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Risk Variable Specifications

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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 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 copyrighted and stewarded by the American Heart Association. Used with permission.
  • History of Fall risk variable incorporated a value set from 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
[Note: C44.x is excluded.]

 

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
Procedure codes: 02HA0QZ, 02HA0RJ, 02HA0RS, 02HA0RZ, 02HA3QZ, 02HA3RJ, 02HA3RS, 02HA3RZ, 02HA4QZ, 02HA4RJ, 02HA4RS, 02HA4RZ, 02HL3DZ, 02WA0JZ, 02WA0QZ, 02WA0RS, 02WA0RZ, 02WA3QZ, 02WA3RS, 02WA3RZ, 02WA4QZ, 02WA4RS, 02WA4RZ

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
Procedure codes: 02HA0QZ, 02HA0RJ, 02HA0RS, 02HA0RZ, 02HA3QZ, 02HA3RJ, 02HA3RS, 02HA3RZ, 02HA4QZ, 02HA4RJ, 02HA4RS, 02HA4RZ, 02HL3DZ, 02WA0JZ, 02WA0QZ, 02WA0RS, 02WA0RZ, 02WA3QZ, 02WA3RS, 02WA3RZ, 02WA4QZ, 02WA4RS, 02WA4RZ

CCW Chronic Condition: Heart Failure (rev. 02/2019)

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).

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
[Note: D50.1, D57.3, D62 are excluded.]

 

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
Procedure codes: HZ2ZZZZ, HZ30ZZZ, HZ31ZZZ, HZ32ZZZ, HZ33ZZZ, HZ34ZZZ, HZ35ZZZ, HZ36ZZZ, HZ37ZZZ, HZ38ZZZ, HZ39ZZZ, HZ3BZZZ, HZ40ZZZ, HZ93ZZZ, HZ96ZZZ

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
Average daily dose = (Quantity Dispensed) x (Strength of the formulation) / (Days' Supply)
For Rivaroxaban dose pack, average daily dose = (Quantity Dispensed) x 15 mg / (Day's Supply)
For Apixaban dose pack = (Quantity Dispensed) x 5 mg / (Day's Supply)

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.
Medications included in each class are listed below. Please note, depending on the data source used to identify medication use, some of the medications might not be captured. (example: over-the-counter medication products are not captured in prescription drug data)

Concurrent Use of Antiplatelet

Group 5

   

Total number of days of concurrent use of an anticoagulant and an antiplatelet-containing product

Antiplatelets: Abciximab, Anagrelide, Cangrelor, Cilostazol, Clopidogrel, Dipyridamole, Eptifibatide, Pentosan Polysulfate Sodium, Prasugrel, Ticagrelor, Ticlopidine, Tirofiban, Vorapaxar

Concurrent Use of Salicylate

Group 5

   

Total number of days of concurrent use of an anticoagulant and a salicylate-containing product

Salicylate: Aspirin, Salicylate, Salsalate

Concurrent Use of Non-Selective NSAID

 

   

Total number of days of concurrent use of an anticoagulant and a non-selective NSAID-containing product

Non-selective NSAID: Diclofenac, Diflunisal, Etodolac, Fenoprofen, Flurbiprofen, Ibuprofen, Indomethacin, Ketoprofen, Ketorolac, Meclofenamate, Mefenamic, Meloxicam, Nabumetone, Naproxen, Oxaprozin, Piroxicam, Sulindac, Tolmetin

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

COX-2 inhibitor NSAID: Celecoxib

Concurrent Use of SSRI

Group 5

   

Total number of days of concurrent use of an anticoagulant and an SSRI-containing product

SSRI: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline

Concurrent Use of SNRI

Group 5

   

Total number of days of concurrent use of an anticoagulant and a SNRI-containing product

SNRI: Desvenlafaxine, Duloxetine, Levomilnacipran, Milnacipran, Venlafaxine

Concurrent Use of Serotonin Modulator

Group 5

   

Total number of days of concurrent use of an anticoagulant and a serotonin modulator-containing product

Serotonin modulator: Nefazodone, Trazodone, Vilazodone, Vortioxetine

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)

Anticoagulant: please see the anticoagulants in Active Anticoagulant Use

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