                           DM with unspecified complications, type I not stated as uncontrolled
Diabetic              ICD        250.92    DM with unspecified complications, type II or unspecified type uncontrolled
Diabetic              ICD        250.93    DM with unspecified complications, type I uncontrolled
LifestyleTreatment    CPT         99401    Preventive medicine counseling and/or risk factor reduction intervention(s) provided to
LifestyleTreatment    CPT         99402    an individual (separate procedure); approximately reduction intervention(s) provided to
                                           Preventive medicine counseling and/or risk factor 15 minutes
LifestyleTreatment    CPT         99403    an individual (separate procedure); approximately reduction intervention(s) provided to
                                           Preventive medicine counseling and/or risk factor 30 minutes
LifestyleTreatment    CPT         99404    Preventive medicine counseling and/or risk factor 45 minutes
                                           an individual (separate procedure); approximately reduction intervention(s) provided to
LifestyleTreatment    CPT         98960    Education and training procedure); approximately 60 minutes
                                           an individual (separate for patient self-management by a qualified, nonphysician health
HDL                   LOINC   14646-4      care professional using a standardized curriculum, face-to-face with the patient (could
HDL                   LOINC   12772-0
HDL                   LOINC   26015-8
HDL                   LOINC   26017-4
HDL                   LOINC   18263-4
HDL                   LOINC   2085-9
HDL                   LOINC   35243-5
HDL                   LOINC   35197-3
HDL                   LOINC   49130-8
HDL                   LOINC   9832-7
HDL                   LOINC   9833-5
LDL                   LOINC   22748-8
LDL                   LOINC   18261-8
LDL                   LOINC   18262-6
LDL                   LOINC   13457-7
LDL                   LOINC   12773-8
LDL                   LOINC   2089-1
LDL                   LOINC   35198-1
LDL                   LOINC   39469-2
LDL                   LOINC   43392-0
LDL                   LOINC   43393-8
LDL                   LOINC   46984-1
LDL                   LOINC   46985-8
LDL                   LOINC   49132-4
LDL                   LOINC   55440-2
Asthma                ICD     493.90       Unspecified Asthma without mention of status asthmaticus; or mention of acute                              493.90 Unspecified Asthma without mention of status asthmaticus; or mention of acute exacerbation unspecified
Asthma                ICD     493.91       exacerbation unspecified status asthmaticus
                                           Unspecified Asthma with
Asthma                ICD     493.92       Unspecified Asthma with (acute) exacerbation
Asthma                ICD     493.00       Extrinsic asthma without mention of status asthmaticus; or mention of acute                                493.00 Extrinsic asthma without mention of status asthmaticus; or mention of acute exacerbation unspecified
Asthma                ICD     493.01       exacerbation unspecified asthmaticus
                                           Extrinsic asthma with status
Asthma                ICD     493.02       Extrinsic asthma with (acute) exacerbation
Asthma                ICD     493.10       Intrinsic asthma without mention of status asthmaticus; or mention of acute                                493.10 Intrinsic asthma without mention of status asthmaticus; or mention of acute exacerbation unspecified
Asthma                ICD     493.11       exacerbation unspecified asthmaticus
                                           Intrinsic asthma with status
Asthma                ICD     493.12       Intrinsic asthma with (acute) exacerbation
Asthma                ICD     493.20       Chronic obstructive asthma without mention of status asthmaticus; or mention of acute                      493.20 Chronic obstructive asthma without mention of status asthmaticus; or mention of acute exacerbation unspecified
Asthma                ICD     493.21       exacerbation unspecified with status asthmaticus
                                           Chronic obstructive asthma
Asthma                ICD     493.22       Chronic obstructive asthma with (acute) exacerbation
Hypertension          ICD     401          Essential Malignant Hypertension                                                                              500 Miners
Hypertension          ICD     401.1        Essential Benign Hypertension                                                                                     asthma
Hypertension          ICD     401.9        Essential Unspecified Hypertension
Hypertension          ICD     402          Malignant hypertensive heart disease without heart failure
Hypertension          ICD     402.01       Malignant hypertensive heart disease with heart failure
Hypertension          ICD     402.1        Benign hypertensive heart disease without heart failure
Hypertension          ICD     402.11       Benign hypertensive heart disease with heart failure
Hypertension          ICD     402.9        Unspecified hypertensive heart disease without heart failure
Hypertension          ICD     402.91       Unspecified hypertensive heart disease with heart failure
Hypertension          ICD     403          Malignant hypertensive Chronic Kidney disease with CKD stage 1 through 4 or
Hypertension          ICD     403.01       unspecified
                                           Malignant hypertensive Chronic Kidney disease with CKD stage 5 or ESRD
Hypertension          ICD     403.1        Benign hypertensive Chronic Kidney disease with CKD stage 1 through 4 or unspecified
Hypertension          ICD     403.11       Benign hypertensive Chronic Kidney disease with CKD stage 5 or ESRD
Hypertension          ICD     403.9        Unspecified hypertensive Chronic Kidney disease with CKD stage 1 through 4 or
Hypertension          ICD     403.91       unspecified hypertensive Chronic Kidney disease with CKD stage 5 or ESRD
                                           Unspecified
Hypertension          ICD     404          Hypertensive heart & CKD Malignant without heart failure and with CKD Stage 1 through
Hypertension          ICD     404.01       Stage 4, or unspecified
                                           Hypertensive heart & CKD Malignant with heart failure and with CKD Stage 1 through
Hypertension          ICD     404.02       Stage 4, or unspecified
                                           Hypertensive heart & CKD Malignant without heart failure and with CKD Stage 5 or ESRD
Hypertension          ICD     404.03       Hypertensive heart & CKD Malignant with heart failure and with CKD Stage 5 or ESRD
Hypertension          ICD     404.1        Hypertensive heart & CKD Benign without heart failure and with CKD Stage 1 through
Hypertension          ICD     404.11       Stage 4, or unspecified
                                           Hypertensive heart & CKD Benign with heart failure and with CKD Stage 1 through Stage
Hypertension          ICD     404.12       4, or unspecified & CKD Benign without heart failure and with CKD Stage 5 or ESRD
                                           Hypertensive heart
Hypertension          ICD     404.13       Hypertensive heart & CKD Benign with heart failure and with CKD Stage 5 or ESRD
Hypertension          ICD     404.9        Hypertensive heart & CKD, unspecified, without heart failure and with CKD Stage 1
Hypertension          ICD     404.91       through Stageheart & CKD, unspecified, with heart failure and with CKD Stage 1 through
                                           Hypertensive 4, or unspecified
Hypertension          ICD     404.92       Stage 4, or unspecified
                                           Hypertensive heart & CKD, unspecified, without heart failure and with CKD Stage 5 or
Hypertension          ICD     404.93       ESRD
                                           Hypertensive heart & CKD, unspecified, with heart failure and with CKD Stage 5 or ESRD
Dental Complication   ICD     526.5        Alveolar Osteistis or Dry Socket
Dental Complication            ICD      998.11       Hemorrhage complicating a procedure
Dental Complication            ICD      951.4        Injury to facial nerve
Dental Complication            ICD      524.3        Displacement of Upper Tooth
Routine Extraction             Dental   71101        Single tooth, Uncomplicated
Routine Extraction             Dental   71109        Each additional tooth, same quadrant, same appointment
Routine Extraction             Dental   71201        Odontectomy, (extraction), Erupted Tooth, Surgical Approach, Requiring Surgical Flap
Routine Extraction             Dental   71209        and/or Sectioning of Tooth. quadrant
                                                     Each additional tooth, same
Routine Extraction             Dental   71211        Single Tooth
Routine Extraction             Dental   71219        Each additional Tooth same quadrant
Routine Extraction             Dental   72111        Single tooth
Routine Extraction             Dental   72119        Each additional tooth, same quadrant
Routine Extraction             Dental   72211        Single tooth
Routine Extraction             Dental   72219        Each additional tooth, same quadrant
Routine Extraction             Dental   72221        Single tooth
Routine Extraction             Dental   72229        Each additional tooth, same quadrant
Routine Extraction             Dental   72231        Single tooth
Routine Extraction             Dental   72239        Each additional tooth, same quadrant
Routine Extraction             Dental   71101        Single tooth, Uncomplicated
Routine Extraction             Dental   71101        Single tooth, Uncomplicated
Routine Extraction             Dental   71109        Each additional tooth, same quadrant, same appointment
Routine Extraction             Dental   71201        Odontectomy, (extraction), Erupted Tooth, Surgical Approach, Requiring Surgical Flap
Routine Extraction             Dental   71209        and/or Sectioning of Tooth. quadrant
                                                     Each additional tooth, same
Routine Extraction             Dental   71211        Single Tooth
Routine Extraction             Dental   71219        Each additional Tooth same quadrant
Mammogram                      CPT      77051        Computer-aided detection (computer algorithm analysis of digital image data for lesion
Mammogram                      CPT      77052        detection) with further physician review for interpretation, digital image data for lesion
                                                     Computer-aided detection (computer algorithm analysis of with or without digitization
Mammogram                      CPT      77053        detection) with further physician review for interpretation, with or withoutand
                                                     Mammary ductogram or galactogram, single duct, radiological supervision digitization
Mammogram                      CPT      77054        interpretation
                                                     Mammary ductogram or galactogram, multiple ducts, radiological supervision and
Mammogram                      CPT      77055        interpretation unilateral
                                                     Mammography;
Mammogram                      CPT      77056        Mammography;bilateral
Mammogram                      CPT      77057        Screening mammography, bilateral (2-view film study of each breast)
Mammogram                      CPT      77058        Magnetic resonance imaging, breast, without and/or with contrast material(s); unilateral
Mammogram                      CPT      77059        Magnetic resonance imaging, breast, without and/or with contrast material(s);bilateral
Obesity                        ICD      278.00       Obesity, unspecified
Obesity                        ICD      278.01       Morbid obesity
Obesity                        ICD      278.03       Obesity hypoventilation syndrome                                                                ?
Obesity                        ICD      649.1        Obesity complicating pregnancy, childbirth or the puerperium, unspecified as to episode
Obesity                        ICD      649.11       Obesity complicating applicable
                                                     of care of care or not pregnancy, childbirth or the puerperium, delivered with or without
Obesity                        ICD      649.12       mentioncomplicating pregnancy, childbirth or the puerperium,delivered with mention of
                                                     Obesity of antepartum condition
Obesity                        ICD      649.13       postpartum complication
                                                     Obesity complicating pregnancy, childbirth or the puerperium, antepartum condition or
Obesity                        ICD      649.14       complication
                                                     Obesity complicating pregnancy, childbirth or the puerperium, postpartum condition or
BMI >30 Adult                  ICD      V85.30       complicationINDEX 30.0-30.9 ADULT
                                                     BODY MASS
BMI >30 Adult                  ICD      V85.31       BODY MASS INDEX 31.0-31.9 ADULT
BMI >30 Adult                  ICD      V85.32       BODY MASS INDEX 32.0-32.9 ADULT
BMI >30 Adult                  ICD      V85.33       BODY MASS INDEX 33.0-33.9 ADULT
BMI >30 Adult                  ICD      V85.34       BODY MASS INDEX 34.0-34.9 ADULT
BMI >30 Adult                  ICD      V85.35       BODY MASS INDEX 35.0-35.9 ADULT
BMI >30 Adult                  ICD      V85.36       BODY MASS INDEX 36.0-36.9 ADULT
BMI >30 Adult                  ICD      V85.37       BODY MASS INDEX 37.0-37.9 ADULT
BMI >30 Adult                  ICD      V85.38       BODY MASS INDEX 38.0-38.9 ADULT
BMI >30 Adult                  ICD      V85.39       BODY MASS INDEX 39.0-39.9 ADULT
BMI >30 Adult                  ICD      V85.4        BODY MASS INDEX 40 AND OVER ADULT
BMI >30 Adult                  ICD      V85.41       Body Mass Index 40.0-44.9, adult
BMI >30 Adult                  ICD      V85.42       Body Mass Index 45.0-49.9, adult
BMI >30 Adult                  ICD      V85.43       Body Mass Index 50.0-59.9, adult
BMI >30 Adult                  ICD      V85.44       Body Mass Index 60.0-69.9, adult
BMI >30 Adult                  ICD      V85.45       Body Mass Index 70 and over, adult
BMI <30 Adult                  ICD      V85.0        BODY MASS INDEX LESS THAN 19 ADULT
BMI <30 Adult                  ICD      V85.1        BODY MASS INDEX BETWEEN 19-24 ADULT
BMI <30 Adult                  ICD      V85.21       BODY MASS INDEX 25.0-25.9 ADULT
BMI <30 Adult                  ICD      V85.22       BODY MASS INDEX 26.0-26.9 ADULT
BMI <30 Adult                  ICD      V85.23       BODY MASS INDEX 27.0-27.9 ADULT
BMI <30 Adult                  ICD      V85.24       BODY MASS INDEX 28.0-28.9 ADULT
BMI <30 Adult                  ICD      V85.25       BODY MASS INDEX 29.0-29.9 ADULT
Major depression               ICD      309.1        Prolonged depressive reaction
Major depression               ICD      296.20       Major depressive affective disorder, single episode, unspecified
Major depression               ICD      296.21       Major depressive affective disorder, single episode, mild
Major depression               ICD      296.22       Major depressive affective disorder, single episode, moderate
Major depression               ICD      296.23       Major depressive affective disorder, single episode, severe, without mention of psychotic behavior
Major depression               ICD      296.24       Major depressive affective disorder, single episode, severe, specified as with psychotic behavior
Major depression               ICD      296.25       Major depressive affective disorder, single episode, in partial or unspecified remission
Major depression               ICD      296.26       Major depressive affective disorder, single episode, in full remission
Major depression counselling   CPT      96101        Psychological testing (includes psychodiagnostic assessment of emotionally, intellectual
Major depression counselling   CPT      96102        abilities, personality and psychopathology, eg, MMPI, Rorshach, WAIS), per hour of
                                                     Psychological testing (includes psychodiagnostic assessment of emotionally, intellectual
Major depression counselling   CPT      90804        Individual psychotherapy, insight oriented, behavior modifying and/or with qualified
                                                     abilities, personality and psychopathology, eg, MMPI, Rorshach, WAIS),supportive, in an
Major depression counselling   CPT      90805        office or outpatient facility, approximately services minutes face-to-face with the
                                                     with medical evaluation and management 20 to 30
Major depression counselling   CPT      90806        Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an
Major depression counselling   CPT      90807        office or outpatient facility, approximately services minutes face-to-face with the
                                                     with medical evaluation and management 45 to 50
Major depression counselling   CPT      90808        Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an
Major depression counselling   CPT      90809        office or outpatient facility, approximately services minutes face-to-face with the
                                                     with medical evaluation and management 75 to 80
Major depression counselling   CPT      90816        Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an
Major depression counselling   CPT      90817        inpatient hospital, partial hospital or residential care setting, approximately 20 to 30
                                                     with medical evaluation and management services
Major depression counselling   CPT      90818        Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an
Major depression counselling   CPT      90819        inpatient hospital, partial hospital or residential care setting, approximately 45 to 50
                                                     with medical evaluation and management services
Major depression counselling   CPT      90821        Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an
Major depression counselling   CPT      90822        inpatient hospital, partial hospital or residential care setting, approximately 75 to 80
                                                     with medical evaluation and management services
Retinal/Eye exam               CPT      92012        Ophthalmological services: medical examination and evaluation, with initiation or
Retinal/Eye exam               CPT      92014        continuation of diagnostic and treatment program; intermediate,with initiation or
                                                     Ophthalmological services: medical examination and evaluation, established patient
Retinal/Eye exam               CPT      92002        continuation of diagnostic and treatment program; comprehensive, established patient,
                                                     Ophthalmological services: medical examination and evaluation with initiation of
Retinal/Eye exam               CPT      92004        diagnostic and treatment program; intermediate,and evaluation with initiation of
                                                     Ophthalmological services: medical examination new patient
Retinal/Eye exam               CPT      99201        diagnostic and treatment program; comprehensive, new patient, one or more visits
                                                     New Patient office visit level 1
Retinal/Eye exam               CPT      99202        New Patient office visit level 2
Retinal/Eye exam               CPT      99211        Established patient office visit level 1
Retinal/Eye exam               CPT      99212        Established patient office visit level 2
Neuropathy testing             CPT      95860        Needle electromyography; one extremity with or without related paraspinal areas
Neuropathy testing             CPT      95861        Needle electromyography; two extremity with or without related paraspinal areas
Neuropathy testing             CPT      95863        Needle electromyography; three extremity with or without related paraspinal areas
Neuropathy testing             CPT      95864        Needle electromyography; four extremity with or without related paraspinal areas
Neuropathy testing             CPT      95900        Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-
Neuropathy testing             CPT      95903        wave study
                                                     Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave
Neuropathy testing             CPT      95904        study conduction, amplitude and latency/velocity study, each nerve; sensory
                                                     Nerve
Microalbuminuria               ICD      791.0        Proteinuria
Microalbuminuria               ICD      646.20       Unspecified renal disease in pregnancy, without mention of hypertension, unspecified
Microalbuminuria               ICD      646.21       episode of care disease in pregnancy, without mention of hypertension, delivered
                                                     Unspecified renal
Microalbuminuria               ICD      646.22       Unspecified renal disease in pregnancy, without mention of hypertension, delivered with
Microalbuminuria               ICD      646.23       postpartum conditions in pregnancy, without mention of hypertension, antepartum
                                                     Unspecified renal disease
Microalbuminuria               ICD      646.24       Unspecified renal disease in pregnancy, without mention of hypertension, postpartum
Microalbuminuria               ICD      593.6        Postural proteinuria
HbA1C Observation              LOINC       4548-4
HbA1C Observation              LOINC      17855-8
HbA1C Observation              LOINC      17856-6
HbA1C Observation              LOINC      41995-2
HbA1C Observation              LOINC       4549-2
Diabetic medication            ATC            A10    Drugs used in Diabetes
Antibiotics                    ATC             J01   Antibacterials for systemic use
Lipid panel                    CPT          80061    Lipid Panel
Renal test                     CPT          82042    Urine or other source, quantitative, each specimen (Albumin)
Renal test                     CPT          82043    Microalbumin, quantitative
Renal test                     CPT          82044    Urine, microalbumin, semiquantitative
HbA1C test                     CPT          83036    Glycosylated (A1C)
Anti-hypertensives             ATC            C02    Antihypertensives
Obesity medication             Greenrain
                                      1392-4496-001   Orlistat
Major depression medication    ATC              N05   Psycholeptics
Major depression medication    ATC              N06   Psychoanaleptics
Major depression medication    ATC              N07   Other nervous system drugs
Microalbuminuria medication    ATC              C09   Agents acting on the renin-angiotensin system
Microalbumin observation       LOINC         1754-1   Albumin
Microalbumin observation       LOINC         6942-7   Albumin
Microalbumin observation       LOINC        14957-5   Albumin
Lipid modifying medication     ATC              C10   Lipid modifying agents
LDL                            CPT            83721   LDL Cholesterol
HDL                            CPT            83718   HDL Cholesterol
Total cholesterol              CPT            82465   Cholesterol, serum or whole blood, total
Triglycerides                  CPT            84478   Triglycerides
Renal test                     CPT            82570   Creatinine; other source (24hr)
Renal test                     CPT            82565   Creatinine; blood - BUN/Creatinine Ratio with Glomerular Filtration Rate, Estimated (eGFR)
Renal test                     CPT            82575   Creatinine chemistry/toxicology; clearance
Anti-hypertensives             ATC              C03   Diuretics
Anti-hypertensives             ATC              C04   Peripheral vasodilators
Anti-hypertensives             ATC              C07   Beta blocking agents
Anti-hypertensives             ATC              C08   Calcium channel blockers
Anti-hypertensives             ATC              C09   Agents acting on the renin-angiotensin system
Common cold                    ICD              460   Acute nasopharyngitis (common cold)
Spirometry                     CPT            94010   Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
Spirometry                     CPT            94014   Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation
Spirometry                     CPT            94015   Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)
Spirometry                     CPT            94060   Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
Spirometry                     CPT            94070   Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)
Spirometry                     CPT            94620   Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)
Acute Asthma                   ICD           493.91   Unspecified Asthma with status asthmaticus
Acute Asthma                   ICD           493.92   Unspecified Asthma with (acute) exacerbation
Acute Asthma                   ICD           493.01   Extrinsic asthma with status asthmaticus
Acute Asthma                   ICD           493.02   Extrinsic asthma with (acute) exacerbation
Acute Asthma                   ICD           493.11   Intrinsic asthma with status asthmaticus
Acute Asthma                   ICD           493.12   Intrinsic asthma with (acute) exacerbation
Acute Asthma                   ICD           493.21   Chronic obstructive asthma with status asthmaticus
Acute Asthma                   ICD           493.22   Chronic obstructive asthma with (acute) exacerbation
Asthma controller medication   ATC        R03BA       Glucocorticoids
Asthma controller medication   ATC        R03BC       Antiallergic agents, excluding corticosteroids
Asthma controller medication   ATC        R03BX       Other drugs for obstructive airway diseases, inhalants
Asthma controller medication   ATC        R03CB       Non-selective beta-adrenoreceptor agonists
Asthma controller medication   ATC        R03DA       Xanthines
Asthma controller medication   ATC        R03DB       Xanthines and adrenergics
Asthma controller medication   ATC        R03DC       Leukotriene receptor antagonists
Asthma controller medication   ATC        R03DX       Other anti-asthmatics for systemic use
 ATC Level 1
   Code        Contents
A              Alimentary tract and metabolism
B              Blood and blood forming organs
C              Cardiovascular system
D              Dermatologicals
G              Genito-urinary system and sex hormones
H              Systemic hormonal preparations, excluding sex hormones and insulins
J              Antiinfectives for systemic use
L              Antineoplastic and immunomodulating agents
M              Musculo-skeletal system
N              Nervous system
P              Antiparasitic products, insecticides and repellents
R              Respiratory system
S              Sensory organs
V              Various
Code   Name                                               Example
A01    Stomatological preparations                        Salicylic acid
A02    Drugs for acid related disorders                   Omeprazole

A03    Drugs for functional gastrointestinal disorders    Papaverine

A04    Antiemetics and antinauseants                      Metoclopramide
A05    Bile and liver therapy                             Ursodeoxycholic acid
A06    Laxatives                                          Docusate sodium

A07    Antidiarrheals, intestinal anti-inflammatory/anti- Loperamide
       infective agents
A08    Antiobesity preparations, excluding diet           Not available in drug list
       products
A09    Digestives, including enzymes                      Simethicone
A10    Drugs used in diabetes                             Metformin
A11    Vitamins                                           Multivitamin

A12    Mineral supplements                                Magnesium gluconate
A13    Tonics                                             Not listed
A14    Anabolic agents for systemic use                   Testosterone

A15    Appetite stimulants                                Amitriptyline
A16    Other alimentary tract and metabolism              Not available
       products
B01    Antithrombotic agents                              Warfarin
B02    Antihemorrhagics                                   Aprotinin
B03    Antianemic preparations                            Folic acid
B05    Blood substitutes and perfusion solutions          Albumin
B06    Other hematological agents                         Hyaluronidase

C01    Cardiac therapy                                    Bisoprolol
C02    Antihypertensives                                  Candesartan
C03    Diuretics                                          Furosemide

C04    Peripheral vasodilators                            Nitroglycerin

C05    Vasoprotectives                                    Lidocaine
C07    Beta blocking agents                               Metoprolol

C08    Calcium channel blockers                           Verapamil

C09    Agents acting on the renin-angiotensin system      Lisinopril
C10   Lipid modifying agents                         Fenofibrate
D01   Antifungals for dermatological use             Nystatin

D02   Emollients and protectives                     Zinc/castor oil
D03   Preparations for treatment of wounds and       Isosorbide dinitrate
      ulcers

D04   Antipruritics, including antihistamines,       Lidocaine
      anesthetics, etc.
D05   Antipsoriatics                                 Tar
D06   Antibiotics and chemotherapeutics for          Demeclocycline
      dermatological use
D07   Corticosteroids, dermatological preparations   Hydrocortisone

D08   Antiseptics and disinfectants                  Chlorhexidine
D09   Medicated dressings                            Fusidic acid

D10   Anti-acne preparations                         Minocycline

D11   Other dermatological preparations              Cetrimide

G01   Gynecological antiinfectives and antiseptics   Ascorbic acid

G02   Other gynecologicals                           Bromocriptine


G03   Sex hormones and modulators of the genital     Megestrol
      system
G04   Urologicals                                    Oxybutynin

H01   Pituitary and hypothalamic hormones and        Thyrotropin alpha
      analogues

H02   Corticosteroids for systemic use               Prednisone


H03   Thyroid therapy                                Levothyroxine sodium

H04   Pancreatic hormones                            Insulin


H05   Calcium homeostasis                            Calcitonin
J01   Antibacterials for systemic use                Doxycycline


J02   Antimycotics for systemic use                  Fluconazole

J04   Antimycobacterials                             Isoniazid
J05   Antivirals for systemic use                    Oseltamivir


J06   Immune sera and immunoglobulins                Diphtheria antitoxin


J07   Vaccines                                       Influenza inactivated (Flu)

L01   Antineoplastic agents                          Cyclophosphamide

L02   Endocrine therapy                              Triptorelin


L03   Immunostimulants                               Filgrastim


L04   Immunosuppressants                             Cyclosporin

M01   Anti-inflammatory and antirheumatic products   Naproxen

M02   Topical products for joint and muscular pain   Dimethyl sulfoxide

M03   Muscle relaxants                               Baclofen

M04   Antigout preparations                          Allopurinol

M05   Drugs for treatment of bone diseases           Zoledronic acid

M09   Other drugs for disorders of the musculo-      Sodium Hyaluronate
      skeletal system

N01   Anesthetics                                    Propofol
N02   Analgesics                                     Morphine

N03   Antiepileptics                                 Phenytoin
N04   Anti-parkinson drugs                           Levodopa

N05   Psycholeptics                                  Chlorpromazine
N06   Psychoanaleptics                               Imipramine
N07   Other nervous system drugs                     Neostigmine

P01   Antiprotozoals                                 Albendazole

P02   Anthelmintics                                  Praziquantel

P03   Ectoparasiticides, including scabicides,       Permethrin
      insecticides and repellents

R01   Nasal preparations                             Xylometazoline
R02   Throat preparations                            Paracetamol
R03   Drugs for obstructive airway diseases          Ipratropium


R05   Cough and cold preparations                    Pseudoephedrine


R06   Antihistamines for systemic use                Loratadine

R07   Other respiratory system products              Salbutamol
S01   Ophthalmologicals                              Neomycin

S02   Otologicals                                    Chloramphenicol

S03   Ophthalmological and otological preparations   Gentamicin

V01   Allergens                                      Azathioprine
V03   All other therapeutic products                 Protamine

V04   Diagnostic agents                              Gonadorelin

V06   General nutrients                              Amino Acid

V07   All other non-therapeutic products             Not available in drug list


V08   Contrast media                                 Not available in drug list

V09   Diagnostic radiopharmaceuticals                Not available in drug list
V10   Therapeutic radiopharmaceuticals               Not available in drug list

V20   Surgical dressings                             Not available in drug list
Description
Used for oral/dental treatment
Used to treat conditions caused by an imbalance between mucosal defence mechanisms and acid
secreations
Used to treat all the diseases that pertain to the gastrointestinal tracts such as the diseases of
esophagus, stomach,.......etc
Used against vomiting and nausea (e.g. treat motion sickness)
Used to treat the dysfunction of liver and bile.
Used to induce bowel movements or to loosen the stool, most often taken to treat constipation

Used to provide symptomatic relief for diarrhea, remedying pain by reducing inflammation/fight
against the infections and pathogens
Used to reduce or control weight

Used for the treatment of digestive problems including enzymes
Used for lowering glucose levels in the blood
Used to provide the body with the required vitamines when they cannot be synthesized in
sufficient quantities by an organism
Used to provide the living organisms with the essential dietary elements

Used to increase protein synthesis within cells (cell growth) and affect the development and
maintenance of male characteristics
Used to increase the appetite
No drugs available at HAAD Formulary

Used for the prevention and treatment of ischaemic events (e.g, stroke)
Used to promote hemostasis (stop bleeding)
Used to increase either the number of red cells or the amount of hemoglobin in the blood
Used to increase blood volume and mimic human blood's oxygen transport ability
Used for the problems associated with blood such as volume, circulation and hematological
disorders and carbon monoxide poisoning
Used to treat heart diseases such as angina, heart failure and suppress fast heart beat
Used to decrease high blood pressure
Used to increase the excretion of water from bodies (urination) to treat heart failure, liver
cirrhosis, hypertension and certain kidney diseases and drug poisoning
Used to decrease vessels resistance and increase blood flow by widening the blood vessels

Used in the treatment of hemorrhoids and varicose veins
Used to control cardiac arrhythmias, heart protection after the heart attack, and hypertension

Used to decrease blood pressure, lowering of the heart rate and the potential for heart block.

Used to regulate blood pressure and water (fluid) balance.
Used to inhibit the synthesis of cholestrol
Used to treat fungal infections such as athlete's foot, ringworm, serious systemic infections such as
cryptococcal meningitis, and others
Used to correct dryness and scaling of the skin
Used to treat the wounds or ulcers involves examination, cleaning, and closure, (e.g. cleaning can
be done by using different solutions including tap water, sterile saline solution, or antiseptic
solutions.
Used to inhibit the itching that is often associated with sunburns, allergic reactions, eczema,
psoriasis, chickenpox, fungal infections, insect bites
Used to treat psoriasis ( chronic, non-infectious disease that affects mainly the skin)
Used to kills or inhibits the growth of bacteria, micro-organisms or cancerous cells

Used in the treatment of rash, eczema, and dermatitis

Used to reduce the possibility of infection, sepsis, or putrefaction
Used to absorbs fluid, removes pus and debris from the wound surface and provide anti-bacterial
activity in case of wounds or injury.
Used to inhibit the cycle of acne, whether by targeting acne bacteria, keeping pores clear of
blockages, or reducing inflammation
Used for inhibiting and removing skin pigmentation and skin roughness, skin scars and improve
wrinkles.
Used to treat problems associated with the female reproductive system such as the hormonal
imbalance, fertility, polycystic ovary syndrom.
Used to treat Parkinson's Disease, menstrual irregularities, reduce or prevent breast milk
production, except after childbirth (postpartum), pituitary tumors, , neuroleptic malignant
syndrome, and type 2 diabetes.
Used to generate development, maintenance, and functioning of the organs of reproduction and
other organs and tissues.
Used to treat and manage the male/female urological tract disorders ( kidneys, ureters, urinary
bladder and urethra)
Used to regulate the homeostasis of the human body to control important processes like growth,
blood pressure, thyroid gland function, the conversion of food into energy (metabolism), breast
milk production and temperature regulation
Used to control and manage a wide range of physiologic systems such as stress response, immune
response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood
electrolyte levels, and behavior.
Used to replace or provide the thyroid hormones in order to regulate the rate of metabolism and
affect the growth and rate of function of many other systems in the body
Used to stimulate or inhibit the hormones that help in the breakdown and storage of the
carbohydrates, protein, and fat from the chyme (digestive enzymes), drop in the level of blood
sugar.
Used to stimulates calcium release from the bone, reduces its excretion from the kidney and assists
in the conversion vitamin D to calcitriol (active form) (Hypocalcemia) and produce calcitonin in
response to high calcium levels (Hypercalcemia)
Used to reduce the possibility of infection, sepsis, or putrefaction, some are germicides, capable to
destroy microbes (bacteriocidal), while others can prevent or inhibit the growth of bacteria
(bacteriostatic)
Used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious
systemic infections such as cryptococcal meningitis, and others
Used to treat Mycobacteria infections such as tuberculosis
Used to treat viral infections (specific antivirals are used for specific viruses) such as HIV and the
hepatitis B and C viruses, which can cause liver cancer by inhibiting their development but not
destroying them.
Used to stimulate the passive immunity that are effectively against pathogens which are capable of
evading the immune system in the lazy state but which are not robust enough to evade the
stimulated immune system (e.g. Ebola infection)
Used to stimulates the body's immune system to recognize, destroy the foreign agent and
remember destroying it in case of later encounters
Used to inhibit and combat the development of neoplasms (abnormal proliferation of cells) usually
causes a cancerous or non-cancerous tumor
Used to deal with disorders of endocrine glands (adds, blocks, or removes hormones) that regulate
many functions including mood, growth and development, tissue function, and metabolism

Used to stimulate the immune system, inducing activation or increasing activity of any of its
components through providing specific or non-specific antigenic responses (lupus erythematosus)

Used to inhibit the undesirable response from the immune system, such as in autoimmune diseases
(Myasthenia gravis)
Used to reduce acute or chronic pain and inflammation and slow down disease progression

Used topically to reduce joint and muscles pain related to tension, overuse and injury from
exercise or physically-demanding work.
Used to affects skeletal muscle function, decreases the muscle tone and alleviate some symptoms
such as muscle spasms.
Used to manage the symptoms of the recurrent attacks of acute inflammatory arthritis (red,
tender, hot, swollen joint) via reducing uric acid in the blood
Used to treat disorder associated with skeletal system that place a person at risk for bone fractures
(Osteoporosis)
Used to minimize the loss function of the musculoskeletal system (signs, symptoms, laboratory
abnormalities, etc....) that may lead to inability to perform well and may further limit the individual.

Used to causes anesthesia (loss of sensation) to facilitate surgery
Used to relieve pain as they act in various ways on the peripheral and central nervous systems

Used to suppress the rapid and excessive firing of neurons that start a seizure
Used to treat and relieve the symptoms of Parkinson's disease either by increasing dopamine
activity or reducing acetylcholine activity in the central nervous system.
Used to produces a calming effect upon the patient
Used to produces an arousing effect upon the patient
Drugs are use for producing a myriad of effects on the activity and function of the central nervous
system
 Used for the treatment of protozoan infection (an infectious disease caused or transmitted by a
parasite called Protozoa)
Used to expel parasitic worms (helminths) from the body, by either stunning or killing them

Used to work agains parasitism (relationship between living organism and parasite) by reduce the
load of scabies and prevent the re-infection, work against the eggs and larvae of insects and
discourages them from landing or climbing on that surface
Used to releive the blockage of the nasal passages
Used to decrease the symptoms of throat inflammation.
Used to relax smooth muscle around the airways, increasing the calibre of the airways and
improving air flow, reduce the inflammation in the airways, reduce symptoms for some people who
have COPD and increase the oxygen level in the body
Used to treat coughing and related conditions. For dry coughs, treatment with cough suppressants
may be suppress the body's urge to cough, while in productive coughs, using expectorants that
loosen mucus from the respiratory tract.
Used to treat allergies and reduce the normal symptoms of insect stings by inhibiting the release or
action of histamine
Used to relief symptoms of asthma and other conditions of airways obstruction
Used to deal with diseases and surgery of the visual pathways through applied to the eyelids or
placed in the space between the eyelids and the area surrounding the eye.
Used to treat conditions that may affect your hearing or balance such as ear infections and tinnitus

Used to ensure health, comfort, and infection-fighting capabilities of the eye.

Used to inhibit the hypersensitivity reaction that is caused by non-parasitic antigen
Therapeutic products include complementary medicines (herbal, over the counter drugs) and
medical devices (lenses, blood products and endoscopes) for human use
Used for carrying out analytical processes for a disease, mineral content, drug effectiveness, and
organ function.
Used to provide the organism with the nutrients if it cannot be synthesized by the organism in
sufficient quantities
Products or compounds that are used for analytical processes, success of surgeries and minimise
bad effects, enhance the appearance or odor of the human body, destroy microorganisms, good
hygiene and health.
Used to enhance the contrast of structures or fluids within the body in medical imaging. by
enhancing the visibility of blood vessels and the gastrointestinal tract
Used as tracers in the diagnosis and treatment of many diseases.
Used in the field of nuclear medicine as tracers in the diagnosis and treatment of many diseases

Used to promote recovery and prevent further harm in the case of wounds or surgery
Glossary
Term
Disease Group
Inpatient
Outpatient
ACHS
ADA
AHRQ
CDC
HEDIS
NHQR
Glossary
       Definition
       As defined by HAAD breakdown of WHO diagnosis categories
       Encounter.Type = 3 or 4
       Encounter.Type = 1, 2, 5 or 6
       The Australian Council on Healthcare Standards
       American Diabetes Association
       Agency for Healthcare Research and Quality
       Centers for Disease Control and Prevention
       Health Effectiveness Data and Information Set (National Committee for Quality Assurance)
       National Healthcare Quality Report (Agency for Healthcare Research and Quality)
Criteria for evaluating individual Quality Indicators


                •Supported by research literature
   Validity     •Used elsewhere [AHRQ,ACHS]
                •Supported by Abu Dhabi’s care standards

                •Directly relevant to a public health challenge
  Relevance     •Supports the new model of care [Outpatient
                •Underlying behaviours modifiable [prescribin

                •Data collected and validated automatically a
 Practicality   •Data available from most providers [Colds vs
                •Performance management transferable to P

								
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