Program Criteria
Criteria for Referring a Patient to an AllOne Health Disease Management Program
Asthma
ICD-9 Codes:
CAD
ICD-9 Codes:
- 140.xx Acute myocardial infarction
- 411.xx Other acute and subacute forms of ischemic heart disease
- 412.xx Old myocardial infarction
- 413.xx Angina pectoris
- 414.0xx Coronary atherosclerosis
- 414.8 Other specified forms of chronic ischemic heart disease
- 414.p Chronic ischemic heart disease, unspecified
- V45.81 Aortocoronary bypass status
- V45.82 PTCA status
Procedure Codes:
- 36.0-36.06 Removal of coronary artery obstruction and insertion of stent(s)
- 36.09 Other removal of coronary obstruction
- 36.10-26.19 Aortocoronary bypass for heart revascularization
- 36.07 Insertion of drug-eluting coronary artery stent(s)
COPD
ICD-9 Codes:
- 491.0 Simple chr bronchitis
- 491.1 Mucopurul chr bronchitis
- 491.20 Obs chr brnc wp act exa
- 491.21 Obs chr brnc w act exa
- 491.22 Obs chr bronc w ac bronc
- 491.8 Chronic bronchitis NEC
- 491.9 Chronic bronchitis NOS
- 492.0 Emphysematous bleb
- 492.8 Emphysema NEC
- 496 Chr airway obstruct NEC
Depression
ICD-9 Codes:
- 296.2x – Major depression, single episode
- 296.3x – Major depression, recurrent episodes
- 300.4 – Neurotic depression (anxiety depression, depressive reaction, dysthymic disorder, neurotic depressive state, reactive depression)
- Ages 18 and over
- Requires patient consent
Diabetes
ICD-9 Codes:
- 250.xx
- 648.xx – Gestational diabetes
Heat Failure
ICD-9 Codes:
- 398.91 Rheumatic heart failure
- 402.01 Mal hypert hrt dis w CHF
- 402.11 Benign hyp hrt dis w CHF
- 402.91 Hyperten heart dis w CHF
- 404.01 Mal hyper hrt/ren w CHF
- 404.03 Mal hyp hrt/ren w CHF
- 404.11 Ben hyper hrt/ren w CHF
- 404.13 Ben hyp hrt/ren w CHF & RF
- 404.91 Hyper hrt/ren NOS w CHF
- 404.93 Hyp ht/ren NOS w CHF & RF
- Congestive heart failure, unspecified
- 428.1 Left heart failure
- 428.2 Systolic heart failure
- 428.3 Diastolic heart failure
- 428.4 Combined systolic and diastolic heart failure
- 428.9 Heart failure, unspecified
Prenatal Program
- Referral is made upon diagnosis of pregnancy in teens and women when confirmed by their physician
- Referral made preferably prior to 29 weeks for program effectiveness
Weight Management Program
Click on the following links for useful Weight Management Program Criteria Charts for adults and children for use in your office.
ICD-9 Codes:
Lifestyle Management Program
Is a telephonic coaching program offering resources to help the patient take control of his/her health. The program provides telephonic contact with a personal Health Coach who will work directly with the patient to develop a plan to live healthier. Health Coaches are experienced health care professionals including registered nurses, dietitians, and exercise physiologists.
Addresses lifestyle issues affecting:
- Blood pressure
- Cholesterol
- Nutrition
- Physical Activity
- Stress
Catastrophic Case Management
Refers members who:
- Require high-tech or extensive home care;
- Are terminally ill;
- Have sustained traumatic injury;
- Require frequent hospital admissions; or
- Have a long-term illness.
Intermediate Case Management
Refer members who:
- Have been diagnosed with chronic illness;
- Are interested in education about smart lifestyle choices;
- Have questions and concerns about their health care; or
- Are interested in community resources that are available.
Transition of Care
Refer members who:
- Are planning an elective surgery or are recovering from surgery e.g., joint replacements;
- Are interested in education about smart lifestyle choices;
- Have questions and concerns about your health care; or
- Are interested in community resources that are available.
To refer a patient to one of our Case Management Programs—catastrophic, intermediate care or transition of care—call 1-866-430-2551, extension 2114, weekdays, 8 a.m. to 8 p.m.