Overview
In numerous tables in Strategy, you will find tables that contain Diagnostic Groupings that organize metrics in the table. These groups, ingeneral, contain similar diagnoses that align with an organ system or related medical specialty. Our groupings are based on the ICD-10-CM Chapters which divide all ICD-10 codes into 21 groups with specific code ranges. The table below shows this alignment with some important qualifications.
We have also provided a spreadsheet that will allow you to look up a specific ICD-10 code and pinpoint which chapter is matched to each ICD-10 code, and consequently to the Trella Health Diagnostic group in the table.
Although many places in Strategy mention "Diagnostic Categories," or "Major Diagnostic Categories," do not try to draw a connection to CMS's Major Diagnostic Categories (MDC). In some cases you will be able to find an obvious similarity, but the alignment will not work for all groupings or diagnoses.
This sample image shows how the Trella Health Diagnostic Groupings appear in a table. It is possible that some diagnostic groups will not be represented in a table. If there are no claims to populate a diagnostic group, we will not include that group in the table. Also, if the patient count in a group is too small to reveal, that is, the patient count is less than 11 (<11) we will add that group to the category, Aggregated INS MDCs.
| EH Diagnostic Grouping found in the Portal | ICD-10-CM Chapter Name | ICD-10 Code Range |
| Aggregated INS MDC's |
|
varies |
| Blood & Immunological |
Chapter 3 - Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism |
D50-D89 |
| Circulatory System |
Chapter 9 - Diseases of the circulatory system |
I00-I99 |
| Congenital Anomalies |
Chapter 17 - Congenital malformations, deformations and chromosomal abnormalities |
Q00-Q99 |
| Digestive System |
Chapter 11 - Diseases of the digestive system |
K00-K95 |
| Ear & Mastoid Process |
Chapter 8 - Diseases of the ear and mastoid process |
H60-H95 |
| Endocrine & Metobolic |
Chapter 4 - Endocrine, nutritional and metabolic diseases |
E00-E89 |
| Eye & Adnexa |
Chapter 7 - Diseases of the eye and adnexa |
H00-H59 |
| Factors Influencing Health |
Chapter 21 - Factors influencing health status and contact with health services |
Z00-Z99 |
| Genitourinary System |
Chapter 14 - Diseases of the genitourinary system |
N00-N99 |
| Infectious Diseases |
Chapter 1 - Certain infectious and parasitic diseases |
A00-B99 |
| Injury & Poisoning |
Chapter 19 - Injury, poisoning and certain other consequences of external causes |
S00-T88 |
| Mental Disorders |
Chapter 5 - Mental, Behavioral and Neurodevelopmental disorders |
F01-F99 |
| Musculoskeletal System |
Chapter 13 - Diseases of the musculoskeletal system and connective tissue |
M00-M99 |
| Neoplasms |
Chapter 2 - Neoplasms |
C00-D49 |
| Nervous System |
Chapter 6 - Diseases of the nervous system |
G00-G99 |
|
Other Abnormal Findings |
Chapter 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified |
R00-R99 |
| Perinatal Period |
Chapter 16 - Certain conditions originating in the perinatal period |
P00-P96 |
| Pregnancy & Childbirth |
Chapter 15 - Pregnancy, childbirth and the puerperium |
O00-O9A |
| Respiratory System |
Chapter 10 - Diseases of the respiratory system |
J00-J99 |
| Skin Diseases |
Chapter 12 - Diseases of the skin and subcutaneous tissue |
L00-L99 |
|
Chapter 20 - External causes of morbidity |
V00-Y99 |
Aggregated INS MDCs
The first entry is titled, “Aggregated INS MDC’s” which represents the combined percentage for all diagnostic groupings that are too small to be presented on their own. In any case where the total number of patients in a specific diagnostic group drops below 11 patients, we can't show that number for privacy reasons. We roll all diagnostic groups that represent counts <11 into this one category and present that total percentage under this header. Another way to look at it: this row includes all diagnostic groups that have insufficient counts aggregated into a single metric. It is possible that this group itself could contain less than 11 (<11).
Other Abnormal Findings
This category includes the following general categories of diagnoses. For more information on ICD-10 codes in this category, see the attached spreadsheet (below)
- Abnormality of Gait
- Chronic Fatigue Syndrome
- Adult Failure to Thrive
- Debility
- Dysphagia
- Septic Shock
- Retention of Urine
- Generalized Edema
- Syncope and Collapse
Chapters 18, 19, 21 - Factors Influencing Health
These chapters include a broad collection of diverse diagnoses. We combed through the entire list and reassigned each diagnosis to one of the other groups that seemed more appropriate. There is no simple category or algorithm for describing where we placed the diagnoses from this category. The attached Spreadsheet at the bottom of the page will allow you to look for the placement of any missing ICD-10 code.
Knee and Hip Replacements
If a patient has a knee or hip replacement, the Diagnostic grouping for the subsequent care would be different depending on the initial reason for the care. For example, if a patient falls in their home and causes an injury that requires a knee replacement, the DG would be Injury and Poisoning. In contrast, an elective total knee replacement would be considered Musculoskeletal System and Connective Tissue. In other words, the same post operative treatment could show up in different Diagnostic Groupings.
Locating a Specific Diagnosis
The attached spreadsheet contains the ICD-10 diagnoses codes, their descriptions along with the ICD-10-CM chapters to which each diagnosis aligns. In addition, we have listed the diagnostic groupings names as they are found in Strategy. By searching for a specific ICD-10 code, you can identify how that diagnosis aligns with the metrics in Strategy. Instructions are included in the Spreadsheet.
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