Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: ENT05
MultiStage: No
DXCat Label: Hearing Loss due to Acoustic Trauma Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Unilateral mild hearing loss secondary to Hearing threshold > 21dB [audiogram report]
DX 38810-38812;
acoustic trauma
AND hearing threshold ≤ 40 dB [audiogram report]
1.02 Bilateral mild hearing loss secondary to Stage 1.01
STAGE 1.01 + DX 31534;
acoustic trauma
AND involving both ears
1.03 Mild hearing loss secondary to acoustic
trauma with tinnitus
1.04 Moderate hearing loss secondary to
acoustic trauma
1.05 Bilateral moderate hearing loss secondary
to acoustic trauma with tinnitus
1.06 Moderate hearing loss secondary to
acoustic trauma with tinnitus
1.07 Moderately severe hearing loss secondary
to acoustic trauma
1.08 Bilateral moderately severe hearing loss
secondary to acoustic trauma
1.09 Moderately severe hearing loss secondary
to acoustic trauma with tinnitus
1.10 Severe hearing loss secondary to acoustic
trauma
1.11 Bilateral severe hearing loss secondary to
acoustic trauma
1.12 Severe hearing loss secondary to acoustic
trauma with tinnitus
1.13 Profound hearing loss secondary to
acoustic trauma
1.14 Bilateral profound hearing loss secondary
to acoustic trauma
1.15 Profound hearing loss secondary to
acoustic trauma with tinnitus
Stage 1.01-1.02
AND tinnitus
Hearing threshold > 41dB [audiogram report]
AND hearing threshold ≤ 56 dB [audiogram report]
Stage 1.04
AND involving both ears
Stage 1.04-1.05
AND tinnitus
Hearing threshold > 56dB [audiogram report]
AND hearing threshold ≤ 70 dB [audiogram report]
Stage 1.07
AND involving both ears
Stage 1.07-1.08
AND tinnitus
Hearing threshold > 71 [audiogram report]
AND hearing threshold ≤ 90 dB [audiogram report]
Stage 1.10
AND involving both ears
Stage 1.10-1.11
AND tinnitus
Hearing threshold > 91 dB [audiogram report]
Stage 1.13
AND involving both ears
Stage 1.14-1.15
AND tinnitus
STAGE 1.01 + DX 38830-38832;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
Thursday, January 07, 2010 9:21:29 AM
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