Description of Measure | Prevalence of clinically diagnosed diabetes mellitus (by ICD-9-CM or ICD-10-CM codes) |
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Data Source | Centers for Medicare and Medicaid Services |
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Type of Data Source | Administrative |
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Data Set | Medicare National 5% Sample |
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Health Care System Data | Yes |
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Regional or National? | National |
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Demographic Group | Patients aged 65 and older using fee-for-service Medicare |
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Numerator | Patients in denominator with diagnosed diabetes from an outpatient, inpatient or carrier claim. |
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Denominator | Patients aged 65 or older with full-year Part A and B enrollment and at least one outpatient visit in the calendar year, within the specified age and gender group. |
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Primary Data Source Indicator | Diabetes status determined by the presence of an ICD-9-CM code (250.x, 357.2, 362.01, 362.02 or 366.41) or ICD-10-CM code (E08.3xx, E08.4xx, E09.3xx, E09.4xx, E10.xxx, E11.xxx, E13.0x, E13.1x, E13.2x, E13.3xx, E13.4x, E13.5x, E13.6xx, E13.8, E13.9) for diabetes or diabetic complications on at least one inpatient, outpatient or carrier claim during the given calendar year. |
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Primary Indicator Method of Measurement | Diagnoses from inpatient, outpatient, and carrier claims. |
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Secondary (1) Variable | Age at the end of the previous calendar year |
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Secondary (2) Variable | Sex/gender |
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Period Currently Available | 2005–2019
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Analytical Considerations | In published literature, disease is diagnosed by ICD-9-CM or ICD-10-CM codes in alternate ways (one outpatient; two or more outpatient or one inpatient; differences in sample). Care must be taken in comparisons. |
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Limitations of Indicator | As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will underestimate the level of chronic kidney disease in the general population. |
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ICD-10-CM Code for CKD | A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4 |
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