This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having attention deficit hyperactivity disorder (ADHD) or other conduct disorders as of the end of the calendar year.
The CCW’s other chronic or potentially disabling condition variables require enrollees to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (FFS Medicare Part A and Part B coverage during the entire specified time period).
For ADHD and other conduct disorders, beneficiaries must have at least one inpatient claim or two other non-drug claims of any service type with a related code in any position during the 2-year reference period. When 2 claims are required, they must occur at least one day apart. You can find more detailed information on the algorithm criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
Source: CCW (derived)
|0||Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS)
|1||Beneficiary met claims criteria but did not have sufficient FFS coverage|
|2||Beneficiary did not meet claims criteria but had sufficient FFS coverage|
|3||Beneficiary met claims criteria and had sufficient FFS coverage|