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This variable is contained in the following files:
SAS Name
BPH
This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for benign prostatic hyperplasia as of the end of the calendar year.
ResDAC Comments
From CY 2017 to CY 2021, the MBSF: Chronic Conditions segment also has a previous (CC27) version. The algorithm used to create the Benign Prostatic Hyperplasia End-of-Year Indicator variable in the CC27 version includes more DX codes and a reduced reference period.
| Code | Code value |
|---|---|
| 0 | Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage |
| 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 |
The CCW’s chronic condition indicator variables require beneficiaries to satisfy both claims criteria (a minimum number/type of claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (FFS Part A and Part B coverage during the entire specified time period).
For benign prostatic hyperplasia, beneficiaries must have at least one inpatient, skilled nursing facility (SNF), or home health claim, or two Part B (institutional or non-institutional) claims that are at least one day apart, with a benign prostatic hyperplasia code in any position during the two-year reference period. If any qualifying claim also has a diagnosis code for benign neoplasm (of the prostate), then it is excluded from this indicator. Refer to the coding algorithm for details.
You can find more detailed information on the algorithm criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories-chronic
Source: CCW (derived)