Zepbound
Example Question Scenarios
Summary: This logic checks the patient's record for an active diagnosis of obesity or overweight.
Parameters:
- Searches for the following ICD-10 diagnosis code(s): E66*, Z68.3*, Z68.4* (wildcard pattern)
- Searches for the following SNOMED code(s): 414916001
ICD-10
E66* (10 codes)
Code | Description |
|---|---|
E66.01 | Morbid (severe) obesity due to excess calories |
E66.09 | Other obesity due to excess calories |
E66.1 | Drug-induced obesity |
E66.2 | Morbid (severe) obesity with alveolar hypoventilation |
E66.3 | Overweight |
E66.811 | Obesity, class 1 |
E66.812 | Obesity, class 2 |
E66.813 | Obesity, class 3 |
E66.89 | Other obesity not elsewhere classified |
E66.9 | Obesity, unspecified |
Z68.3* (10 codes)
Code | Description |
|---|---|
Z68.30 | Body mass index [BMI] 30.0-30.9, adult |
Z68.31 | Body mass index [BMI] 31.0-31.9, adult |
Z68.32 | Body mass index [BMI] 32.0-32.9, adult |
Z68.33 | Body mass index [BMI] 33.0-33.9, adult |
Z68.34 | Body mass index [BMI] 34.0-34.9, adult |
Z68.35 | Body mass index [BMI] 35.0-35.9, adult |
Z68.36 | Body mass index [BMI] 36.0-36.9, adult |
Z68.37 | Body mass index [BMI] 37.0-37.9, adult |
Z68.38 | Body mass index [BMI] 38.0-38.9, adult |
Z68.39 | Body mass index [BMI] 39.0-39.9, adult |
Z68.4* (5 codes)
Code | Description |
|---|---|
Z68.41 | Body mass index [BMI] 40.0-44.9, adult |
Z68.42 | Body mass index [BMI] 45.0-49.9, adult |
Z68.43 | Body mass index [BMI] 50.0-59.9, adult |
Z68.44 | Body mass index [BMI] 60.0-69.9, adult |
Z68.45 | Body mass index [BMI] 70 or greater, adult |
SNOMED CT
Code | Description |
|---|---|
414916001 | Obesity (disorder) |
Summary: This logic checks the patient's record for a BMI greater than or equal to 30 on or before starting Zepbound treatment.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Confirms value is greater than or equal to 30.
Summary: This logic checks the patient's record for a BMI greater than or equal to 27 on or before starting Zepbound treatment.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Confirms value is greater than or equal to 27.
Summary: This logic checks the patient's record for weight-related comorbidities.
Parameters:
- Searches for the following ICD-10 diagnosis code(s): E78.0, E78.00, E78.01
- Searches for the following SNOMED code(s): 13644009, 238076009
- Searches for the following ICD-10 diagnosis code(s): I10
- Searches for the following SNOMED code(s): 38341003
- Searches for the following ICD-10 diagnosis code(s): E11* (expands to 87 codes)
- Searches for the following SNOMED code(s): 44054006
- Searches for the following ICD-10 diagnosis code(s): G47.3* (expands to 9 codes)
- Searches for the following SNOMED code(s): 73430006
ICD-10
E11* (87 codes)
Code | Description |
|---|---|
E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) |
E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma |
E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma |
E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma |
E11.21 | Type 2 diabetes mellitus with diabetic nephropathy |
E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication |
E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E11.3531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E11.3541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E11.3551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
E11.36 | Type 2 diabetes mellitus with diabetic cataract |
E11.37X1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
E11.37X2 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
E11.37X3 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
E11.37X9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication |
E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy |
E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy |
E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy |
E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication |
E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
E11.59 | Type 2 diabetes mellitus with other circulatory complications |
E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy |
E11.620 | Type 2 diabetes mellitus with diabetic dermatitis |
E11.621 | Type 2 diabetes mellitus with foot ulcer |
E11.622 | Type 2 diabetes mellitus with other skin ulcer |
E11.628 | Type 2 diabetes mellitus with other skin complications |
E11.630 | Type 2 diabetes mellitus with periodontal disease |
E11.638 | Type 2 diabetes mellitus with other oral complications |
E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma |
E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma |
E11.65 | Type 2 diabetes mellitus with hyperglycemia |
E11.69 | Type 2 diabetes mellitus with other specified complication |
E11.8 | Type 2 diabetes mellitus with unspecified complications |
E11.9 | Type 2 diabetes mellitus without complications |
E11.A | Type 2 diabetes mellitus without complications in remission |
SNOMED CT
Code | Description |
|---|---|
13644009 | Hypercholesterolemia (disorder) |
38341003 | Hypertensive disorder, systemic arterial (disorder) |
44054006 | Diabetes mellitus type 2 (disorder) |
73430006 | Sleep apnea (disorder) |
55822004 | Hyperlipidemia (disorder) |
Summary: This logic checks the patient's record for an active diagnosis of obesity or overweight.
Parameters:
- Searches for the following ICD-10 diagnosis code(s): E66*, Z68.3*, Z68.4*, Z68.27, Z68.28, Z68.29 (wildcard pattern)
- Searches for the following SNOMED code(s): 414916001
ICD-10
E66* (10 codes)
Code | Description |
|---|---|
E66.01 | Morbid (severe) obesity due to excess calories |
E66.09 | Other obesity due to excess calories |
E66.1 | Drug-induced obesity |
E66.2 | Morbid (severe) obesity with alveolar hypoventilation |
E66.3 | Overweight |
E66.811 | Obesity, class 1 |
E66.812 | Obesity, class 2 |
E66.813 | Obesity, class 3 |
E66.89 | Other obesity not elsewhere classified |
E66.9 | Obesity, unspecified |
Z68.3* (10 codes)
Code | Description |
|---|---|
Z68.30 | Body mass index [BMI] 30.0-30.9, adult |
Z68.31 | Body mass index [BMI] 31.0-31.9, adult |
Z68.32 | Body mass index [BMI] 32.0-32.9, adult |
Z68.33 | Body mass index [BMI] 33.0-33.9, adult |
Z68.34 | Body mass index [BMI] 34.0-34.9, adult |
Z68.35 | Body mass index [BMI] 35.0-35.9, adult |
Z68.36 | Body mass index [BMI] 36.0-36.9, adult |
Z68.37 | Body mass index [BMI] 37.0-37.9, adult |
Z68.38 | Body mass index [BMI] 38.0-38.9, adult |
Z68.39 | Body mass index [BMI] 39.0-39.9, adult |
Z68.4* (5 codes)
Code | Description |
|---|---|
Z68.41 | Body mass index [BMI] 40.0-44.9, adult |
Z68.42 | Body mass index [BMI] 45.0-49.9, adult |
Z68.43 | Body mass index [BMI] 50.0-59.9, adult |
Z68.44 | Body mass index [BMI] 60.0-69.9, adult |
Z68.45 | Body mass index [BMI] 70 or greater, adult |
SNOMED CT
Code | Description |
|---|---|
414916001 | Obesity (disorder) |
Summary: This logic checks the patient's record for an active prescription for Zepbound. It verifies that the medication was active on the patient's medication list for at least 14 days prior to the PA Initiation Request. This assumes that the current request is for a continuation of existing therapy rather than a new start.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Filters for medications with the following status: active
- Excludes searching for records within the following number of days prior to the PA Initiation Request: 14
Summary: This logic verifies the patient is 18 years of age or older.
Parameters:
- Uses the following unit of measurement: a
- Confirms value is greater than or equal to: 18
Summary: This logic checks the patient's record for active GLP-1 agonists to identify overlapping therapy.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Filters for medications with the following status: active
Summary:
This logic checks that the prescribed medication meets quantity limits. The rule is satisfied if the daily usage or prescribed quantity is within specified limit.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Validates that the quantity does not exceed the following: 0.08 milliliters (NCIt code: C28254 - Milliliter), 0.16 per unit (NCIt code: C64933 - Each)
- Validates that the quantity does not exceed the following: 0.096 milliliters (NCIt code: C28254 - Milliliter), 0.04 per unit (NCIt code: C64933 - Each), 2.4 milliliters (NCIt code: C28254 - Milliliter), 1 per unit (NCIt code: C64933 - Each)
- Validates that the quantity does not exceed the following: 2 milliliters (NCIt code: C28254 - Milliliter), 4 per unit (NCIt code: C64933 - Each)
Refer to the ZEPBOUND® Prescribing Information for complete product details, including indications, dosing, contraindications, warnings, and adverse reactions.