Claims data provide information on the patient’s medical history, including healthcare utilization, comorbidities, and prescription medication use. This project offered an opportunity to explore risk variables that might be difficult to ascertain in routine clinical settings. Fifty-eight risk variables and three interactions were operationalized in the model, and our team further categorized these variables and interactions into seven groups:
- Group 1: Demographics
- Group 2: History of bleeds
- Group 3: Clinical factors
- Group 4: Anticoagulant use
- Group 5: Other medication use
- Group 6: Socioeconomic proxy
- Group 7: Healthcare utilization
The table on this page provides a summary of the risk variables. The detailed data dictionary and the ICD-10-CM/ICD-10-PCS code table can be downloaded from the Model Software Download webpage.
For risk variables that were operationalized from the code sets developed by other organizations, sources of the original code sets are provided. The Chronic Conditions Data Warehouse (CCW) condition categories, the Specification Manual for Joint Commission National Quality Measures, the eCQM specification for the American Heart Association measure, and the Healthcare Effectiveness Data and information Set (HEDIS) from the National Committee for Quality Assurance are periodically updated. Users of the risk prediction model are encouraged to review the source specifications to identify the up-to-date codes for the clinical concepts.
As indicated in the Sources column in the following table:
- Four risk variables incorporated code sets from version 2020A of the Specification Manual for Joint Commission National Quality Measures developed by The Joint Commission (TJC): Acute Ischemic Stroke, LVAD Status, Heart Failure, and Venous Thromboembolism. The TJC code sets are copyrighted by The Joint Commission. © The Joint Commission, 2022. Reprinted with permission.
- Coronary Artery Disease risk factor incorporated a value set from 2019 copyrighted and stewarded by the American Heart Association. Used with permission.
- History of Falls risk variable incorporated a value set from the measurement year 2018 specifications of HEDIS®. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
Return to the Anticoagulant-Related Bleeding Prediction Model front page.
Risk Variables |
Variable Groups |
ICD-10-CM and ICD-10-PCS Codes |
Sources |
Risk Variable Definition |
|
Hypertension |
Group 3 |
H35.03x, I10-I13.x, I15.x, I67.4, N26.2 |
CCW Chronic Condition: Hypertension (rev. 02/2019) |
Hypertension as defined by the Chronic Conditions Warehouse (CCW) |
|
Hypertensive Crisis |
Group 3 |
I16.x |
Hypertensive urgency, hypertensive emergency, and unspecified hypertensive crisis occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
|
Pulmonary Hypertension |
Group 3 |
I27.0, I27.2x |
Primary and secondary pulmonary hypertension, excluding other pulmonary heart diseases, such as chronic cor pulmonale, chronic pulmonary embolism, Eisenmenger syndrome |
|
|
Severe Hepatic Conditions |
Group 3 |
B15.0, B16.0, B16.2, B17.11, B18.x, B19.0, B19.11, B19.21, I85.1x, K70.11, K70.3x-K70.4x, K71.1x, K71.3-K71.5x, K71.7, K72.0x-K73.9, K74.3-K74.69, K76.1, K76.2, K76.6-K76.7, K76.81 |
Diagnoses of severe or chronic hepatic conditions identified using the following keywords in ICD-10-CM K70-K77: chronic, cirrhosis, with ascites, with hepatic coma, with hepatic failure, hepatorenal syndrome, hepatopulmonary syndrome, hepatic necrosis, portal hypertension; and secondary esophageal varices |
|
|
Liver Transplant Complications |
Group 3 |
T86.4x |
Liver transplant complications, rejection, failure, or infection |
|
|
Chronic Kidney Impairment |
Group 3 |
N18.3, N18.4, N18.5, N18.6, N18.9, Z99.2 |
Chronic kidney disease (CKD), including Stages 3, 4, 5, End Stage Renal Disease (ESRD)/dialysis, CKD stage unspecified |
|
|
Acute Kidney Failure |
Group 3 |
N17.x, N19 |
Acute and unspecified kidney failure |
|
|
Kidney Transplant Complications |
Group 3 |
T86.1x |
Kidney transplant complications, rejection, failure, or infection |
|
|
Primary Solid Tumor |
Group 3 |
C00.x-C26.x, C30.x-C34.x, C37-C39.x, C40.x-C41.x, C43.x, C4A.x, C45.x-C49.x, C50.x-C58, C60.x-C69.x, C70.x-C75.x, C7A.x, C76.x, C80.1 |
Malignant neoplasms |
|
|
Metastatic Solid Tumor |
Group 3 |
C7B.x, C77.x-C79.x, C80.0, C80.2 |
Secondary neuroendocrine tumors and secondary malignant neoplasm of lymph nodes, respiratory and digestive organs, or other sites |
|
|
Hematological Neoplasm |
Group 3 |
C81.x-C86.x, C88.x, C90.00, C90.02, C90.10, C90.12, C90.20, C90.22, C90.30, C90.32, C91.00, C91.02, C91.10, C91.12, C91.30, C91.32, C91.40, C91.42, C91.50, C91.52, C91.60, C91.62, C91.90, C91.92, C91.A0, C91.A2, C91.Z0, C91.Z2, C92.00, C92.02, C92.10, C92.12, C92.20, C92.22, C92.30, C92.32, C92.40, C92.42, C92.50, C92.52, C92.60, C92.62, C92.90, C92.92, C92.A0, C92.A2, C92.Z0, C92.Z2, C93.00, C93.02, C93.10, C93.12, C93.30, C93.32, C93.90, C93.92, C93.Z0, C93.Z2, C94.00, C94.02, C94.20, C94.22, C94.30, C94.32, C94.40, C94.42, C94.6, C94.80, C94.82, C95.00, C95.02, C95.10, C95.12, C95.90, C95.92, C96.x, D45-D47.x, D75.81 |
Malignant neoplasms of lymphoid, hematopoietic and related tissue, polycythemia vera, myelodysplastic syndromes, excluding “in remission” codes |
|
|
Acute Ischemic Stroke |
Group 3 |
I63.x |
Ischemic Stroke code set for the Stroke (STK-2, STK-3, STK-4) measures stewarded and maintained by The Joint Commission (ver. 2020A) |
Acute ischemic stroke occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
History of Ischemic Stroke |
Group 3 |
I69.3x, Z86.73 |
Sequelae of ischemic stroke |
|
|
Sequelae of ICH |
Group 3 |
I69.0x, I69.1x, I69.2x |
Sequelae of intracranial hemorrhage (ICH): nontraumatic subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage, or other nontraumatic intracranial hemorrhage |
|
|
GI Ulcers and Varices |
Group 3 |
I85.0x, I86.4, K22.1x, K22.3, K25.x-K28.x |
Esophageal, gastric, duodenal, peptic, and gastrojejunal ulcers, primary esophageal varices, and gastric varices, excluding secondary esophageal varices |
|
|
Gastritis and Duodenitis |
Group 3 |
K29.x |
Gastritis, duodenitis, and gastroduodenitis |
|
|
GI Conditions - IBD |
Group 3 |
K50.x, K51.x |
Inflammatory bowel disease (IBD): Crohn's disease, ulcerative conditions |
|
|
GI Conditions - Inflammatory conditions |
Group 3 |
K20.x, K21.0, K35.2-K35.89x, K36, K37, K52.0-K52.21, K52.29-K52.9, K55.3x, K57.x, K62.7 |
Diverticulitis, esophagitis, enterocolitis, colitis, appendicitis, proctitis |
|
|
GI Conditions - Hemorrhoids |
Group 3 |
K64.x |
Hemorrhoids |
|
|
Myocardial Infarction |
Group 3 |
I21.x, I22.x |
CCW Chronic Condition: Acute Myocardial Infarction (rev. 02/2019) |
Myocardial infarction, as defined by the Chronic Conditions Warehouse (CCW), occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
Coronary Artery Disease |
Group 3 |
I20.x, I24.x, I25.10, I25.11x, I25.5-I25.9, Z95.1, Z95.5, Z98.61 |
Coronary Artery Disease No MI value set for the Coronary Artery Disease (CAD): Beta-Blocker Therapy - Prior Myocardial infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than 40%) measure stewarded and maintained by American Heart Association (ver. 2019) |
Angina, Dressler's syndrome, unspecified acute ischemic heart disease, atherosclerotic heart disease, presence of coronary bypass graft, presence of angioplasty implant and graft |
|
LVAD Status |
Group 3 |
Diagnosis code: Z95.811 |
Adapted from the Left Ventricular Assistive Device (LVAD) and Heart Transplant code set for the Advanced Certification Heart Failure (ACHF) measure set stewarded and maintained by The Joint Commission (ver. 2020A). |
Left ventricular assistive device (LVAD): Presence of heart assist device or a care encounter with a procedure code indicating insertion or revision of implantable heart assist system, short-term external heart assist system, biventricular short-term external heart assist system |
| Heart Failure |
Group 3 |
Diagnosis code: Z95.811, I09.81, I11.0, I13.0, I13.2, I50.x |
CCW Chronic Condition: Heart Failure (rev. 02/2019) |
Heart failure as defined by the Chronic Conditions Warehouse (CCW) or presence of left ventricular assistive device (LVAD) |
|
Atrial Fibrillation |
Group 3 |
I48.0-I48.2, I48.91 |
CCW Chronic Condition: Atrial Fibrillation (rev. 02/2020) |
Atrial fibrillation as defined by the Chronic Conditions Warehouse (CCW) |
|
Venous Thromboembolism |
Group 3 |
I26.02, I26.09, I26.92-I26.99, I28.9, I80.1x-I80.22x, I80.29x-I80.3, I80.9, I82.22x, I82.29x, I82.401-I82.439, I82.4Yx, I82.501- I82.539, I82.5Yx, I82.890, I82.891, I82.90, I82.91 |
Adapted from the Venous Thromboembolism code set for Venous Thromboembolism VTE-6 Hospital Acquired Potentially-Preventable Venous Thromboembolism measure stewarded and maintained by The Joint Commission (ver. 2020A) |
Acute and chronic embolism and thrombosis for venous thromboembolism |
|
Heart Valves |
Group 3 |
Z95.2, Z95.3, Z95.4 |
Presence of prosthetic heart valve, xenogenic heart valve, or other heart valve replacement |
|
|
Vascular Implants & Grafts |
Group 3 |
Z95.5, Z95.1, Z95.820, Z95.828, Z95.9 |
Angioplasty, bypass, and vascular implants and grafts (proxy for patients who may be taking aspirin and/or antiplatelet therapy) |
|
|
Anemia |
Group 3 |
D50.0, D50.8-D53.9, D55.0-D57.219, D57.40-D61.9, D63.0-D64.9 |
Iron deficiency, nutritional deficiency, enzyme deficiency/disorder, hemolytic, other anemia (exclude Sickle-cell trait and acute posthemorrhagic anemia) |
|
|
Coagulation Defect |
Group 3 |
D65, D66, D67, D68.0-D68.4, D68.8, D68.9 |
Disseminated intravascular coagulation, hereditary factor VIII deficiency, hereditary factor IX deficiency, other coagulation defects, excluding thrombophilia |
|
|
Platelet Defect |
Group 3 |
D69.1-D69.9 |
Purpura, thrombocytopenia, and hemorrhagic conditions, excluding allergic purpura |
|
|
Diabetes |
Group 3 |
E08.x, E09.x, E10.1x-E10.351x, E10.359, E10.36-E10.9, E11.0-E11.9, E13.00-E13.355x, E13.359, E13.36, E13.39-E13.9 |
CCW Chronic Condition: Diabetes (rev. 02/2019) |
Diabetes mellitus and diabetes-related complications as defined by the Chronic Conditions Warehouse (CCW) |
|
Alcohol Use Disorders |
Group 3 |
Diagnosis codes: F10.10, F10.120-F10.20, F10.220-F10.99, G62.1, I42.6, K29.20, K29.21, K70.x, P04.3, Q86.0, T51.0X1A, T51.0X2A, T51.0X3A, T51.0X4A, Z71.41, Z71.42 |
CCW Other Chronic or Potentially Disabling Condition: Alcohol Use Disorders (rev. 06/2019) |
Alcohol use disorders as defined by the Chronic Conditions Warehouse (CCW) |
|
Alzheimer's and Dementia |
Group 3 |
F01.5x, F02.8x, F03.9x, F04, F05, F06.1, F06.8, G13.8, G30.x, G31.01-G31.2, G94, R41.81, R54 |
CCW Chronic Condition: Alzheimer's Disease and Related Disorders or Senile Dementia (rev. 02/2019) |
Alzheimer’s disease and related disorders or senile dementia as defined by the Chronic Conditions Warehouse (CCW) |
|
History of Falls |
Group 3 |
R29.6, W01.x, W06.x-W08.x, W10.x, W18.x, W19.x, Z91.81 |
Adapted from the Falls value set for the Potentially Harmful Drug-Disease Interactions in the Elderly measure stewarded and maintained by the National Committee for Quality Assurance (ver. 2018-10-01) |
Patients who are noted as having repeated falls and a history of falling |
|
Prior GI Bleeding |
Group 2 |
I85.01, I85.11, K22.11, K22.6, K25.0, K25.2, K25.4, K25.6, K26.0, K26.2, K26.4, K26.6, K27.0, K27.2, K27.4, K27.6, K28.0, K28.2, K28.4, K28.6, K29.01, K29.21, K29.31, K29.41, K29.51, K29.61, K29.71, K29.81, K29.91, K31.811, K31.82, K50.111, K50.811, K50.911, K51.011, K51.211, K51.311, K51.411, K51.511, K51.811, K51.911, K55.21, K57.01, K57.11, K57.13, K57.21, K57.31, K57.33, K57.41, K57.51, K57.53, K57.81, K57.91, K57.93, K62.5, K63.81, K66.1, K92.0, K92.1, K92.2 |
Shehab et al. Pharmacoepidemiol Drug Saf. 2019; 28(7): 951:964. doi.org/10.1002/pds.4783 |
Gastrointestinal bleed (GIB) occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
Prior ICH |
Group 2 |
I60.x, I61.x, I62.x, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.345A, S06.346A, S06.347A, S06.348A, S06.349A, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.355A, S06.356A, S06.357A, S06.358A, S06.359A, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.365A, S06.366A, S06.367A, S06.368A, S06.369A, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X5A, S06.4X6A, S06.4X7A, S06.4X8A, S06.4X9A, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, 06.5X4A, S06.5X5A, S06.5X6A, S06.5X7A, S06.5X8A, S06.5X9A, S06.6X0A, S06.6X1A, S06.6X2A, 06.6X3A, S06.6X4A, S06.6X5A, S06.6X6A, S06.6X7A, S06.6X8A, S06.6X9A |
Shehab et al. Pharmacoepidemiol Drug Saf. 2019; 28(7): 951:964. doi.org/10.1002/pds.4783 |
Intracranial hemorrhage (ICH) occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
Prior Other Bleeding |
Group 2 |
H05.23x, H43.1x, I31.2, M25.0x, N42.1, N92.4, N93.8, N93.9, N95.0, N99.520, N99.530, R04.0-R04.2, R04.89, R04.9, R23.3, R31.0, R31.9, R58 |
Shehab et al. Pharmacoepidemiol Drug Saf. 2019; 28(7): 951:964. doi.org/10.1002/pds.4783 |
History of other bleed occurred as an acute care encounter (i.e., inpatient hospitalizations, ED visits, observation stays) |
|
Prior Acute Hemorrhagic Anemia |
Group 2 |
D62 |
Acute hemorrhagic anemia |
|
|
Naïve Anticoagulant Use |
Group 4 |
No exposure of any anticoagulant in 6 months prior to the index date |
||
Active Anticoagulant Use |
Active exposure of an anticoagulant at the start of the outcome measurement period (requiring at least one day of exposure before the index date). Active exposure is determined by the anticoagulant prescription with a dispensing date (i.e., fill date) closest to the index date and with an exposure end date equal to or after the index date. Exposure end date = dispensing date + (days' supply -1) + 10 |
|||
|
Warfarin |
Group 4 |
Warfarin use |
||
|
Rivaroxaban low dose |
Group 4 |
Rivaroxaban use; average daily dose >0 to 10 mg |
||
|
Rivaroxaban medium dose |
Group 4 |
Rivaroxaban use; average daily dose >10 to 15 mg |
||
|
Rivaroxaban high dose |
Group 4 |
Rivaroxaban use; average daily dose >15 mg |
||
|
Injectable AC |
Group 4 |
Injectable anticoagulant: use of Dalteparin, Enoxaparin, Heparin, or Fondaparinux, exclude Heparin Lock Flush |
||
|
Edoxaban low dose |
Group 4 |
Edoxaban use; average daily dose >0 to 30 mg |
||
|
Edoxaban high dose |
Group 4 |
Edoxaban use; average daily dose >30 mg |
||
|
Dabigatran low dose |
Group 4 |
Dabigatran use; average daily dose >0 to 150 mg |
||
|
Dabigatran high dose |
Group 4 |
Dabigatran use; average daily dose >150 mg |
||
|
Apixaban low dose |
Group 4 |
Apixaban use; average daily >0 to 5 mg |
||
|
Apixaban high dose |
Group 4 |
Apixaban use; average daily >5 mg |
||
Concurrent Use of Anticoagulant and Another Medication |
Concurrent use of an anticoagulant (see the list of anticoagulants in Active Anticoagulant Use) and a medication that may increase bleeding risk Topical formulations and chemical compounds are excluded. |
|||
|
Concurrent Use of Antiplatelet |
Group 5 |
Total number of days of concurrent use of an anticoagulant and an antiplatelet-containing product |
||
|
Concurrent Use of Salicylate |
Group 5 |
Total number of days of concurrent use of an anticoagulant and a salicylate-containing product |
||
|
Concurrent Use of Non-Selective NSAID |
|
Total number of days of concurrent use of an anticoagulant and a non-selective NSAID-containing product |
||
|
Concurrent Use of COX-2-I NSAID |
Group 5 |
Total number of days of concurrent use of an anticoagulant and a COX-2 inhibitor NSAID-containing product |
||
|
Concurrent Use of SSRI |
Group 5 |
Total number of days of concurrent use of an anticoagulant and an SSRI-containing product |
||
|
Concurrent Use of SNRI |
Group 5 |
Total number of days of concurrent use of an anticoagulant and a SNRI-containing product |
||
|
Concurrent Use of Serotonin Modulator |
Group 5 |
Total number of days of concurrent use of an anticoagulant and a serotonin modulator-containing product |
||
|
Concurrent Use of Acetaminophen |
Group 5 |
Total number of days of concurrent use of an anticoagulant and an acetaminophen-containing drug product |
||
|
Concurrent Anticoagulant Use |
Group 5 |
Total number of days of concurrent (overlapping) use of an anticoagulant and another anticoagulant (different generic name) |
||
|
Polypharmacy |
Group 5 |
Count of unique generic medication names; this count serves as a proxy of the number of different medications that the individual takes |
||
Age |
Age as of the index date calculated using the date of birth |
|||
|
Age <65 |
Group 1 |
|||
|
Age 65 to <70 |
Group 1 |
|||
|
Age 70 to <75 |
Group 1 |
|||
|
Age 75 to <80 |
Group 1 |
|||
|
Age >=80 |
Group 1 |
|||
Sex |
Sex of the individual |
|||
|
Male |
Group 1 |
|||
|
Female |
Group 1 |
|||
Race |
Race of the individual: race is identified using the Research Triangle Institute (RTI) Race Code in the Medicare Beneficiary Summary File. |
|||
|
Unknown |
Group 1 |
|||
|
Non-Hispanic White |
Group 1 |
|||
|
Black (or African-American) |
Group 1 |
|||
|
Other |
Group 1 |
|||
|
Asian/Pacific Islander |
Group 1 |
|||
|
Hispanic |
Group 1 |
|||
|
American Indian/Alaska Native |
Group 1 |
|||
Medicare-Medicaid Dual Eligibility |
Medicare-Medicaid dual eligibility category based on the definition in CCW Technical Guidance: Options for Determining Which CMS Medicare Beneficiaries Are Dually Eligible for Medicare and Medicaid Benefits Dual eligibility category is assigned using the monthly Dual Eligible Status code (DUAL_STUS_CD) in the Medicare Beneficiary Summary File in the following order of priority: full dual eligibility, restricted dual eligibility, not dual eligible. |
|||
|
Full dual eligibility |
Group 6 |
At least one dual eligible status code with the value of 02, 04, 08 |
||
|
Restricted dual eligibility |
Group 6 |
At least one dual eligible status code with the value of 01, 03, 05, 06 |
||
|
Not dual eligible |
Group 6 |
At least one dual eligible status code with the value of NA, 00, 99, 09 |
||
Part D Low-Income Subsidy |
Part D low-income subsidy category (LIS) Low-income subsidy is assigned using the Cost Sharing Group code (CST_SHR_GRP_CD) in the Medicare Beneficiary Summary File in the following order of priority: Eligible for Low-Income Subsidy, Not Eligible. |
|||
|
Eligible for LIS |
Group 6 |
At least one cost sharing group code with the value of 01, 02, 03, 04, 05, 06, 07, 08 |
||
|
Not eligible for LIS |
Group 6 |
At least one cost sharing group code with the value of 00, 09, 10, 13, Missing |
||
|
Skilled Nursing Facility Use |
Group 7 |
Presence of a skilled nursing facility (SNF) short stay (<100 days): identified using the start date of the SNF stay |
||
|
Home Health Use |
Group 7 |
Presence of home health service: identified using the start date of the home health service |
||
|
Hospital Discharge |
Group 7 |
Presence of hospital discharge: identified using the end date of the hospitalization |
||
|
Gastritis/Duodenitis x Anemia |
Group 3 |
Interaction term between gastritis/duodenitis and anemia |
||
|
Anticoag Naïve Status x Active Anticoag Use |
Group 4 |
Interaction term between anticoagulant naive status and active anticoagulant exposure |
||
|
Chronic Kidney Impairment x Active Anticoag Use |
Group 4 |
Interaction term between renal impairment and active anticoagulant exposure |
||
