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Data Source

Note that counts represent encounters of care and could be greater than the number of individual patients treated. One encounter may include multiple codes; indicators are not mutually exclusive.
Produced by the Kentucky Injury Prevention and Research Center, as bona fide agent for the Kentucky Department for Public Health, October 2020. Data source: Kentucky Outpatient Services Database and Kentucky inpatient hospitalization claims files, Cabinet for Health and Family Services, Office of Health Data and Analytics. Data are provisional and subject to change. This report was supported by Cooperative Agreement Number 6 NU17CE924971-02-01, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.

Definitions from ICD-10-CM Data

Emergency Department Nonfatal Overdoses

Emergency department (ED) nonfatal overdoses are drug overdoses that present in the ED, defined by any mention of those categorized codes in the discharge paperwork. See below for diagnosis codes.  For T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, a 5th character of the following—and for all other codes a 6th character of the following—is required:

1: Accidental (unintentional)
2: Intentional self-harm
3: Assault or
4: Undetermined intent.

Note: 5th or 6th characters of “5” (denoting adverse effect) or “6” (denoting underdosing) are excluded from overdose-related counts.

If present, a 7th character of “A” is required, indicating an initial encounter for active treatment.

Any Drug
T36–T50: Poisoning by drugs, medicaments, and biological substances

Any Opioid
T40.0X: Poisoning by opium
T40.1X: Poisoning by heroin
T40.2X: Poisoning by other opioids
T40.3X: Poisoning by methadone
T40.4X: Poisoning by synthetic narcotics
T40.60: Poisoning by unspecified narcotics and
T40.69: Poisoning by other narcotics

Heroin 
T40.1X: Poisoning by heroin

Non-Heroin Opioid
T40.0X: Poisoning by opium
T40.2X: Poisoning by other opioids
T40.3X: Poisoning by methadone
T40.4X: Poisoning by synthetic narcotics
T40.60: Poisoning by unspecified narcotics and
T40.69: Poisoning by other narcotics

Stimulant
T40.5X: Poisoning by cocaine
T43.60: Poisoning by unspecified psychostimulants
T43.61: Poisoning by caffeine
T43.62: Poisoning by amphetamines
T43.63: Poisoning by methylphenidate
T43.64: Poisoning by ecstasy and
T43.69: Poisoning by other psychostimulants

Cocaine 
T40.5X: Poisoning by cocaine

Non-Cocaine Stimulant
T43.60: Poisoning by unspecified psychostimulants
T43.61: Poisoning by caffeine
T43.62: Poisoning by amphetamines
T43.63: Poisoning by methylphenidate
T43.64: Poisoning by ecstasy and
T43.69: Poisoning by other psychostimulants

Also see Drug(s) with Potential for Abuse and Dependence and Infectious Disease, which are indicators in both ED and inpatient data.

Drug(s) with Potential for Abuse and Dependence

The Council of State and Territorial Epidemiologists’ (CSTE) Indicator 7 definition was used (see below for codes), except both ED and inpatient regular expressions take an “any mention” approach and scan all diagnosis codes included in discharge; the CSTE’s inpatient definition typically only scans the primary diagnosis code.

F11.1–F11.9: Opioid-related disorders
F12.1–F12.9: Cannabis-related disorders
F13.1–F13.9: Sedative-, hypnotic-, or anxiolytic related disorders
F14.1–F14.9: Cocaine-related disorders
F15.1–15.9: Other stimulant-related disorders
F16.1–F16.9: Hallucinogen-related disorders
F19.1–F19.9: Other psychoactive substance-related disorders
O99.32: Drug use complicating pregnancy, childbirth, and the puerperium
P04.4: Newborn suspected to be affected by maternal use of drugs of addiction
P96.1: Neonatal withdrawal symptoms from maternal use of drugs of addiction
T40.0–T40.9: Poisoning by narcotics and hallucinogens
T42.3: Poisoning by barbiturates
T42.4: Poisoning by benzodiazepines
T42.6: Poisoning by other antiepileptic and sedative-hypnotic drugs
T42.7: Poisoning by unspecified antiepileptic and sedative-hypnotic drugs and
T43.6: Poisoning by psychostimulants

For all T codes, adverse effects, underdosing, and encounters due to sequela are excluded.

Infectious Disease

Hepatitis A
B15.0: Hepatitis A with hepatic coma and
B15.9: Hepatitis A without hepatic coma

Hepatitis C
B17.10: Acute hepatitis C without hepatic coma
B17.11: Acute hepatitis C with hepatic coma
B18.2: Chronic viral hepatitis C
B19.20: Unspecified viral hepatitis C without hepatic coma
B19.21: Unspecified viral hepatitis C with hepatic coma and
Z22.52: Carrier of viral hepatitis C

Human Immunodeficiency Virus (HIV) Disease
B20: Human immunodeficiency virus (HIV) disease and
Z21: Asymptomatic human immunodeficiency virus (HIV) infection status

Endocarditis
B37.6: Candidal endocarditis
I33.0: Acute and subacute infective endocarditis
I33.9: Acute and subacute infective endocarditis, unspecified
I38: Endocarditis, valve unspecified
I39: Endocarditis and heart valve disorders in diseases classified elsewhere and
A32.82: Listerial endocarditis

Hepatitis A Comorbid to Drug Use
Any ICD-10-CM code found in Drug(s) with Potential for Abuse and Dependence AND one or more of the ICD-10-CM codes found in Hepatitis A.

Hepatitis C Comorbid to Drug Use 
Any ICD-10-CM code found in Drug(s) with Potential for Abuse and Dependence AND one or more of the ICD-10-CM codes found in Hepatitis C.

Human Immunodeficiency Virus (HIV) Disease Comorbid to Drug Use 
Any ICD-10-CM code found in Drug(s) with Potential for Abuse and Dependence AND one or more of the ICD-10-CM codes found in Human Immunodeficiency Virus (HIV) Disease.

Endocarditis Comorbid to Drug Use
Any ICD-10-CM code found in Drug(s) with Potential for Abuse and Dependence AND one or more of the ICD-10-CM codes found in Endocarditis.

Inpatient Hospitalizations

Also see Drug(s) with Potential for Abuse and Dependence and Infectious Disease, which are indicators in both ED and inpatient data.

Neonatal Abstinence Syndrome
Both codes must be present for an inpatient hospitalization to be counted. Also note that neonates are group by their year of BIRTH, not discharge (like all other patients). For example, an infant born with NAS at the end of 2019, but discharged in the first quarter of 2020, will be included in the 2019 count. Thus inpatient data from the first quarter of the year following the final was pulled to allow for those babies discharged later.

P96.1: Neonatal withdrawal symptoms from maternal use of drugs of addiction AND
Z38: Liveborn infant according to place of birth and type of delivery