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Scientific Data Documentation
Patient 1990
DSN: CC37.NAMCS90.PATIENTS ABSTRACT This material provides documentation for users of the Micro-Data tapes of the National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics. Section I, "Description of the National Ambulatory Medical Care Survey," includes information on the scope of the survey, the sample, field activities, data collection procedures, medical coding procedures, population estimates, and sampling errors. Section II provides technical details of the tape (number of tracks, record length, etc.), and a detailed description of the contents of each data record by location. Section III contains marginal data or estimates for each item on the data record in Section II. The appendixes contain sampling errors, instructions and definitions for completing the patient record form, and lists of codes used in the survey. Introduction This Micro-Data Tape comprises the data collected by the National Ambulatory Medical Care Survey (NAMCS) in 1989, conducted by the National Center for Health Statistics (NCHS). The National Ambulatory Medical Care Survey provides data from samples of patient records selected from a national sample of office-based physicians. These national estimates describe the utilization of ambulatory medical care services in the United States. In 1990 there were approximately 43,469 patient records provided by 1,684 doctors that participated in the survey. For a brief description of the survey design and data collection procedures, see below. For a more detailed description of the survey design, data collection procedures, and the estimation process see references 1 and 2. There are two important points relative to analyzing data from this micro-data tape that should be noted: 1-Micro-data tape users should be fully aware of the importance of the "patient weight" and how it must be used. Information about the patient weight is presented on page 13. If more information is needed the staff of the Ambulatory Care Statistics Branch can be consulted by calling 301/436-7132 during regular working hours. 2-Users should also be aware of the reliability or unreliability of certain estimates, particularly the smaller estimates. The National Center for Health Statistics, which conducts many health surveys of the American people, considers an estimate to be reliable if it has a relative standard error of 30% or less. Therefore, it is important to know the value of the lowest possible estimate in this survey that is considered reliable, so as not to present data in a journal article or paper that may be unreliable. Most data tape users can obtain an adequate working knowledge of the relative standard error from the information presented in the Appendix. If you would like more information, do not hesitate to consult the staff of the Ambulatory Care Statistics Branch. Technical Description of Tape Data Set Name: NAMC1990 Number of Reels: 1 Number of Recording Tracks: 9 Density (bpi): 1600 or 6250 Language EBEDIC Parity ODD Record Length: 153 Blocksize: 15,300 Number of Records 43,469 Computer Compatibility IBM 360 OR 370 METHODOLOGY Scope of the Survey The basic sampling unit for the NAMCS is the physician-patient encounter or visit. Only visits in the offices of nonfederally employed physicians classified by the American Medical Association (AMA) or the American Osteopathic Association (AOA) as "office-based, patient care" were included in the 1990 NAMCS. In addition, physicians in the specialties of anesthesiology, pathology, and radiology were excluded from the physician universe. Major types of ambulatory encounters not included in the 1990 NAMCS were those made by telephone, those made outside of the physician's office, and those made in hospital or institutional settings. Sampling Frame and Size of Sample The sampling frame for the 1990 NAMCS was composed of all physicians contained in the master files maintained by the AMA and AOA as of December 31, 1989, who met the following criteria: Office-based, as defined by the AMA and AOA: Principally engaged in patient care activities; Nonfederally employed; Not in specialties of anesthesiology, pathology, and radiology. The 1990 NAMCS sample included 3,063 physicians: 2,770 MD's and 293 doctors of osteopathy. Sample physicians were screened at the time of the survey to assure that they met the above-mentioned criteria, 794 physicians did not meet all of the criteria and were, therefore, ruled out of scope (ineligible) for the study. The most frequent reasons for being out of scope were that the physician was retired, deceased, or employed in teaching, research, or administration. Of the 2,269 in-scope (eligible) physicians, 74 percent, participated in the study. The physician universe, sample size, and response rates by physician specialty are shown in table I. Of the participating physicians, 237 saw no patients during their assigned reporting period because of vacations, illness, or other reasons for being temporarily not in practice. Sample Design The 1990 NAMCS utilized a multistage probability design that involved probability samples of primary sampling units (PSU's), physician practices within PSU's, and patient visits within practices. The first-stage sample included 112 PSU's. A PSU is a county, a group of adjacent counties, or a standard metropolitan statistical area (SMSA). The second stage consisted of a probability sample of practicing physicians selected from the master files maintained by the American Medical Association (AMA) and American Osteopathic Association (AOA). Within each PSU, all eligible physicians were stratified by fifteen specialty groups: general and family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular disease, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and all other specialties. The final stage was the selection of patient visits within the annual practices of sample physicians. This involved two steps. First, the total physician sample was divided into 52 random subsamples of approximately equal size, and each subsample was randomly assigned to 1 of the 52 weeks in the survey year. Second, a systematic random sample of visits was selected by the physician during the assigned week. The sampling rate varied for this final step from a 100-percent sample for very small practices to a 20-percent sample for very large practices as determined in a presurvey interview. The method by which the sampling rate was determined is described in reference 3. Field Activities The first contact with the sample physician is through a letter from the Director, NCHS, which may be accompanied by a letter from one of the 16 national medical associations that endorse the NAMCS providing the physician is a member of one or more of these associations. After the physician has received the introductory letter(s) the field representative telephones the physician to set up an appointment with him or her to discuss the survey and instruct the doctor on how to complete the forms. Data Collection The actual data collection for the NAMCS was carried out by the physician aided by his office staff when possible. Two data collection forms were employed by the physician: The Patient Log and the Patient Record (Figure 1). The Patient Log is used to sequentially list patients seen in the physician's office during his assigned reporting week. This list served as the sampling frame to indicate the visit for which data were to be recorded. A perforation between the patient names and patient visit characteristics permitted the physician to remove patient names and protect confidentiality. Based on the physician's estimate of the expected number of office visits each physician was assigned a patient-sampling ratio. These ratios were designed so that about 30 Patient Records were completed during the assigned reporting week. Physicians expecting 10 or fewer visits each day recorded data for all of them, while those expecting more than 10 visits per day recorded data for every second, third, or fifth visit based on the predetermined sampling interval. These procedures minimized the data collection workload and maintained approximately equal reporting levels among sample physicians regardless of practice size. For physicians assigned a patient sampling ratio, a random start was provided on the first page of the log, so that predesignated sample visits on each succeeding page of the log provided a systematic random sample of patient visits during the reporting period. Data Processing In addition to the completeness checks made by the field staff, clerical edits were performed upon receipt of the data for central processing. These procedures proved quite efficient, reducing the item nonresponse rates to a negligible amount--6 percent or less for all data items. Information from the Induction Interview and Patient Record was keypunched, with 100-percent verification and converted to computer tape. Extensive computer consistency and edit checks were also performed. Data items still unanswered at this point were imputed by randomly assigning a value from a Patient Record with similar characteristics; imputations were based on physician specialty and broad diagnostic categories. Medical Coding The patient record form contains three medical items, each of which requires a separate coding system. The three coding systems are described briefly below. A two-way independent verification procedure was used to control the medical coding operation. Differences between coders were adjudicated by a third coder. Definitions of the three medical items are on pages 31 and 33 of this documentation. (A) Patient's Reason for Visit: Information contained in item 9 (patient's reason for visit) of the Patient Record was coded according to an updated version of A Reason for Visit Classification for Ambulatory Care (RVC).4/ The updated classification has not been published as of this writing but the list of codes is contained in Appendix II. The classification was updated to incorporate several new codes as well as changes to existing codes. The system continues to utilize a modular structure composed of seven modules. The digits 1 through 8 precede the 3-digit RVC codes to identify the various modules as follows: Prefix Module "1" = symptom module "2" = disease module "3" = diagnostic, screening, and preventive module "4" = treatment module "5" = injuries and adverse effects module "6" = test results module "7" = administrative module "8" = Uncodable entries "9" = special code = blank A maximum of 3 reasons were coded, in sequence; coding instructions concerning the patient reason for visit are contained in the NAMCS Medical Coding Manual.7/ Copies are available upon request. (B) Physician's Diagnoses: Diagnostic information in item 10 of the Patient Record was coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).5/ For 1990 NAMCS micro-data tape tabulations involving principal diagnoses, the following characteristics exist: 1. The prefix "1" preceding the diagnostic codes has been added to identify all codes in the range 001.00-999.90, e.g. '138100' = '381.00' = Acute nonsupporative otitis media, unspecified. 2. The prefix "20" preceding diagnostic codes represents V code diagnoses V01.00-V82.90, e.g. '201081' = 'V10.81' = personal history of malignant neoplasm of bone. In other words, change the "20" to "V." NOTE: The use of prefixes facilitates the calculation of percent distributions, while substituting "20" for the letter "V" allows that all diagnostic fields on the data tape will contain numerical data. 3. In addition to the diagnostic codes from the ICD-9-CM there are 3 unique codes in the diagnostic fields that were developed by the NAMCS staff: 209900 = - noncodable diagnosis - insufficient information for coding - illegible diagnosis 209970 = diagnosis of "none" 900000 = blank diagnosis A maximum of three diagnoses were coded in sequence: coding instructions concerning diagnoses are contained in the NAMCS Medical Coding Manual.7/ (C) Medication Therapy This Visit: The NAMCS drug data in item 15 have been classified and coded according to a unique classification scheme6/ developed at NCHS. A list of the drug codes are in Appendix III. The patient record form allows for the recording of up to 5 drugs. The tape format includes a corresponding allocation of drug fields. More complete coding lists and instructions for using the NAMCS 1990 drug information are contained in the publication entitled: "The Collection and Processing of Drug Information, National Ambulatory Medical Care Survey, United States, 1980."8/ Copies are available upon request. It should be noted that a substantial amount of information concerning each drug is not contained in these data. This additional drug information is contained in a special NAMCS Drug File and is available as a separate micro-data tape.* For information on ordering the micro-data tape for drugs, interested persons should contact the Ambulatory Care Statistics Branch, Division of Health Care Statistics, Room 9-52, 6525 Belcrest Road, Hyattsville, Maryland 20782. The telephone number is 301/436-7132. POPULATION FIGURES The base population used in computing annual visit rates is presented in table II. These figures are based on provisional estimates for the civilian noninstitutionalized population as of July 1, 1990, provided by the U.S. Bureau of the Census. The population estimates are presented here solely for the purpose of providing denominators for rate computation and should not be considered as official population estimates. *It should be noted, however, that it is not possible to link the information on the drug file with the information on the patient file. ESTIMATION PROCEDURES Statistics produced from the 1990 National Ambulatory Medical Care Survey were derived by a multistage estimating procedure. The procedure produces essentially unbiased national estimates and has basically three components: (1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) a ratio adjustment to fixed totals. Each of these components is described briefly below. (1) INFLATION BY RECIPROCALS OF SAMPLING PROBABILITIES.--Since the survey utilized a three-stage sample design, there were three probabilities: (A) The probability of selecting the PSU, (B) the probability of selecting a physician within the PSU, and (C) the probability of selecting a patient visit within the physician's practice. The last probability was defined to be the exact number of office visits during the physician's specified reporting week divided by the number of Patient Records completed. All weekly estimates were inflated by a factor of 52 to derive annual estimates. (2) ADJUSTMENT FOR NONRESPONSE--Estimates from the NAMCS data were adjusted to account for sample physicians who did not participate in the study. This was done in such a manner as to minimize the impact of nonresponse on final estimates by imputing to nonresponding physicians the practice characteristics of similar responding physicians. For this purpose, similar physicians were judged to be physicians having the same specialty designation and practicing in the same PSU. (3) RATIO-ADJUSTMENT.--A poststratification adjustment was made within each of fifteen physician specialty groups. The ratio adjustment is a multiplication factor which had as its numerator the number of physicians in the universe in each physician specialty group, and as its denominator the estimated number of physicians in that particular specialty group. The numerator was based on figures obtained from the AMA-AOA master files, and the denominator was based on data from the sample. SAMPLING ERRORS Procedures for calculating sampling errors as well as estimates of standard errors of statistics derived from the NAMCS are described in the technical notes of reference 2 or 10, as well as Appendix I of this document. PATIENT WEIGHT The "patient weight" is a vital component in the process of producing national estimates from sample data and its use should be clearly understood by all micro-data tape users. The statistics contained on the micro-data tape reflect data concerning only a sample of patient visits--and not a complete count of all the visits that occurred in the United States. Each record on the data tape represents one visit in the sample of 43,469 visits. In order to obtain national estimates from the sample, each record is assigned an inflation factor called the "patient weight". By aggregating the "patient weights" on the 43,469 sample records for 1990 the user can obtain the total of 704,603,932 estimated visits made by all patients in the United States. The marginal tables on pages 23 to 27 contain data on numbers of records for selected variables as well as the corresponding national estimated number of visits obtained by aggregating the "patient weights" on those records. Designated Specialty Codes ______________________________________________________________________________ Designated Specialties in the National Ambulatory Medical Care Survey, 1989 (From 1984 AMA List of Designated Specialty Codes) ______________________________________________________________________________ GENERAL PRACTICE OTORHINOLARYNGOLOGY GP General Practice OTO Otorhinolaryngology FP Family Practice FPS Facial plastic surgery, Otolaryngology INTERNAL MEDICINE NEUROLOGY IM Internal Medicine CHN Child Neurology N Neurology PEDIATRICS UROLOGY ADL Adolescent Medicine NPM Neonatal-Perinatal Medicine U Urologic Surgery PD Pediatrics PDA Pediatric Allergy ALL OTHER SPECIALTIES PDC Pediatric Cardiology PDE Pediatrics, Endocrinology ABS Abdominal Surgery PHO Pediatrics, Hematology-Oncology AM Aerospace Medicine PNP Pediatrics, Nephrology A Allergy AI Allergy and Immunology GENERAL SURGERY CDS Cardiovascular Surgery PA Clinical Pharmacology GS General Surgery CRS Colon and Rectal Surgery CCM Critical Care Medicine OBSTETRICS AND GYNECOLOGY DIA Diabetes EM Emergency Medicine GYN Gynecology END Endocrinology OBG Obstetrics and Gynecology GE Gastroenterology OBS Obstetrics GPM General Preventive Medicine PSYCHIATRY GER Geriatrics HS Hand Surgery CHP Child Psychiatry HNS Head and Neck Surgery P Psychiatry HEM Hematology PYA Psychoanalysis IG Immunology ID Infectious Diseases CARDIOVASCULAR DISEASES LM Legal Medicine NEP Nephrology CD Cardiovascular Diseases NS Neurological Surgery NTR Nutrition DERMATOLOGY OM Occupational Medicine ON Oncology D Dermatology OS Other Specialty PDS Pediatric Surgery ORTHOPEDIC SURGERY PM Physical Medicine and Rehabilitation ORS Orthopedic Surgery PS Plastic Surgery PH Public Health OPHTHALMOLOGY PUD Pulmonary Disease RHU Rheumatology OPH Ophthalmology TS Thoracic Surgery TRS Traumatic Surgery US Unspecified Specialty VS Vascular Surgery Tables Table I TABLE I. DISTRIBUTION OF PHYSICIANS IN THE UNIVERSE AND IN THE 1990 NATIONAL AMBULATORY MEDICAL CARE SURVEY SAMPLE BY PHYSICIAN SPECIALTY AND RESPONSE STATUS: UNITED STATES, 1990. _______________________________________________________________________________ UNITED NAMCS OUT OF IN NON- GOOD RESPONSE STATES SAMPLE SCOPE SCOPE RE- RE- RATE** UNIVERSE* SPONSE SPONSE _______________________________________________________________________________ ALL SPECIALTIES 326,987 3063 794 2269 585 1684 74 GENERAL/ FAMILY 56,523 450 114 336 83 253 75 PRACTICE OSTEOPATHY 12,844 293 74 219 40 179 82 INTERNAL MEDICINE 46,317 257 61 196 62 134 68 PEDIATRICS 26,580 204 72 132 26 106 80 GENERAL SURGERY 19,458 280 83 197 48 149 76 OBSTETRICS & GYNECOLOGY 25,458 197 40 157 43 114 73 ORTHOPEDIC SURGERY 14,291 140 23 117 34 83 71 CARDIOVASCULAR DISEASES 10,769 149 35 114 38 76 67 DERMATOLOGY 5,953 135 22 113 34 79 70 UROLOGY 7,356 141 31 110 31 79 72 PSYCHIATRY 22,163 127 36 91 26 65 71 NEUROLOGY 5,704 133 40 93 15 78 84 OPHTHALMOLOGY 13,082 130 19 111 19 92 83 OTOLARYNGOLOGY 6,337 126 23 103 34 69 67 ALL OTHER SPECIALTIES 54,152 301 121 180 52 128 71 ___________________________ *THESE DATA ARE DERIVED FROM THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN OSTEOPATHIC ASSOCIATION AND REPRESENT THE TOTAL NUMBER OF PHYSICIANS WHO ARE ELIGIBLE FOR NAMCS. ** RESPONSE RATE (PERCENT) = RESPONSE DIVIDED BY IN SCOPE. Table II - Pop. Estimates Used in Computing Annual Visit Rate Estimates for Ages 0-44 Table II. U.S. population 1/ estimates used in computing annual visit rates for the National Ambulatory Care Survey, by age, sex, race, and geographic region: July 1, 1990. All <5 5-14 15-24 25-34 35-44 Ages years years years years years _______________________________________________________________________________ (in 1,000's 2/) TOTAL 246,098 19,085 35,637 34,952 42,730 37,329 SEX Male 119,364 9,768 18,243 17,318 21,025 18,274 Female 126,734 9,317 17,394 17,635 21,705 19,055 RACE AND SEX White 207,125 15,388 28,754 28,283 35,676 31,896 Male 101,042 7,943 14,793 14,043 17,759 15,835 Female 106,083 7,445 13,961 14,240 17,917 16,061 Black 30,371 2,986 5,562 5,110 5,344 4,077 Male 14,175 1,518 2,825 2,439 2,422 1,820 Female 16,196 1,468 2,737 2,671 2,922 2,257 Other 8,602 711 1,321 1,559 1,710 1,356 Male 4,147 307 625 836 844 619 Female 4,455 404 696 723 866 737 REGION Northeast 49,901 Midwest 59,788 South 84,223 West 52,187 ___________________________ 1/ Civilian noninstitutional population 2/ Numbers may not add to totals because of rounding. Estimates for Ages 45-75 and Over Table II. U.S. population 1/ estimates used in computing annual visit rates for the National Ambulatory Care Survey, by age, sex, race, and geographic region: July 1, 1990. All 45-54 55-64 65-74 75 years Ages years years years and over _______________________________________________________________________________ (in 1,000's 2/) TOTAL 246,098 25,319 21,266 18,096 11,685 SEX Male 119,364 12,276 10,049 8,077 4,336 Female 126,734 13,043 11,217 10,019 7,348 RACE AND SEX White 207,125 21,801 18,538 16,213 10,578 Male 101,042 10,682 8,817 7,252 3,920 Female 106,083 11,119 9,721 8,961 6,658 Black 30,371 2,647 2,138 1,576 930 Male 14,175 1,172 966 676 336 Female 16,196 1,475 1,172 899 594 Other 8,602 870 590 307 177 Male 4,147 421 266 149 80 Female 4,455 449 324 159 97 REGION Northeast 49,901 Midwest 59,788 South 84,223 West 52,187 ___________________________ 1/ Civilian noninstitutional population 2/ Numbers may not add to totals because of rounding. RECORD LAYOUT Introduction 1990 FORMAT FOR PATIENT MICRO DATA TAPE THIS SECTION CONSISTS OF A DETAILED BREAKDOWN OF EACH TAPE RECORD, PROVIDING A BRIEF DESCRIPTION OF EACH ITEM OF DATA INCLUDED IN THE RECORDS. THE DATA ARE ARRANGED SEQUENTIALLY ACCORDING TO THEIR PHYSICAL LOCATION ON THE TAPE RECORD. UNLESS OTHERWISE STATED IN THE "ITEM DESCRIPTION" COLUMN, THE DATA ARE DERIVED FROM THE PATIENT RECORD (PAGE 7). THE AMA AND THE INDUCTION INTERVIEW (REFERENCE 3) ARE ALTERNATE SOURCES OF DATA, WHILE THE COMPUTER GENERATES OTHER ITEMS BY RECODING SELECTED DATA ITEMS. Record Layout ITEM FIELD TAPE NO. LENGTH LOCATION ITEM DESCRIPTION AND CODES _______________________________________________________________________________ 1 6 1-6 DATE OF VISIT 1.1 2 1-2 MONTH OF VISIT 01-12: JANUARY-DECEMBER 1.2 2 3-4 DAY OF VISIT 01-31 1.3 2 5-6 YEAR OF VISIT LAST 2 DIGITS OF YEAR (90,91) 3 2 7-8 PATIENT AGE (IN YEARS; DERIVED FROM DATE OF BIRTH) 00-99 4 1 9 SEX 1 = FEMALE 2 = MALE 5 1 10 RACE 0 = UNSPECIFIED 1 = WHITE 2 = BLACK 3 = ASIAN/PACIFIC ISLANDER 4 = AMERICAN INDIAN/ESKIMO/ALEUT 6 1 11 ETHNICITY 0 = UNSPECIFIED 1 = HISPANIC ORIGIN 2 = NOT HISPANIC 7 9 12-20 EXPECTED SOURCE(S) OF PAYMENT 7.1 1 12 SELF-PAY (1=YES, AND 0=NO) 7.2 1 13 MEDICARE 7.3 1 14 MEDICAID 7.4 1 15 BLUE CROSS/BLUE SHIELD 7.5 1 16 OTHER COMMERCIAL INSURANCE 7.6 1 17 HMO/PRE=PAID PLAN 7.7 1 18 NO CHARGE 7.8 1 19 OTHER 7.9 1 20 UNKNOWN 8 1 21 WAS PATIENT REFERRED BY ANOTHER PHYSICIAN 1 = YES 2 = NO 9 15 22-36 PATIENT REASONS FOR VISIT (SEE PAGE 8 AND REF. 4) 9.1 5 22-26 REASON # 1 10050-89990 = 10050-89990 BLANK = 90000 9.2 5 27-31 REASON # 2 10050-89990 = 10050-89990 BLANK = 90000 9.3 5 32-36 REASON # 3 10050-89990 = 10050-89990 BLANK = 90000 10 18 37-54 PHYSICIAN'S DIAGNOSES (SEE PAGE 9 AND REF. 5) 10.1 6 37-42 DIAGNOSIS # 1 00100-V9990 = 100100-209990 BLANK = 900000 10.2 6 43-48 DIAGNOSIS # 2 00100-V9990 = 100100-209990 BLANK = 900000 10.3 6 49-54 DIAGNOSIS # 3 00100-V9990 = 100100-209990 BLANK = 900000 11.1 1 55 HAVE YOU SEEN PATIENT BEFORE? 1 = YES 2 = NO 11.2 1 56 IF YES, FOR THE DIAGNOSIS IN ITEM 10A? 0 = NOT APPLICABLE 1 = YES 2 = NO 12 17 57-73 SCREENING/DIAGNOSTIC SERVICES THIS VISIT 12.1 1 57 NONE (1=YES, AND 0=NO) 12.2 1 58 PAP TEST 12.3 1 59 PELVIC EXAM 12.4 1 60 BREAST PALPATION 12.5 1 61 MAMMOGRAM 12.6 1 62 VISUAL ACUITY 12.7 1 63 BLOOD PRESSURE CHECK 12.8 1 64 URINALYSIS 12.9 1 65 CHEST X-RAY 12.10 1 66 DIGITAL RECTAL EXAM 12.11 1 67 PROCT/SIGMOIDOSCOPY 12.12 1 68 STOOL BLOOD EXAM 12.13 1 69 ORAL GLUCOSE TOLERANCE 12.14 1 70 CHOLESTEROL MEASURE 12.15 1 71 HIV SEROLOGY 12.16 1 72 OTHER BLOOD TEST 12.17 1 73 OTHER (SPECIFY) 13 7 74-80 COUNSELING/ADVICE 13.1 1 74 NONE (1=YES, AND 0=NO) 13.2 1 75 WEIGHT REDUCTION 13.3 1 76 CHOLESTEROL REDUCTION 13.4 1 77 SMOKING CESSATION 13.5 1 78 HIV TRANSMISSION 13.6 1 79 BREAST SELF EXAM 13.7 1 80 OTHER 14 6 81-86 NON-MEDICATION THERAPY 14.1 1 81 NONE (1=YES, AND 0=NO) 14.2 1 82 PSYCHOTHERAPY 14.3 1 83 CORRECTIVE LENSES 14.4 1 84 AMBULATORY SURGERY 14.5 1 85 PHYSIOTHERAPY 14.6 1 86 OTHER (SPECIFY) 15 1 87 WERE MEDICATIONS ORDERED OR PROVIDED AT THIS VISIT? 1 = YES 0 = NO 16 1 88 NUMBER OF MEDICATIONS CODED (0 TO 5) 17 35 89-123 MEDICATIONS 7 89-95 MEDICATION # 1 17.1 5 89-93 CODE: 00005-61610 90000- BLANK 99980- UNKNOWN ENTRY 99999- ILLEGIBLE ENTRY 17.2 1 94 NEW MEDICATION?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 17.3 1 95 FOR DX IN ITEM 10A?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 7 96-102 MEDICATION # 2 17.4 5 96-100 CODE: 00005-61610 90000- BLANK 99980- UNKNOWN ENTRY 99999- ILLEGIBLE ENTRY 17.5 1 101 NEW MEDICATION?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 17.6 1 102 FOR DX IN ITEM 10A?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 7 103-109 MEDICATION # 3 17.7 5 103-107 CODE: 00005-61610 90000- BLANK 99980- UNKNOWN ENTRY 99999- ILLEGIBLE ENTRY 17.8 1 108 NEW MEDICATION?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 17.9 1 109 FOR DX IN ITEM 10A?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 7 110-116 MEDICATION # 4 17.10 5 110-114 CODE: 00005-61610 90000- BLANK 99980- UNKNOWN ENTRY 99999- ILLEGIBLE ENTRY 17.11 1 115 NEW MEDICATION?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 17.12 1 116 FOR DX IN ITEM 10A?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 7 117-123 MEDICATION # 5 17.13 5 117-121 CODE: 00005-61610 90000- BLANK 99980- UNKNOWN ENTRY 99999- ILLEGIBLE ENTRY 17.14 1 122 NEW MEDICATION?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 17.15 1 123 FOR DX IN ITEM 10A?: 0 = UNKNOWN 1 = YES 2 = NO 3 = NOT APPLICABLE 18 8 124-131 DISPOSITION OF THIS VISIT 18.1 1 124 NO FOLLOW-UP PLANNED (1=YES, AND 0=NO) 18.2 1 125 RETURN AT SPECIFIED TIME 18.3 1 126 RETURN IF NEEDED, P.R.N. 18.4 1 127 TELEPHONE FOLLOW-UP PLANNED 18.5 1 128 REFERRED TO OTHER PHYSICIAN 18.6 1 129 RETURNED TO REFERRING PHYSICIAN 18.7 1 130 ADMIT TO HOSPITAL 18.8 1 131 OTHER (SPECIFY) 19 3 132-134 DURATION OF THIS VISIT (IN MINUTES) 000-999 20 6 135-140 PATIENT WEIGHT (SEE PAGE 13) A RIGHT JUSTIFIED, ALPHANUMERIC INTEGER DEVELOPED BY THE NAMCS STAFF FOR THE PURPOSE OF PRODUCING NATIONAL ESTIMATES FROM SAMPLE ESTIMATES. 21 1 141 GEOGRAPHIC REGION (BASED ON ACTUAL LOCATION OF PHYSICIAN'S PRACTICE) 1 = NORTHEAST 2 = MIDWEST 3 = SOUTH 4 = WEST 22 1 142 METROPOLITAN/NONMETROPOLITAN (BASED ON ACTUAL LOCATION IN CONJUNCTION WITH THE DEFINITION OF THE BUREAU OF THE CENSUS AND THE U.S. OFFICE OF MANAGEMENT AND BUDGET.) 1 = SMSA (STANDARD METROPOLITAN STATISTICAL AREA) 2 = NON-SMSA 23 3 143-145 PHYSICIAN SPECIALTY (COLLECTED FROM INDUCTION INTERVIEW - REFERENCE 3) SEE "LIST OF DESIGNATED SPECIALTY CODES" ON PAGE 21 OF THIS DOCUMENTATION. 24 1 146 TYPE OF DOCTOR 1 = M.D. - DOCTOR OF MEDICINE 2 = D.O. - DOCTOR OF OSTEOPATHY *** THE FOLLOWING FIELDS HAD DATA IMPUTED TO REPLACE BLANKS *** 25 1 147 BIRTH YEAR (1 = IMPUTED) , (BLANK = NOT IMPUTED) 26 1 148 SEX 27 1 149 REFERRAL 28 1 150 SEEN PATIENT BEFORE 29 1 151 IF YES, FOR DIAGNOSIS IN 10A 30 1 152 DISPOSITION OF VISIT 31 1 153 DURATION OF VISIT MARGINAL DATA General Information For all specialties any cell with an estimate of 549,000 visits or less has a relative standard error of 30 percent or more. Such an estimate is consi- dered an unreliable statistic according to the standards of reliability of the National Center for Health Statistics. For individual specialties the 30 percent relative standard error level varies. See Table III in Appendix I for the errors for individual specialties. --- Data not available ... Category not applicable - Quantity zero 0.0 Quantity more than 0 but less than 0.05 * Figure does not meet standards of reliability or precision = Figure suppressed to comply with confidentiality requirements 1990 Marginal Data Patient Age _______________________________________________________________________________ PATIENT TOTAL < 15 15-24 25-44 45-64 65-74 75+ _________ _________ _________ _________ _________ _________ _________ AGE ALL 43469 7105 4072 12300 9786 5753 4453 704603932 138427244 68917861 194195125 149785681 86421898 66856123 100.000 19.646 9.781 27.561 21.258 12.265 9.488 Patient Sex _______________________________________________________________________________ PATIENT TOTAL FEMALE MALE _________ _________ _________ SEX ALL 43469 25737 17732 RECORDS 704603932 427151485 277452447 VISITS 100.000 60.623 39.377 PERCENT Patient Age and Sex _______________________________________________________________________________ PATIENT FEMALE FEMALE FEMALE FEMALE FEMALE FEMALE AGE TOTAL < 15 15-24 25-44 45-64 65-74 75 + _________ _________ _________ _________ _________ _________ _________ AND SEX ALL 43469 3344 2597 8079 5723 3244 2750 704603932 65229184 45164732 132182801 89696775 51529352 43348641 100.000 9.258 6.410 18.760 12.730 7.313 6.152 MALE MALE MALE MALE MALE MALE < 15 15-24 25-44 45-64 65-74 75 + ________ _________ _________ _________ _________ _________ 3761 1475 4221 4063 2509 1703 73198060 23753129 62012324 60088906 34892546 23507482 10.389 3.371 8.801 8.528 4.952 3.336 Patient Race _______________________________________________________________________________ PATIENT ASIAN/PA AMER IN/ UNSPECI RACE TOTAL WHITE BLACK ISLANDER ESK/ALEU FIED _________ _________ _________ _________ _________ _________ ALL 43469 37404 3641 1097 149 1178 RECORDS 704603932 597305535 62317477 21311949 2382418 21286553 VISITS 100.000 84.772 8.844 3.025 0.338 3.021 PERCENT Ethnicity _______________________________________________________________________________ ETHNICITY NOT UNSPECI- TOTAL HISPANIC HISPANIC FIED _________ _________ _________ _________ ALL 43469 2235 38456 2778 RECORDS 704603932 35455966 619747449 49400517 VISITS 100.000 5.032 87.957 7.011 PERCENT Source of Payment _______________________________________________________________________________ SOURCE OF BL CROSS OTHER PAYMENT TOTAL SELF PAY MEDICARE MEDICAID BL SHELD COMMER _________ _________ _________ _________ _________ _________ ALL 43469 12547 9287 3435 5693 10401 RECORDS 704603932 214456001 139765557 59588042 85158174 168943656 VISITS 100.000 30.436 19.836 8.457 12.086 23.977 PERCENT HMO/PRE- NO PAIDPLAN CHARGE OTHER UNKNOWN _________ _________ _________ _________ 5783 1015 2537 901 RECORDS 101872428 12810494 38065646 13749455 VISITS 14.458 1.818 5.402 1.951 PERCENT Patient Referral Status _______________________________________________________________________________ PATIENT TOTAL YES NO _________ _________ _________ REFERRAL STATUS ALL 43469 3379 40090 RECORDS 704603932 38806462 665797470 VISITS 100.000 5.508 94.492 PERCENT Visit Status _______________________________________________________________________________ VISIT OLD PAT OLD PAT STATUS TOTAL NEW PAT NEWPROB OLDPROB _________ _________ _________ _________ ALL 43469 7962 8435 27072 RECORDS 704603932 113962103 159635337 431006492 VISITS 100.000 16.174 22.656 61.170 PERCENT Diagnostic Services _______________________________________________________________________________ DIAGNOSTIC PELVIC BREAST MAMMO VISUAL SERVICES TOTAL NONE PAP TEST EXAM PALPATON GRAM ACUITY _________ _________ _________ _________ _________ _________ _________ ALL 43469 16191 1686 2657 2081 641 2897 704603932 254305069 33898003 51421992 39508759 11773313 45290714 100.000 36.092 4.811 7.298 5.607 1.671 6.428 BLOOD CHEST DIG-RECT PROCTO STOOL-BL PRESSURE URINE X RAY AL EXAM SIGMOID OOD EXAM _________ _________ _________ _________ _________ _________ 14995 5372 1144 1572 183 916 271390139 89903669 20292518 25823146 3056707 17480381 38.517 12.759 2.880 3.665 0.434 2.481 ORAL GLU CHOLESTR HIV OTHER BL OTHER COSE TOL MEASURE SEROLOGY OOD TEST DX SERV _________ _________ _________ _________ _________ 168 1401 77 5038 11467 RECORDS 3421022 26155232 1280325 94008659 176389679 VISITS 0.486 3.712 0.182 13.342 25.034 PERCENT Counseling/Advice _______________________________________________________________________________ COUNSELING/ WEIGHT CHOLEST SMOKING ADVICE TOTAL NONE REDUCT REDUCT CESSATN _________ _________ _________ _________ _________ ALL 43469 27298 2439 1208 832 704603932 442832526 44378101 22565544 14937311 100.000 62.848 6.298 3.203 2.120 HIV BREAST TRANSMI SELF EX OTHER _________ _________ _________ 89 888 12637 RECORDS 1740467 16173737 198607455 VISITS 0.247 2.295 28.187 PERCENT Non-Medication Therapy _______________________________________________________________________________ NON-MEDICATION PSYCHO CORRECT AMBULAT PHYSIO THERAPY TOTAL NONE THERAPY LENSES SURGERY THERAPY OTHER _________ _________ _________ _________ _________ _________ _________ ALL 43469 33834 1786 650 1240 1229 5065 704603932 566077396 26922487 9580216 14203476 16572358 75338015 100.000 80.340 3.821 1.360 2.016 2.352 10.692 Number of Medications _______________________________________________________________________________ NUMBER OF MEDICATIONS TOTAL 0 MEDS 1 MED 2 MEDS 3 MEDS 4 MEDS 5 MEDS _________ _________ _________ _________ _________ _________ ________ ALL 43469 18794 13536 6423 2564 1042 1110 RECORDS 704603932 280016515 230715556 110864853 44477093 19120582 19409333 VISITS 100.000 39.741 32.744 15.734 6.312 2.714 2.755 PERCENT Disposition _______________________________________________________________________________ DISPOSITION NO RETURN RETURN TELEPHON REFER TO RETURNTO TOTAL FOLLOW SPECTIME IFNEEDED FOLLOWUP OTR PHYS REF PHYS _________ _________ _________ _________ _________ _________ _________ ALL 43469 3871 27543 9221 1659 1301 642 704603932 68309720 437529637 159101311 27206621 22938595 7209576 100.000 9.695 62.096 22.580 3.861 3.256 1.023 ADMIT TO OTHR DIS HOSPITAL POSITION _________ _________ 496 914 RECORDS 6801684 11512920 VISITS 0.965 1.634 PERCENT Duration of Visit _______________________________________________________________________________ DURATION ZERO 1-5 6-10 11-15 16-30 31+ OF TOTAL MINUTES MINUTES MINUTES MINUTES MINUTES MINUTES _________ _________ _________ _________ _________ _________ _________ VISIT ALL 43469 503 3720 11506 12985 11154 3601 704603932 8261906 63382795 199086194 217607654 167689929 48575454 100.000 1.173 8.996 28.255 30.884 23.799 6.894 MSA-NonMSA _______________________________________________________________________________ MSA- TOTAL MSA* NONMSA (*MSA = METROPOLITAN STATISTICAL AREA) _________ _________ _________ NONMSA ALL 43469 31840 11629 RECORDS 704603932 502762107 201841825 VISITS 100.000 71.354 28.646 PERCENT MD vs. DO _______________________________________________________________________________ MD VS DO TOTAL DO MD _________ _________ _________ ALL 43469 5434 38035 RECORDS 704603932 39287285 665316647 VISITS 100.000 5.576 94.424 PERCENT 13 Most Frequently Visited Specialties _______________________________________________________________________________ 13 MOST TOTAL GEN PRAC INT MED PEDIATRI GEN SURG OB-GYNS ORTH SUR _________ _________ _________ _________ _________ _________ _________ FREQUENTLY VISITED ALL 43469 11614 3993 3679 2897 2969 1947 SPECIALTIES 704603932 209788017 96621652 81148099 22402012 61242887 32916921 100.000 29.774 13.713 11.517 3.179 8.692 4.672 CARD VAS DERMATOL URO SURG PSYCHIAT NEUR SUR OPHTHALM _________ _________ _________ _________ _________ _________ 1243 2530 1584 1455 1597 2932 11240354 24009272 9546451 20963445 6228367 43841794 1.595 3.407 1.355 2.975 0.884 6.222 OTOLARYN OTHER _________ _________ 2185 2844 RECORDS 17959127 66695534 VISITS 2.549 9.466 PERCENT Geographic Region ______________________________________________________________________________ GEOGRAPHIC NORTH- MID- REGION TOTAL EAST WEST SOUTH WEST _________ _________ _________ _________ _________ ALL 43469 7984 11755 14052 9678 RECORDS 704603932 127804714 180276364 235302526 161220328 VISITS 100.000 18.139 25.585 33.395 22.881 PERCENT General RFV-7 Modules ______________________________________________________________________________ GENERAL RFV-7 DAGNOSTC INJURY + TEST MODULES SYMPTOM DISEASE SCRENING TREATMENT ADVERSE RESULTS TOTAL MODULE MODULE PREVNTIV MODULE EFFECTS MODULE _________ _________ _________ _________ _________ _________ _________ ALL 43469 25559 4219 5718 4612 1333 484 704603932 400322681 66121274 110058660 69045344 22426313 9021315 100.000 56.815 9.384 15.620 9.799 3.183 1.280 ADMINIST UNCODE- MODULE ABLE BLANK _________ _________ _________ 441 446 657 RECORDS 8340993 7916952 11350400 VISITS 1.184 1.124 1.611 PERCENT Major ICD-9-CM Classes ______________________________________________________________________________ MAJOR INF/PAR ENDOCRIN MENTAL NERVOUS CIRCULAT ICD-9-CM TOTAL DISEASES NEOPLASM NUT+META DISORDRS SYSTEM SYSTEM _________ _________ _________ _________ _________ _________ _________ CLASSES ALL 43469 1577 1690 1567 2026 5536 3473 704603932 27075132 21941191 29456030 29928841 80128460 55989290 100.000 3.843 3.114 4.181 4.248 11.372 7.946 RESPIRAT DIGESTIV GENITOUR SKIN+SUB MUSCULOS SYMPTOMS SYSTEM SYSTEM SYSTEM TISSUE SYSTEM SIGNS+IL _________ _________ _________ _________ _________ _________ 5000 1663 2932 2892 2975 1820 100294151 26153934 41067442 36836338 47100540 27220502 14.234 3.712 5.828 5.228 6.685 3.863 INJURY + SUPLEMEN ALL OTHR UNKNOWN POISNING CLASIFIC DAGNOSES + BLANK _________ _________ _________ _________ 3118 5712 601 887 RECORDS 51133536 104417560 10721547 15139438 VISITS 7.257 14.819 1.522 2.149 PERCENT All Specialties ______________________________________________________________________________ ALL SPECIALTIES ALLERGY ABDOMIN ADOLESC ALLERGY CARDIOV CARDIOV AL SURG ENT MED +IMMUNO DISEASS SURGERY TOTAL A ABS ADL AI CD CDS _________ _________ _________ _________ _________ _________ _________ 43469 143 13 21 102 1243 42 ALL 704603932 6777314 241072 1669626 3210615 11240354 930520 100.000 0.962 0.034 0.237 0.456 1.595 0.132 CHILD CHILD COLON + DERMA EMERGEN ENDO NEUROLO PSYCH REC SUR TOLOGY CY MED CRINOLO CHN CHP CRS D EM END _________ _________ _________ _________ _________ _________ 75 82 51 2530 215 59 238908 1304431 1293037 24009272 6233803 1887331 0.034 0.185 0.184 3.407 0.885 0.268 _______________________________________________________________________________ ALL SPECIALTIES FAMILY FAC PLA GASTRO GERIA GYNECOL GENERAL (CONT.) PRACTIC SUR OTO ENTEROL TRICS ONCOLOG PRACTIC FP FPS GE GER GO GP _________ _________ _________ _________ _________ _________ 5439 21 300 41 38 6175 127376992 112581 5787571 84501 383914 82411025 18.078 0.016 0.821 0.012 0.054 11.696 GENERAL GYNECO HEMA INFECTI INTERNL MATERNA SURGERY LOGY TOLOGY OUS DSS MEDICIN FETLMED GS GYN HEM ID IM MFM _________ _________ _________ _________ _________ _________ 2897 231 150 18 3993 21 22402012 3258078 2769823 273096 96621652 385833 3.179 0.462 0.393 0.039 13.713 0.055 NEUROLOGY NEPHRO NEO-PER NEUROLO NUTRITION OBSTETS LOGY NAT MED SURGERY + GYN N NEP NPM NS NTR OBG _________ _________ _________ _________ _________ _________ 1522 196 4 175 3 2738 5989459 2815006 28828 3526550 30345 57984809 0.850 0.400 0.004 0.501 0.004 8.229 OCCUPAT ONCOLOGY OPHTHAL ORTHOPE OTHER OTOLARY NAL MED MOLOGY SURGERY SPECLTY NGOLOGY OM ON OPH ORS OS OTO _________ _________ _________ _________ _________ _________ 41 275 2932 1947 103 2164 1770134 5827465 43841794 32916921 689198 17846546 0.251 0.827 6.222 4.672 0.098 2.533 PSYCH PEDIA PEDIATR PEDIATR PEDIATR PED HEM IATRY TRICS ALLERGY CARDIOL IC SURG ATO-ONC P PD PDA PDC PDS PHO _________ _________ _________ _________ _________ _________ 1198 3552 26 64 78 12 17418230 78585058 367224 414215 3796294 83148 2.472 11.153 0.052 0.059 0.539 0.012 PHYS ME PLASTIC PULMONA PSYCHOA REPRODU RHEUMA + REHAB SURGERY RY DISS NALYSIS ENDOCRI TOLOGY PM PS PUD PYA REN RHU _________ _________ _________ _________ _________ _________ 87 205 138 175 51 171 1102960 4158782 2456232 2240784 1244628 4307461 0.157 0.590 0.349 0.318 0.177 0.611 TRAUMAT THORACI UROLOGI UNSPECI VASCULA IC SURG SURGERY CAL SUR FIED SURGERY TRS TS U US VS _________ _________ _________ _________ _________ 28 47 1584 30 23 566440 619285 9546451 2733330 792994 0.080 0.088 1.355 0.388 0.113 ______________________________________________________________________________ *FIGURE DOES NOT MEET STANDARDS OF RELIABILITY. SEE TABLE III ON PAGE 29. _____________________________________________________________________________ APPENDICES Appendix I Provisional Relative Standard Errors The standard error is primarily a measure of the sampling variability that occurs by chance because only a sample is surveyed, rather than the entire universe. The relative standard error (R.S.E.) of an estimate is obtained by dividing the standard error of the estimate by the estimate itself and is expressed as a percentage of the estimate. Table III.Relative standard errors for estimated numbers of DRUG MENTIONS: National Ambulatory Medical Care Survey, 1990. _______________________________________________________________________________ Estimated number Specialty Group* of drug mentions ___________________________________________________________ (x 1000) All A B C D _______________________________________________________________________________ 100 --------- 69.7 55.7 50.5 32.3 61.8 200 --------- 49.4 39.8 36.6 24.8 44.6 300 --------- 40.4 32.8 30.6 21.6 37.1 400 --------- 35.0 28.6 27.1 19.9 32.7 500 --------- 31.4 25.8 24.7 18.8 29.7 700 --------- 26.6 22.2 21.8 17.4 26.0 1,000 --------- 22.4 19.0 19.2 16.3 22.7 2,000 --------- 16.1 14.5 15.8 14.9 18.3 5,000 --------- 10.6 10.9 13.3 14.0 14.9 10,000 --------- 8.0 9.4 12.4 13.7 13.7 50,000 --------- 5.1 8.0 11.5 13.5 12.5 100,000 --------- 4.6 7.8 11.4 13.4 12.4 690,000 --------- 4.1 ______________________________________________________________________________ * All Specialties....................................(30% R.S.E. = 549,000) * A. General and Family Practice....................(30% R.S.E. = 362,000) * B. Pediatrics and OBG.............................(30% R.S.E. = 313,000) * c. General Surgery, Orthopedic Surgery, Cardiovascular Diseases, Psychiatry, Urology, Dermatology, Neurology, Ophthalmology, Otolaryngology, and Doctors of Osteopathy..........................(30% R.S.E. = 121,000) * D. Internal Medicine and "other" specialties......(30% R.S.E. = 490,000) Example of use of table: An aggregate estimate of 2 million drug mentions from a dermatologist has a relative standard error of 14.9%, or a standard error of 298,000 drug mentions (19.9 percent of 2 million). 1/ These errors may be used temporarily until the final errors are developed. Instructions ITEM 1 - DATE OF VISIT Self-explanatory ITEM 3 - DATE OF BIRTH Self-explanatory ITEM 4 - SEX Self-explanatory ITEM 5 - COLOR OR RACE If the patient's race is not obvious, the physician (or assistant) should mark the box which in his judgment is most appropriate. 1 - White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. 2 - Black: A person having origins in any of the black racial groups of Africa. 3 - Asian/Pacific Islander: A person having origins in any of the original peoples of Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Samoa. 4 - American Indian/Eskimo/Aleut: A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. ITEM 6 - Ethnicity If the patient's ethnicity is not obvious, the physician (or assistant) should mark the box which in his judgment is most appropriate. 1 - Hispanic Origin: A person of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture or origin, regardless of race. 2 - Not Hispanic: Check "Not Hispanic" for all persons who are not of Hispanic Origin. ITEM 7 - EXPECTED SOURCE(S) OF PAYMENT Check the source or sources which, to the best of your knowledge, describe how this visit will be paid for. If several categories are necessary to describe payment sources, check all that apply. 1 - Self-Pay: Any charges billed directly to the patient or patient's family which will not be reimbursed by a third party. Includes "co-payments" and "deductibles." Does not include pre-paid plans for which no co-payment is charged. 2 - Medicare: Any charges paid in-part or in-full by a Medicare plan. Include payments made directly to the physician as well as payments reimbursed to the patient. 3 - Medicaid: Any charges paid in-part or in-full by a Medicaid plan. Include payments made directly to the physician as well as payments reimbursed to the patient. 4 - Blue Cross/Blue Shield: Any charges paid by B.C. or B.S. either directly to physician or reimbursed to patient. If charges are covered under a BC/BS sponsored prepaid plan, check this box and the HMO/prepaid plan box below. 5 - Other Commercial Insurance: Any charges paid by a private insurance company. Include payment made directly to physician as well as reim- bursed to the patient. 6 - HMO/Prepaid Plans: Charges included under a health maintenance organization plan or other pre-payment plan. Include IPA's, PPO's, etc. 7 - No Charge: Visits for which no fee is charged. Do not include visits paid for as part of a total care package, e.g., post-operative visits included in a surgical fee, pregnancy visits for which a flat fee was charged covering entire pregnancy, and HMO and prepaid systems. 8 - Other: (Specify) Any other source of payment not covered in above categories. Examples include workman's compensation programs, local welfare, CHAMPUS, and VA. ITEM 8 - WAS PATIENT REFERRED FOR THIS VISIT BY ANOTHER PHYSICIAN? This item is intended to provide an idea of the "flow" of ambulatory patients from one physician to another. This item concerns referral to the sample physician by a different physician. The counterpart to this item is box 5 of Item 16 which concerns referrals by the sample physician to another physi- cian. The interest is in referrals for this visit and not in referrals for any prior visit. Referrals are any visits that are made because of the advice or direction of a physician other than the one being visited. ITEM 9 - PATIENT'S COMPLAINT(S), SYMPTOM(S) OR OTHER REASON(S) FOR THIS VISIT (in patient's own words) (1) We want the patient's principal complaint, symptom or other reason as it seems to the patient. The physician may recognize right away, or may find out after examination, that the real problem is some- thing entirely different, but here we are interested in how the patient defines his trouble. (2) The item (like all other items on the Patient Record) refers to patient's complaint, symptom or other reason for this visit. Conceivably, the patient may be in treatment for a serious illness, but if his principal problem on this visit is a cut finger or a twisted ankle, that is the information we want. (3) The complaint or symptom should be described in the patient's own words. We will obtain the physician's diagnosis in Item 10. Here we want the patient's description of the problem: "pain in chest," "cramps after eating," or whatever. Space has been allotted for: (a) most important, and (b) other complaints, symptoms, and reasons, if mentioned by patient. In actuality we code up to three patient problems regardless of whether they are listed in (a) or (b), or both. They are coded in the order they are listed. There will, of course, be visits by patients for reasons other than some complaint or symptom. Examples might be: annual checkup, routine prenatal or postnatal care. In such cases, the physician should simply enter the reason for the visit. (But remember that if the reason for patient visit was only to pay a bill or ask the physician to fill out an insurance form or to drop off a specimen, no Patient Record should be completed. ITEM 10 - PHYSICIAN'S DIAGNOSES This item should never be blank. a. Under "PRINCIPAL DIAGNOSIS" record best assessment of diagnosis associated with the patient's most important complaint/reason in Item 9. If possible, enter a final or provisional diagnosis; otherwise diagnosis may be expressed in "problem" terms. If no diagnosis exists for the reason in Item 9 (e.g., visits for well-person exam), enter "well person" or other appropriate description of the situation. ITEM 11 - HAVE YOU SEEN PATIENT BEFORE? "Seen," means "provided care for" at any time in the past. If no (never saw patient before), the physician marks that box and goes on to Item 12. If he marks "Yes," he must also answer the sub-question: Has he seen this patient before for the condition diagnosed in Item 10? ITEM 12 - DIAGNOSTIC/SCREENING SERVICES Check appropriate boxes for all services ordered or provided during this visit. 1. None: Self-explanatory 2. Pap test: Papanicolaou test 3. Pelvic exam: Self-explanatory 4. Breast palpation: Manual examination to detect abnormalities. 5. Mammogram: A roentgenogram of the breast. 6. Visual Acuity: Self-explanatory 7. Blood pressure check: Self-explanatory 8. Urinalysis: Physical, chemical, or microscopic examination of urine. 9. Chest X-ray: Single or multiple x-rays of the chest for diagnosis or screening purposes. Excludes fluoroscopy and studies of ribs, bony thorax and spine. 10. Digital rectal exam: Manual examination of the rectum. 11. Proct/sigmoidoscopy: Examination of the rectum and sigmoid by means of the sigmoidoscope. 12. Stool blood exam: Self-explanatory 13. Oral glucose tolerance: An oral test taken to measure a patient's glucose level. 14. Cholesterol measure: A blood test taken to measure the level of cholesterol in a patient's blood. 15. HIV Serology: The study of the HIV antigen-antibody reaction in vitro. 16. Other Blood Test: Self-explanatory 17. Other(specify): Services not listed or included in the boxes above. Any such "other" services should be described on the line provided. ITEM 13 - COUNSELING/ADVICE (check all ordered or provided) 1. None 2. Weight Reduction 3. Cholesterol Reduction 4. Smoking Cessation 5. HIV Transmission 6. Breast Self-exam 7. Other The physician should check each box for which he or she ordered or provided counseling, advice, education, instructions, or recommendations to the patient during this visit. ITEM 14 - NON-MEDICATION THERAPY Check all services, ordered or provided at this visit. 1. None. 2. PSYCHOTHERAPY: All treatments designed to produce a mental or emotional response through suggestion, persuasion, reeducation, reassurance, or support, including psychological counseling hypnosis, psychoanalysis, and transactional therapy. 3. CORRECTIVE LENSES: Provision, ordering or prescription for glasses or contact lenses. 4. AMBULATORY SURGERY: Any surgical procedure performed in the office or ordered to be performed elsewhere on an outpatient basis. Include management of fractures, suture of wounds, application or removal of casts, incision and draining of abscesses, irrigations, aspirations, dilation, and excisions. 5. PHYSIOTHERAPY: Any form of physical therapy ordered or provided, including any treatment using heat, light sound, or physical pressure or movement; for example, ultrasonic, ultraviolet, infrared, whirlpool, diathermy, cold, and manipulative therapy. 6. OTHER: Treatments or nonmedication therapies ordered or provided that are not listed or included in the preceding categories. ITEM 15 - MEDICATION THERAPY THIS VISIT: List all medications, including biologicals, ordered, injected, administered, or otherwise provided at this visit. Include nonprescription as well as prescription drugs. Use the same specific drug name (brand or generic) that you used on any prescription or office medical record. Do not enter broad drug classes, such as "laxative" or "cough preparation". Limit entries to drug name only. Additional information such as dosage strength or regimen is not required. Check "yes" or "no" before each drug name to indicate whether the drug is a new prescription for this patient. Check "yes" or "no" after drug name to indicate whether or not the drug was provided/prescribed for the principal diagnosis in Item 10. ITEM 16 - DISPOSITION THIS VISIT Eight codes are provided to describe the physician's disposition of the case on this visit. The physician should mark as many categories as apply. DISPOSITION DEFINITION 1. No Follow-up Planned: No return visit or telephone contact is scheduled for the patient's problem on this visit. 2. Return at Specified Time: The patient is told to schedule an appointment or is instructed to return at a particular time. 3. Return if Needed, P.R.N.: No future appointment is made, but the patient is instructed to make an appointment with the physician if the patient considers it necessary. (P.R.N., pro re nata, as necessary, as the occasion arises.) 4. Telephone Follow-up The patient is instructed to telephone Planned: the physician on a particular day (to report on this progress), or if the need arises (if he has any trouble or wishes further consultation. 5. Referred to Other The patient is instructed to consult or Physician: seek care from another physician. The patient may or may not return to this physician at a later date. 6. Returned to Referring Patient was referred to this physician Physician: and is now instructed to consult again with the physician who referred him. 7. Admit to Hospital: Patient is instructed that further care or treatment will be provided in a hospital. No further office visits are expected prior to that admission. 8. Other (Specify): Any other disposition of the case not included in the above categories. Any such "other" disposition should be described on the line provided. ITEM 17 - DURATION OF THIS VISIT Include here the entire time the doctor spent with the patient. DO NOT include the time patient spent waiting to see the doctor. DO NOT include the time patient spent receiving care from someone other than the doctor. For example, the nurse gave the patient an inoculation, or a technician administered an electrocardiogram. It is entirely possible that for visits such as these, the patient would not see the doctor at all. In that case, zero minutes should be entered in Item 17. The intent of this item is to get the total time spent in face-to-face contact with the doctor. If more than one patient is seen by the doctor at the same time, apply the following rule: If the doctor can easily segregate the time spent with each (e.g., 3 minutes with one and 27 minutes with the other), he should record that on the patient record forms. If he cannot estimate how much time was spent with each, he should divide the total time equally among the patients seen together. DEFINITIONS OF CERTAIN TERMS USED IN THIS DOCUMENT Office(s).--Premises that the physician identifies as locations for his ambulatory practice. Responsibility over time for patient care and professional services rendered there generally resides with the individual physician rather than with any institution. Visit.--A direct, personal exchange between ambulatory patient and the physician (or members of his staff) for the purpose of seeking care and rendering health services. Ambulatory patient.--An individual presenting for personal health services, neither bedridden nor currently admitted to any health care institution on the premises. Drug mention(s).--The physician's entry of a pharmaceutical agent ordered or provided--by any route of administration--for prevention, diagnosis, or treatment. Generic as well as brand-name drugs are included. Along with all new drugs, the physician also records continued medications, if the patient was specifically instructed during the visit to continue the medication. Patients.--Can be classified as either: In-scope: All patients seen by the physician or member of his staff in his office(s). Out-of-scope: Patients seen by the physician in a hospital, nursing home, or other extended care institution, or the patient's home. Note: If the doctor has a private office (which fits definition of "office") located in a hospital, the ambulatory patients seen there would be considered "in-scope." The following types of patients are also considered out of scope: patients seen by the physician in any institution (including outpatient clinics of hospitals) for which the institution has the primary responsibility for the care of the patient over time. patients who telephone and receive advice from the physician patients who come to the office only to leave a specimen, pick up insurance forms, or pay their bills patients who come to the office only to pick up medications previously prescribed by the physician Physician.--Can be classified as either: In-Scope: All duly licensed doctors of medicine and doctors of osteopathy currently in practice who devote most of their practice to caring for ambulatory patients at an office location. Out-of-Scope: Those physicians who treat patients only indirectly, including specialists in anesthesiology, pathology, forensic pathology, radiology, therapeutic radiology, and diagnostic radiology, and the following physi- cians. physicians in military service physicians who treat patients only in an institutional setting (e.g., patients in nursing homes and hospitals) physicians employed full time by an industry or institution and having no private practice (e.g., physicians who work for the VA, the Ford Motor Company, etc.) physicians who either spend no time seeing ambulatory patients or whose patient-care activity is secondary to another principal activity, such as teaching, administration, or research. Physician specialty.--Principal specialty (including general practice) as designated by the physician at the time of the survey. Those physicians for whom a specialty was not obtained were assigned the principal specialty recorded in the Master Physician files maintained by the AMA or AOA. Region of practice location.--The four geographic regions which correspond to those used by the U.S. Bureau of the Census, are as follows: Region States Included Northeast..........................Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Midwest............................Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska North Dakota, Ohio, South Dakota, Wisconsin South..............................Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia West Virginia West...............................Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, Alaska, Hawaii Appendix II - Reason For Visit Classification Summary of Codes MODULE CODE NUMBER ______________________________________________________________________________ SYMPTOM MODULE General Symptoms................................1001-1099 Symptoms Referable to Psychological and Mental Disorders..............................1100-1199 Symptoms Referable to the Nervous Sys- tem (excluding sense organs)..................1200-1259 Symptoms Referable to the Cardiovascular and Lymphatic Systems.........................1260-1299 Symptoms Referable to the Eyes and Ears.........1300-1399 Symptoms Referable to the Respiratory System........................................1400-1499 Symptoms Referable to the Digestive System........................................1500-1639 Symptoms Referable to the Genitourinary System........................................1640-1829 Symptoms Referable to the Skin, Nails, and Hair......................................1830-1899 Symptoms Referable to the Musculoskele- tal System....................................1900-1999 DISEASE MODULE Infective and Parasitic Diseases................2001-2099 Neoplasms.......................................2100-2199 Endocrine, Nutritional, and Metabolic Diseases......................................2200-2249 Diseases of the Blood and Blood-Forming Organs........................................2250-2299 Mental Disorders................................2300-2349 Diseases of the Nervous System..................2350-2399 Diseases of the Eye.............................2400-2449 Diseases of the Ear.............................2450-2499 Diseases of the Circulatory System..............2500-2599 Diseases of the Respiratory.....................2600-2649 Diseases of the Digestive System................2650-2699 Diseases of the Genitourinary System............2700-2799 Diseases of the Skin and Subcutaneous Tissue........................................2800-2899 Diseases of the Musculoskeletal System and Connective Tissue..................2900-2949 Congenital anomalies............................2950-2989 Perinatal Morbidity and Mortality Conditions....................................2990-2999 DIAGNOSTIC,SCREENING, AND PREVENTIVE MODULE General Examinations............................3100-3199 Special Examinations............................3200-3299 Diagnostic Tests................................3300-3399 Other Screening and Preventive Pro- cedures.......................................3400-3499 Family Planning.................................3500-3599 TREATMENT MODULE Medications.....................................4100-4199 Preoperative and Postoperative Care.............4200-4299 Specific Types of Therapy.......................4400-4499 Specific Therapeutic Procedures.................4500-4599 Medical Counseling..............................4600-4699 Social Problem Counseling.......................4700-4799 Progress Visit, NEC.............................4800-4899 INJURIES AND ADVERSE EFFECTS MODULE Injury by Type and/or Location..................5001-5799 Injury, NOS.....................................5800-5899 Poisoning and Adverse Effects...................5900-5999 TEST RESULTS MODULE.............................6100-6700 ADMINISTRATIVE MODULE...........................7100-7140 UNCODABLE ENTRIES...............................8990-8999 Note: NEC = not elsewhere classifiable; NOS = not otherwise specified. SYMPTOM MODULE General Symptoms (1001-1099) 1005.0 Chills 1010.0 Fever Includes: High temperature 1015.0 Tiredness, exhaustion Includes: Fatigue No energy Run down Worn out 1020.0 General weakness 1025.0 General ill feeling Includes: Not feeling well Multiple complaints Diffuse Cx Malaise Illness, NOS Sick, NOS 1030.0 Fainting (syncope) Includes: Blacking out Passing out Fainting spells Excludes: Unconsciousness (5840.0) 1035.0 Symptoms of fluid abnormalities 1035.1 Edema Includes: Bloated Holding water Swollen with water Dropsy Ankles swelling (both) Excludes: Swelling of one ankle (1930.5) 1035.2 Excessive sweating, perspiration 1035.3 Excessive thirst 1040.0 Weight gain Includes: Obesity Overweight Too fat Excludes: Counseling for weight problem (4600.0) 1045.0 Weight loss 1045.1 Recent weight loss 1045.2 Underweight 1050.0 Chest pain and related symptoms (not referable to body system) 1050.1 Chest pain Excludes: Heart pain (1265.0) 1050.2 Chest discomfort, pressure, tightness 1050.3 Burning sensation in the chest 1055.0 Pain, site not referable to a specific body system Includes: Buttock pain Gluteal pain Perineal pain Excludes: Chest pain (1050.1) Abdominal pain (1545.1-1545.3) 1055.1 Rib pain 1055.2 Side pain, flank pain 1055.3 Groin pain Includes: Pubic pain 1055.4 Facial pain Includes: Jaw pain Pain over eye 1060.0 Pain and related symptoms, generalized, site unspecified 1060.1 Pain, unspecified Includes: Ache all over 1060.2 Cramps, spasms, site unspecified Excludes: Menstrual cramps (1745.2) 1060.3 Stiffness, site unspecified 1065.0 Tumor or mass, site unspecified 1070.0 Bleeding, site unspecified 1075.0 Symptoms of growth and developmental disorders 1075.1 Lack of growth Includes: Failure to thrive Slowness, physical Too short Immaturity, physical Poor weight gain 1075.2 Excessive growth Includes: Too tall Too big for age Development, early (physical) 1080.0 General Symptoms of infants, NEC 1080.1 Crying too much, fussy, fidgety, irritable Regurgitation, spitting up Excludes: Vomiting (1530.0) 1080.3 Feeding problem 1085.0 General or unspecified nonviral infection 1090.0 Allergy, NOS Includes: Allergic reaction, NOS Food allergy, NOS Milk allergy, NOS Excludes: Allergic skin reaction (2825.0) Allergy to medications (5905.0) Nasal allergy (2635.0) 1095.0 Disorders of motor functions Includes: Ataxia Difficulty in walking Clumsiness Limping Staggering Stumbling Uncoordinated Symptoms Referable to Psychological and Mental Disorders (1100-1199) 1100.0 Anxiety and nervousness Includes: Apprehension Bad nerves Panicky feeling Stress Tension Upset Worried 1105.0 Fears and phobias 1110.0 Depression Includes: Crying excessively Dejected Feeling low Grief Hopelessness Sadness Unhappy 1115.0 Anger Includes: Bitterness Hostile feelings Excludes: Temper problems (1130.4) 1120.0 Problems with identity and Self Esteem Includes: No confidence Loss of identity | Identity crisis No goals Don't like myself Guilt Poor boundaries 1125.0 Restlessness Includes: Hyperactivity Overactivity 1130.0 Behavioral disturbances 1130.1 Antisocial behavior Includes: Avoiding people Excessive shyness Social isolation Withdrawal Lying 1130.2 Hostile Behavior Includes: Aggressiveness Criminality Cruelty Destructiveness Negativism Quarrelsome 1130.3 Hysterical behavior 1130.4 Temper problems Includes: Blowing up Losing temper Temper tantrums 1130.5 Obsessions and compulsions 1135.0 Disturbances of sleep Includes: Night terrors 1135.1 Insomnia Includes: Sleeplessness Can't sleep Trouble falling asleep 1135.2 Sleepiness (hypersomnia) Includes: Drowsiness Can't stay awake 1135.3 Nightmares 1135.4 Sleepwalking 1140.0 Smoking problems Includes: Smoking too much Can't quit smoking Excludes: Smoker's cough (1440.0) Physical symptoms of smoking (see particular symptom) 1145.0 Alcohol-related problems Includes: Drinking problem Excludes: Adverse effects of alcohol (5915.0) Alcoholism (2320.0) 1150.0 Abnormal drug usage Includes: Drug Abuse Frequent or excessive use of stimulants, hallucinogens, depressants, etc. Excludes: Drug addiction (2321.0) Drug dependence (2321.0) Intoxication with drugs (5910.0 Overdose, intentional (5820.1) Overdose, unintentional, NOS (5910.0) 1155.0 Delusions or hallucinations Includes: Seeing things Hearing voices Medicine is poisoned Grandiosity 1160.0 Psychosexual disorders 1160.1 Frigidity, loss of sex drive, lack of response, lack of libido 1160.2 Homosexuality, concerns with 1160.3 Impotence 1160.4 Premature ejaculation 1160.5 Masturbation excessive, concerns about 1160.6 Orgasm, problem with 1165.0 Other symptoms or problems relating psychological and mental disorders, NEC Includes: Can't cope Going crazy Losing my mind Disoriented Mood fluctuation Hate everybody Blunted affect Peculiar thinking Inhibited Excludes: Character disorder (2315.0) Personality disorder (2315.0) 1165.1 Nailbiting 1165.2 Thumbsucking SYMPTOMS REFERABLE TO THE NERVOUS SYSTEM (EXCLUDING SENSE ORGANS) (1200-1259) 1200.0 Abnormal involuntary movements Includes: Shaking Jerking Tics Tremors Twitch Excludes: Eye movements (see 1325.0-1325.4) Eyelid twitch (1340.4) 1205.0 Convulsions Includes: Fits Febrile convulsions Seizures Spells Excludes: Fainting (1030.0) 1210.0 Headache, pain in head Excludes: Sinus headache (1410.1) Migraine (2365.0) 1215.0 Memory, disturbances of Includes: Amnesia Forgetfulness Lack or loss of memory Temporary loss of memory 1220.0 Disturbances of sensation 1220.1 Loss of feeling (anesthesia) Includes: Numbness No response to pain 1220.2 Increased sensation (hyperesthesia) 1220.3 Abnormal sensation (paresthesia) Includes: Prickly feeling Burning, tingling sensation Needles and pins 1220.4 Other disturbances of sense, including smell and taste 1225.0 Vertigo - dizziness Includes: Falling sensation Giddiness (dizziness) Lightheadedness Loss of sense of equilibrium or balance Room spinning 1230.0 Weakness (neurologic) Includes: Right- or left-sided weakness Drooping, facial or NOS Excludes: General weakness (1020.0) 1235.0 Disorders of speech, speech disturbance 1235.1 Stuttering, stammering 1235.2 Slurring 1240.0 Other symptoms referable to the nervous system Includes: Pinched nerve Confusion SYMPTOMS REFERABLE TO THE CARDIOVASCULAR AND LYMPHATIC SYSTEMS (1260-1299) 1260.0 Abnormal pulsations and palpitations 1260.1 Increased heartbeat Includes: Pulse too fast Rapid heartbeat 1260.2 Decreased heartbeat Includes: Pulse too slow Slow heart 1260.3 Irregular heartbeat Includes: Fluttering Skipped beat 1265.0 Heart pain Includes: Heart distress Anginal pain Pain over heart Excludes: Angina pectoris (2515.0) Chest pain (1050.1) 1270.0 Other symptoms of the heart Includes: Bad heart Poor heart Weak heart Heart condition 1275.0 Symptoms of lymph glands (or nodes) 1275.1 Swollen or enlarged glands 1275.2 Sore glands 1280.0 Other symptoms referable to the cardiovascular/lymphatic system, NEC 1280.1 Poor circulation 1280.2 Pallor, paleness 1280.3 Flushed, blushing SYMPTOMS REFERABLE TO THE EYES AND EARS (1300-1399) 1305.0 Vision dysfunctions Excludes: Refractive errors (2405.0) 1305.1 Blindness and half vision 1305.2 Diminished vision Includes: Blurred vision Difficulty reading Poor vision Trouble seeing Can't see distances Weak eyes Scotoma 1305.3 Extraneous vision Includes: Cloudy vision Hazy vision Spots in front of eyes (floaters) 1305.4 Double vision (diplopia) 1310.0 Discharge from eye 1310.1 Bleeding 1310.2 Tearing, watering (lacrimation) 1310.3 Pus, matter, white discharge 1315.0 Eye infection and inflammation 1315.1 Pinkeye 1320.0 Abnormal sensations of the eye Includes: Foreign body sensation 1320.1 Pain Includes: Irritation 1320.2 Itching 1320.3 Burning 1320.4 Strain 1325.0 Abnormal eye movements 1325.1 Abnormal retraction 1325.2 Cross-eyed 1325.3 Pupils unequal 1325.4 Deviation 1330.0 Abnormal appearance of eyes 1330.1 Abnormal color Includes: Bloodshot Red Excludes: Yellow (1610.2) 1330.2 Protrusion (exophthalmos) 1330.3 Cloudy, dull, hazy appearance 1335.0 Other symptoms referable to eye, NEC Includes: Defect, NOS 1335.1 Contact lens problems 1335.2 Allergy 1335.3 Swelling Excludes: Foreign body (5600.0) Injury (5510.0) Abrasion (5410.0) 1340.0 Symptoms of eyelids 1340.1 Infection, inflammation, swelling 1340.2 Itching 1340.3 Mass or growth 1340.4 Abnormal movement Includes: Twitching Blinking Squinting Drooping 1345.0 Hearing dysfunctions 1345.1 Diminished hearing Includes: Deafness Trouble hearing Hearing loss 1345.2 Heightened or acute hearing 1345.3 Extraneous hearing Includes: Ringing (tinnitus) Excludes: Hearing things (1155.0) 1350.0 Discharge from ear Includes: Fluid in ear 1350.1 Bleeding 1350.2 Pus (purulent drainage) 1350.3 Swimmer's ear 1355.0 Earache, or ear infection 1355.1 Earache, pain 1355.2 Ear infection 1360.0 Plugged feeling in ear Includes: Ear wax Ear feels full Congestion in ear Blocked Cracking Popping Ears need cleaning 1365.0 Other symptoms referable to the ears, NEC 1365.1 Itching 1365.2 Growths or mass 1365.3 Pulling at ears, picking at ears 1365.4 Abnormal size or shape, "ears stick out" Excludes: Foreign body in ear (5620.0) SYMPTOMS REFERABLE TO THE RESPIRATORY SYSTEM (1400-1499) 1400.0 Nasal congestion Includes: Drippy nose Runny nose Post-nasal drip Sniffles Stuffy nose Nasal obstruction Excess mucus 1405.0 Other symptoms of nose Excludes: 1405.1 Nosebleed (epistaxis) 1405.2 Sore in nose 1405.3 Inflammation and swelling Includes: Sore nose Infection Red nose 1405.4 Problem with appearance of nose Includes: Too large Bump(s) Undesirable appearance 1410.0 Sinus problems Includes: Sinus drainage 1410.1 Pain and pressure Includes: Sinus headache 1410.2 Sinus inflammation, infection 1410.3 Sinus congestion 1415.0 Shortness of breath Includes: Breathlessness Sensation of suffocation 1420.0 Labored or difficult breathing (dyspnea) Includes: Smothering 1425.0 Wheezing Includes: Sighing respiration 1430.0 Breathing problems, NEC 1430.1 Disorders of respiratory sound, NEC Includes: Abnormal breathing sounds Snoring Rattles Stridor 1430.2 Rapid breathing (hyperventilation) 1435.0 Sneezing 1440.0 Cough Includes: Croupy cough Smoker's cough 1445.0 Head cold, upper respiratory infection (coryza) Includes: Cold, NOS Excludes: Chest cold (1475.0) 1450.0 General viral infection 1450.1 Flu Includes: Grip Influenza Excludes: Croup (2600.0) 1455.0 Symptoms referable to throat 1455.1 Soreness Includes: Throat hurts 1455.2 Pain 1455.3 Infection Includes: Throat virus Excludes: Strep throat (2010.0) 1455.4 Irritation, scratch, tickle 1455.5 Swelling 1455.6 Lump or mass Includes: Sensation of something in throat Excludes: Foreign body in throat (5615.0) 1460.0 Symptoms referable to tonsils Includes: Infection Inflammation 1470.0 Abnormalities of sputum or phlegm 1470.1 Coughing up blood Includes: Hemophysis 1470.2 Pus in sputum 1470.3 Excessive sputum 1475.0 Congestion in chest Includes: Lung congestion Chest cold 1480.0 Disorders of voice 1480.1 Hoarseness, loss of voice 1480.2 Hypernasality 1485.0 Other symptoms referable to the respiratory system, NEC Includes: Drainage in throat SYMPTOMS REFERABLE TO THE DIGESTIVE SYSTEM (1500-1639) 1500.0 Symptoms of teeth and gums 1500.1 Toothache 1500.2 Gum pain 1500.3 Bleeding gums 1505.0 Symptoms referable to lips 1505.1 Cracked, bleeding, dry 1505.2 Abnormal color 1505.3 Cold sore 1510.0 Symptoms referable to mouth Includes: Saliva too thick 1510.1 Pain, burning, soreness 1510.2 Bleeding 1510.3 Dryness 1510.4 Ulcer, sore 1515.0 Symptoms referable to tongue Includes: Ulcer on tongue 1515.1 Pain 1515.2 Bleeding 1515.3 Inflammation, infection, swelling 1515.4 Abnormal color, ridges, coated 1520.0 Difficulty in swallowing (dysphagia) Includes: Choking Inability to swallow 1525.0 Nausea Includes: Upset stomach Sick to stomach Nervous stomach Feel like throwing up 1530.0 Vomiting Includes: Can't keep food down Throwing up Retching Excludes: Regurgitation, infants (1080.2) Vomiting blood (1580.2) 1535.0 Heartburn and indigestion (dyspepsia) Includes: Excessive belching 1540.0 Gastrointestinal infection Includes: Stomach flu Stomach virus Intestinal virus 1545.0 Stomach and abdominal pain, cramps and spasms Includes: Gastric pain Excludes: Groin pain (1055.3) 1545.1 Abdominal pain, cramps, spasms, NOS Includes: Intestinal colic Gas pains Abdominal discomfort, NOS 1545.2 Lower abdominal pain, cramps, spasms Includes: Right lower quadrant (RLQ) pain Left lower quadrant (LLQ) pain Inguinal pain 1545.3 Upper abdominal pain, cramps, spasms Includes: Epigastric pain Left upper quadrant (LUQ) pain Pain in umbilical region Right upper quadrant (RUQ) pain 1565.0 Change in abdominal size 1565.1 Distention, fullness, NOS Includes: Abdominal bloating Stomach fullness 1565.2 Mass or tumor Includes: Mass in groin 1565.3 Abdominal swelling, NOS 1570.0 Appetite, abnormal 1570.1 Excessive appetite Eats too much Always hungry 1570.2 Decreased appetite Not hungry Loss of appetite 1580.0 Gastrointestinal bleeding 1580.1 Blood in stool (melena) 1580.2 Vomiting blood (hematemesis) 1585.0 Flatulence Includes: Gas Bloated, gas Excessive gas Distention due to gas Excludes: Gas pains (1545.1) 1590.0 Constipation 1595.0 Diarrhea Includes: Loose stools The runs 1600.0 Other symptoms or changes in bowel function 1600.1 Discharge in stools Includes: Mucus Pus 1600.2 Worms 1600.3 Changes in size, color, shape, or odor Includes: Bulky stools Too narrow Unusual odor or color 1600.4 Incontinence of stool Includes: Dirty pants (encopresis) Leaking stools 1605.0 Symptoms referable to anus-rectum 1605.1 Pain Includes: Burning Irritation 1605.2 Bleeding 1605.3 Swelling or mass 1605.4 Itching 1610.0 Symptoms of liver, gallbladder, and biliary tract 1610.1 Pain 1610.2 Jaundice Includes: Yellow eyes Yellow skin 1615.0 Other symptoms referable to digestive system Includes: Bad breath Halitosis Stomach problem Stomach trouble Hiccoughs Gastrointestinal distress Epigastric distress SYMPTOMS REFERABLE TO THE GENITOURINARY SYSTEM (1640-1829) 1640.0 Abnormalities of urine Excludes: Abnormal findings of urine tests (6200.0) 1640.1 Blood in urine (hematuria) 1640.2 Pus in urine 1640.3 Unusual color or odor 1645.0 Frequency and urgency of urination 1645.1 Excessive urination, night (nocturia) 1650.0 Painful urination Includes: Burning, discomfort 1655.0 Incontinence of urine (enuresis) 1655.1 Involuntary urination, can't hold urine, dribbling 1655.2 Bedwetting 1660.0 Other urinary dysfunctions 1660.1 Retention of urine Includes: Weak stream Can't urinate 1660.2 Hesitancy Includes: Difficulty in starting stream 1660.3 Large volume Includes: Polyuria 1665.0 Symptoms of bladder Includes: Bladder trouble 1665.1 Pain 1665.2 Infection 1670.0 Symptoms of the kidneys Includes: Kidney trouble 1670.1 Pain 1670.2 Infection 1675.0 Urinary tract infection, NOS Includes: Genitourinary infection Urine infection 1680.0 Other symptoms referable to urinary tract Includes: Passed stones Excludes: Kidney stones or bladder stones (2705.0) 1700.0 Symptoms of penis 1700.1 Pain, aching, soreness, tenderness, painful erection 1700.2 Infection, inflammation, swelling 1700.3 Lumps, bumps, growths, warts 1705.0 Penile discharge 1710.0 Symptoms of prostate Includes: Prostate trouble 1710.1 Swelling 1710.2 Infection 1715.0 Symptoms of the scrotum and testes 1715.1 Pain, aching, tenderness 1715.2 Swelling, inflammation 1715.3 Growths, warts, lumps, bumps 1715.4 Itching, jock itch 1720.0 Other symptoms of male reproductive system Excludes: Psychosexual problems (1160.0-1160.6) 1730.0 Absence of menstruation (amenorrhea) Excludes: Suspected pregnancy (3200.0) Missed a period (3200.0) Period late (3200.0) 1735.0 Irregularity of menstrual interval 1735.1 Frequent 1735.2 Infrequent 1735.3 Unpredictable 1740.0 Irregularity of menstrual flow 1740.1 Excessively heavy (menorrhagia) 1740.2 Scanty flow (oligomenorrhea) 1740.3 Abnormal material, including clots 1745.0 Menstrual symptoms, other and unspecified Includes: Long periods 1745.1 Premenstrual symptoms Includes: Premenstrual tension or irritability Bloating before periods 1745.2 Painful menstruation (dysmenorrhea) Includes: Menstrual cramps Pain in legs and back during menstruation 1750.0 Menopausal symptoms 1750.1 Early or late onset of menopause 1750.2 Vasomotor symptoms-hot flashes 1750.3 Emotional symptoms, change of life problems 1755.0 Uterine and vaginal bleeding Excludes: Bleeding during pregnancy (1790.2) 1755.1 Intermenstrual bleeding (metrorrhagia) Includes: Breakthrough bleeding Bleeding between periods 1755.2 Postmenopausal bleeding 1755.3 Postcoital bleeding, female 1760.0 Vaginal discharge Includes: Bloody, brown, white (leukorrhea), execssive 1765.0 Other vaginal symptoms 1765.1 Pain 1765.2 Infection 1765.3 Itching, burning 1770.0 Vulvar disorders 1770.1 Itching and irritation, swelling 1770.2 Mass, lump 1770.3 Growth, wart, cyst, ulcer, sore 1775.0 Pelvic symptoms 1775.1 Pain 1775.2 Pressure or dropping sensation Includes: Feeling of uterus falling out 1775.3 Infection, inflammation 1790.0 Problems of pregnancy Excludes: Routine prenatal visits (3205.0) 1790.1 Pain during pregnancy 1790.2 Spotting, bleeding during pregnancy 1790.3 Symptoms of onset of labor Includes: Water broke Ruptured membranes Labor pain, contractions 1791.0 Postpartum problems Includes: Bleeding Pain Excludes: Postpartum examination, routine (3215.0) 1795.0 Other symptoms referable to the female reproductive system Includes: Frequent miscarriage 1800.0 Pain or soreness of breast Includes: Tenderness 1805.0 Lump or mass of breast Includes: Bump Knot Nodule Cyst 1810.0 Other symptoms referable to breast 1810.1 Bleeding or discharge from nipple 1810.2 Postpartum problems Includes: Engorgement Postpartum infection Nursing difficulties 1810.3 Problems with shape or size Includes: Too large Too small Sagging Uneven development 1815.0 Symptoms of infertility Includes: Can't get pregnant Inability to conceive Sterility 1820.0 Hormone deficiency or problem 1825.0 Symptoms of sexual dysfunction Includes: Dyspareunia Painful intercourse Excludes: Psychological disorders (see 1160.0-1160.6) SYMPTOMS REFERABLE TO THE SKIN, NAILS, AND HAIR (1830-1899) 1830.0 Acne or pimples Includes: Bad complexion Blackheads Blemishes Breaking out Complexion, NOS Whiteheads 1835.0 Discoloration or pigmentation Includes: Freckles Blotches Redness Spots Circles under eyes Birthmark Excludes: Jaundice (1610.2) Bruise (see 5405.0-5430.0) Flushing (1280.3) Blushing (1280.3) 1840.0 Infections of skin, NOS Includes: Infected blister Excludes: Athlete's foot (2025.0) 1840.1 Infection of skin of head or neck area 1840.2 Infection of skin of arm, hand, or finger 1840.3 Infection of skin of leg, foot, or toe 1845.0 Symptoms of skin moles Includes: Skin mole, NOS 1845.1 Change in size or color 1845.2 Bleeding mole 1850.0 Warts, NOS Includes: Condyloma Condyloma acu