Table 6A: Selected Diagnoses and Services Rendered
Montana Data
14 Awardees
| Line | Diagnostic Category | Applicable ICD-10-CM Code or Value Set Object Identifier (OID) | Number of Visits by Diagnosis Regardless of Primacy (a) | Number of Patients with Diagnosis (b) | Visits per Patient |
|---|---|---|---|---|---|
| Selected Infectious and Parasitic Diseases | |||||
| 1-2. | Symptomatic/Asymptomatic human immunodeficiency virus (HIV) | B20, B97.35, O98.7-, Z21 OID: 2.16.840.1.113883.3.464.1003.120.12.1003 | 1,314 | 448 | 2.93 |
| 3. | Tuberculosis | A15- through A19-, O98.0-, Z86.15, Z22.7 OID: 2.16.840.1.113762.1.4.1151.56 (O98.0- is not in value set) | 226 | 102 | 2.22 |
| 4. | Sexually transmitted infections (gonococcal infections and venereal diseases) | A50- through A64-, Z22.4 OID: 2.16.840.1.113883.3.464.1003.112.11.1003 | 1,249 | 921 | 1.36 |
| 4a. | Hepatitis B | B16.0 through B16.2, B16.9, B17.0, B18.0, B18.1, B19.1-, O98.4- OID: 2.16.840.1.113883.3.464.1003.110.12.1025 (B19.1- and O98.4- are not in value set) | 222 | 145 | 1.53 |
| 4b. | Hepatitis C | B17.1-, B18.2, B19.2- OID: 2.16.840.1.113762.1.4.1222.30 | 2,194 | 878 | 2.50 |
| 4c. | Novel coronavirus (SARS-CoV-2) disease | U07.1 OID: 2.16.840.1.113762.1.4.1248.139, 2.16.840.1.113762.1.4.1200.151 | 1,834 | 1,679 | 1.09 |
| 4d. | Post COVID-19 condition | U09.9 OID: 2.16.840.1.113762.1.4.1222.1391 | 295 | 208 | 1.42 |
| Selected Diseases of the Respiratory System | |||||
| 5. | Asthma | J45- OID: 2.16.840.1.113883.3.526.3.362 | 8,199 | 5,329 | 1.54 |
| 6. | Chronic lower respiratory diseases | J40 (count only when code U07.1 is not present), J41- through J44-, J47- | 9,436 | 4,636 | 2.04 |
| 6a. | Acute respiratory illness due to novel coronavirus (SARS-CoV-2) disease | J12.82, J12.89, J20.8, J40, J22, J98.8, J80 (count codes listed only when code U07.1 is also present) OID: 2.16.840.1.113762.1.4.1029.374 | 58 | 55 | 1.05 |
| Selected Other Medical Conditions | |||||
| 7. | Abnormal breast findings, female | C50.01-, C50.11-, C50.21-, C50.31-, C50.41-, C50.51-, C50.61-, C50.81-, C50.91-, C79.81, D05-, D48.6-, D49.3, N60- through N65-, R92- | 2,027 | 1,507 | 1.35 |
| 8. | Abnormal cervical findings | C53-, C79.82, D06-, N87.0, N87.1, N87.9, R87.61-, R87.629, R87.810, R87.820 | 662 | 493 | 1.34 |
| 9. | Diabetes mellitus | E08- through E13-, O24- (exclude O24.41-) OID: 2.16.840.1.113883.3.464.1003.103.12.1001 | 31,186 | 9,852 | 3.17 |
| 10. | Heart disease (selected) | I01-, I02- (exclude I02.9), I20- through I25-, I27-, I28-, I30- through I52- | 11,012 | 5,484 | 2.01 |
| 11. | Hypertension | I10- through I16-, O10-, O11- | 47,042 | 21,638 | 2.17 |
| 12. | Contact dermatitis and other eczema | L23- through L25-, L30- (exclude L30.1, L30.3, L30.4, L30.5), L58- | 2,460 | 2,024 | 1.22 |
| 13. | Dehydration | E86- | 287 | 257 | 1.12 |
| 14. | Exposure to heat or cold | T33-, T34-, T67-, T68-, T69-, W92-, W93-, X30-, X31-, X32- | 133 | 105 | 1.27 |
| 14a. | Overweight and obesity | E66-, Z68- (exclude Z68.1, Z68.20 through Z68.24, Z68.51, Z68.52) | 25,559 | 12,964 | 1.97 |
| Selected Childhood Conditions (limited to ages 0 through 17) | |||||
| 15. | Otitis media and Eustachian tube disorders | H65- through H69- | 1,754 | 1,360 | 1.29 |
| 16. | Selected perinatal/neonatal medical conditions | A33, P19-, P22- through P29- (exclude P29.3-), P35- through P96- (exclude P54-, P91.6-, P92-, P96.81) | 192 | 112 | 1.71 |
| 17. | Lack of expected normal physiological development (such as delayed milestone, failure to gain weight, failure to thrive); nutritional deficiencies in children only. Does not include sexual or mental development. | E40- through E46-, E50- through E63-, P92-, R62- (exclude R62.7), R63.3- (exclude R63.39) | 833 | 497 | 1.68 |
| Selected Mental Health Conditions and Substance Use Disorders | |||||
| 18. | Alcohol-related disorders | F10-, G62.1, O99.31- | 13,392 | 3,959 | 3.38 |
| 19. | Other substance-related disorders (excluding tobacco use disorders) | F11- through F19- (exclude F17-), G62.0, O99.32- | 23,564 | 5,156 | 4.57 |
| 19a. | Tobacco use disorder | F17-, O99.33-, Z72.0 | 12,445 | 7,598 | 1.64 |
| 20a. | Depression and other mood disorders | F30- through F39- | 66,667 | 18,607 | 3.58 |
| 20b. | Anxiety disorders, including post-traumatic stress disorder (PTSD) | F06.4, F40- through F42-, F43.0, F43.1-, F43.8-, F93.0 | 90,259 | 23,062 | 3.91 |
| 20c. | Attention deficit and disruptive behavior disorders | F90- through F91- | 25,354 | 5,179 | 4.90 |
| 20d. | Other mental disorders, excluding drug or alcohol dependence | F01- through F09- (exclude F06.4), F20- through F29-, F43- through F48- (exclude F43.0- and F43.1-), F50- through F99- (exclude F55-, F64-, F84.2, F90-, F91-, F93.0, F98-), 099.34-, R45.1, R45.2, R45.5, R45.6, R45.7, R45.81, R45.82, R48.0 | 43,352 | 12,146 | 3.57 |
| 20e. | Human trafficking | T74.5- through T74.6-, T76.5- through T76.6-, Z04.81, Z04.82, Z62.813, Z91.42 | - | - | - |
| 20f. | Intimate partner violence | T74.11, T74.21, T74.31, Z69.11 | 84 | 44 | 1.91 |
| Line | Diagnostic Category | Applicable ICD-10-CM, CPT-4/I/II/PLA, or HCPCS Code | Number of Visits (a) | Number of Patients (b) | Visits per Patient |
|---|---|---|---|---|---|
| Selected Diagnostic Tests/Screening/Preventive Services | |||||
| 21. | HIV test | CPT-4: 86689, 86701 through 86703, 87389 through 87391, 87534 through 87539, 87806 | 7,317 | 6,589 | 1.11 |
| 21a. | Hepatitis B test | CPT-4: 80074, 86704 through 86707, 87340, 87341, 87350, 87912 | 2,178 | 2,044 | 1.07 |
| 21b. | Hepatitis C test | CPT-4: 80074, 86803, 86804, 87520 through 87522, 87902 | 7,524 | 6,980 | 1.08 |
| 21c. | Novel coronavirus (SARS-CoV-2) diagnostic test | CPT-4: 87426, 87635, 87636, 87637, HCPCS: U0001, U0002, U0003, U0004, U0005, CPT PLA: 0202U, 0223U, 0225U, 0240U, 0241U | 7,375 | 6,439 | 1.15 |
| 21d. | Novel coronavirus (SARS-CoV-2) antibody test | CPT-4: 86318, 86328, 86408, 86409, 86413, 86428, 86769, 86811 CPT PLA: 0224U, 0226U | 2,021 | 1,778 | 1.14 |
| 21e. | Pre-Exposure Prophylaxis (PrEP)-associated management of all patients on PrEP | Possible codes to explore for PrEP management: CPT-4: 99401 through 99404, ICD-10: Z11.3, Z11.4, Z20.2, Z20.6, Z51.81, Z71.51, Z71.7, Z79.899, Limited to prescribed PrEP based on a patient's risk for HIV exposure AND limited to emtricitabine / tenofovir disoproxil fumarate(FTC/ TDF) or emtricitabine/ tenofovir alafenamide(FTC / TAF) or cabotegravir for PrEP | 490 | 217 | 2.26 |
| 22. | Mammogram | CPT-4: 77063, 77065, 77066, 77067, ICD-10: Z12.31, HCPCS: G0279 | 5,721 | 5,221 | 1.10 |
| 23. | Pap test | CPT-4: 88141 through 88153, 88155, 88164 through 88167, 88174, 88175 ICD-10: Z01.41-, Z01.42, Z12.4 (exclude Z01.411 and Z01.419) HCPCS: G0123, G0143, G0144, G0145, G0147, G0148 | 4,545 | 4,362 | 1.04 |
| 24. | Selected immunizations: hepatitis A; haemophilus influenzae B (Hib); pneumococcal, diphtheria, tetanus, pertussis (DTaP) (DTP) (DT); measles, mumps, rubella (MMR); poliovirus; varicella; hepatitis B | CPT-4: 90632, 90633, 90634, 90636, 90643, 90644, 90645, 90646, 90647, 90648, 90669, 90670, 90696, 90697, 90698, 90700, 90701, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90712, 90713, 90714, 90715, 90716, 90718, 90720, 90721, 90723, 90730, 90731, 90732, 90740, 90743, 90744, 90745, 90746, 90747, 90748 | 10,901 | 9,154 | 1.19 |
| 24a. | Seasonal flu vaccine | CPT-4: 90630, 90653 through 90657, 90658, 90661, 90662, 90672, 90673, 90674, 90682, 90685 through 90689, 90694, 90756 | 13,026 | 12,390 | 1.05 |
| 24b. | Coronavirus (SARS-CoV-2) vaccine | CPT-I: 0001A-0004A, 0011A- 0013A, 0021A-0022A, 0031A-0034A, 0041A-0044A, 0051A-0054A, 0064A, 0071A-0074A, 0081A-0083A, 0091A-0094A, 0104A, 0111A-0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A, 91300-91317 CDT: D1701-D1714 Codes listed include those available as of the release date of this manual. | 4,441 | 4,148 | 1.07 |
| 25. | Contraceptive management | ICD-10: Z30- | 7,476 | 4,591 | 1.63 |
| 26. | Health supervision of infant or child (ages 0 through 11) | CPT-4: 99381 through 99383, 99391 through 99393, ICD-10: Z00.1 -, Z76.1.Z76.2 | 7,895 | 4,980 | 1.59 |
| 26a. | Childhood lead test screening (9 to 72 months) | ICD-10: Z13.88, CPT-4: 83655 | 224 | 207 | 1.08 |
| 26b. | Screening, Brief Intervention, and Referral to Treatment (SBIRT) | CPT-4: 99408, 99409, HCPCS: G0396, G0397, G0443, H0050 | 6,502 | 5,583 | 1.16 |
| 26c. | Smoke and tobacco use cessation counseling | CPT-4: 99406, 99407, HCPCS: S9075 | 13,321 | 8,045 | 1.66 |
| 26d. | Comprehensive and intermediate eye exams | CPT-4: 92002, 92004, 92012, 92014 | 884 | 866 | 1.02 |
| 26e. | Childhood development screenings and evaluations | CPT-4: 96110, 96112, 96113, 96127 ICD-10: Z13.4- | 2,225 | 1,469 | 1.51 |
| Line | Service Category | Applicable ADA Code | Number of Visits (a) | Number of Patients (b) | Visits per Patient |
|---|---|---|---|---|---|
| Selected Dental Services | |||||
| 27. | Emergency services | CDT: D0140, D9110 | 13,060 | 11,359 | 1.15 |
| 28. | Oral exams | CDT: D0120, DO145, D0150, D0160, D0170, D0171, D0180 | 20,980 | 19,175 | 1.09 |
| 29. | Prophylaxis–adult or child | CDT: D1110, D1120 | 18,644 | 13,937 | 1.34 |
| 30. | Sealants | CDT: D1351 | 807 | 716 | 1.13 |
| 31. | Fluoride treatment–adult or child | CDT: D1206, D1208, CPT-4: 99188 | 11,780 | 9,023 | 1.31 |
| 32. | Restorative services | CDT: D21xx through D29xx | 20,163 | 11,034 | 1.83 |
| 33. | Oral surgery (extractions and other surgical procedures) | CDT: D7xxx | 8,600 | 6,975 | 1.23 |
| 34. | Rehabilitative services (Endo, Perio, Prostho, Ortho) | CDT: D3xxx, D4xxx, D5xxx, D6xxx, D8xxx | 10,200 | 5,383 | 1.89 |
Footnotes
'-' Data cannot be calculated or has been suppressed for confidentiality purposes.
Cells that are shaded blue represent data that was not reported or null values.
View Detailed UDS Footnotes
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