Consensus development and application of ICD-9-CM codes for defining chronic illnesses and their complications

Background One particularly difficult challenge in evaluating disease management (DM) programs is defining the scope of economic outcomes to include in the evaluation. Measuring ‘all-cause utilization’ or ‘total costs‘ assumes that a DM intervention impacts the entire spectrum of services rendered and reduces total medical costs, while limiting the evaluation to ‘disease-specific’ costs of the conditions under management may fail to capture any effect the program may have on complications directly related to that primary condition. An acceptable compromise between the two options is to include costs associated with diagnostic codes for the primary condition and those of medical complications directly related to that condition.