ICD-9 ICD-10 Avoidable Emergency Room Visits

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In July 2007, the Medi-Cal Managed Care Division of the California Department of Health Care Services (DHCS) initiated a statewide collaborative Quality Improvement Project (QIP) with all contracted managed care plans (plans) focused on reducing avoidable emergency room (ER) visits among Medi-Cal managed care beneficiaries. This dataset showcases this avoidable emergency room (ER) visits.


“Avoidable” ER visits are defined as visits with a primary diagnosis that match the diagnosis codes selected by the ER collaborative. This list does not include all possible avoidable visit codes. Many additional diagnosis codes could also represent avoidable visits, but were not selected by the collaborative. The rate of avoidable ER visits used in Measure II represents the percentage of all ER visits that match the selected “avoidable” diagnosis codes.
The collaborative defined an avoidable ER visit as a visit which could have been more appropriately managed and/or referred to a primary care provider in an office or clinic setting. As part of DHCS’ s contract requirements in the area of quality assurance, all contracted plans, with the exception of specialty plans, are required to participate in DHCS’s Statewide Collaborative QIP (collaborative).

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United States


John Snow Labs; California Department of Healthcare Service;

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ER Cost, CAE Means, US Healthcare, Utilization Rate, Avoidable Costs, ICD 10 Codes List, ICD 10 Procedure Code, ICD 10 Codes, ICD Codes

Other Titles

Avoidable ER Cost Visits, Avoidable Emergency Room Visits CAE Means, Avoidable Emergency Room Visits US Healthcare, Avoidable Emergency Room Visits Utilization Rate, Avoidable Costs Emergency Room Visits

ICD9The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is the U.S. health system's adaptation of international ICD-9 standard list of six-character alphanumeric codes to describe diagnoses. Standardizing codes improves consistency among physicians in recording patient symptoms and diagnoses for the purposes of payer claims reimbursement and clinical research.stringmaxLength : 6 unique : 1 required : 1
ICD10The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.stringrequired : 1 maxLength : 7
Long_DescriptionLong (full line / sentence) description of the codestringrequired : 1
Short_DescriptionShortened, fixed length description of the codestringrequired : 1
133.8B88.0Other acariasisAcariasis NEC
595.0N30.00Acute cystitisAcute cystitis
466.0J20.9Acute bronchitisAcute bronchitis
472.0J31.0Chronic rhinitisChronic rhinitis
595.81N30.80Cystitis cysticaCystitis cystica
595.9N30.90Cystitis, unspecifiedCystitis NOS
724.5M54.89Backache, unspecifiedBackache NOS