Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: ENT07
MultiStage: No
DXCat Label: Hearing Loss due to Otosclerosis Specificity: A
Etiology: Degenerative
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Otosclerosis Ankylosis of the stapes by overgrowth of bone or otosclerosis [operative/pathology report]
DX 3870-3879;
OR history of hearing loss beginning in third decade of life
AND normal tympanic membrane
AND conductive hearing loss [physical examination via Rinne's or Weber's test]
OR threshold for conductive sound elevated ≥ 30 dB [audiometry report]
1.02 with unilateral mild hearing loss Hearing threshold > 21dB [audiogram report]
AND hearing threshold ≤ 40 dB [audiogram report]
1.03 with bilateral mild hearing loss Stage 1.01-1.02
AND involving both ears
1.04 with mild hearing loss and tinnitus Stage 1.01-1.03
AND tinnitus
1.05 with moderate hearing loss Stage 1.01
AND hearing threshold > 41dB [audiogram report]
AND hearing threshold ≤ 56 dB [audiogram report]
1.06 with bilateral moderate hearing loss Stage 1.05
AND involving both ears
1.07 with moderate hearing loss and tinnitus Stage 1.05-1.06
AND tinnitus
1.08 with moderately severe hearing loss Stage 1.01
AND hearing threshold > 56dB [audiogram report]
AND hearing threshold ≤ 70 dB [audiogram report]
1.09 with bilateral moderately severe hearing
loss
Stage 1.08
AND involving both ears
Stage 1.08-1.09
AND tinnitus
1.10 with moderately severe hearing loss and
tinnitus
1.11 with severe hearing loss Stage 1.01
AND hearing threshold > 71 [audiogram report]
AND hearing threshold ≤ 90 dB [audiogram report]
1.12 with bilateral severe hearing loss Stage 1.11
AND involving both ears
1.13 with severe hearing loss and tinnitus Stage 1.11-1.12
AND tinnitus
1.14 with profound hearing loss Stage 1.01
AND hearing threshold > 91 dB [audiogram report]
STAGE 1.01 + (DX 38900-38905,
38908, 38910, 38913, 38915,
38917, 38920-38921);
STAGE 1.01-1.02 + (DX 38906,
38911-38912, 38914, 38916,
38918, 38922);
STAGE 1.01-1.02 + DX 38830-
38832;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
NO;
Thursday, January 07, 2010 9:21:30 AM
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