Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: ENT18
MultiStage: No
DXCat Label: Otitis Media Specificity: A
Etiology: Infection
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Otitis media with serous effusion History of upper respiratory tract infection
DX 38110-3814, 3829;
AND hearing loss:
AND air/fluid level in ear drum
OR serous effusion from middle ear
1.02 Acute otitis media Stage 1.01
DX 38100-38106, 38200, 38202;
AND earache
AND erythema of tympanic membrane
AND decrease mobility of tympanic membrane
1.03 with persistent effusion Stage 1.01-1.02
NO;
AND effusion persists > 12 weeks
1.04 Recurrent acute otitis media Stage 1.01-1.02
NO;
AND acute otitis media episodes ≤ 6 months
OR more than 4 acute otitis media episodes yearly
2.01 with spontaneous perforation Stage 1.01-1.03
AND spontaneous perforation
2.02 Chronic suppurative otitis media Stage 1.01-2.01
AND drainage or otorrhea from ear ≥ 6 week period
2.03 with cholesteatoma Stage 1.01-2.02
AND cholesteatoma
2.04 with labyrinthitis Stage 1.01-2.03
AND nystagmus
OR dizziness
OR vertigo
2.05 with mastoiditis Stage 1.01-2.04
AND mastoiditis [operative/pathology report or mastoid air cells culture reports growth of
pathologic organism(s) or CT scan or mastoid x-ray report]
2.06 with facial nerve paralysis Stage 1.01-2.05
AND paralysis of one side of the face
2.07 with petrositis Stage 1.01-2.06
AND petrositis [operative/pathology report]
OR growth of pathologic organism(s) [bone culture report]
OR osteomyelitis [bone scan or MRI x-ray report ]
DX 38201;
STAGE 1.01-1.02 + DX 38420-
38425;
DX 3821-3824;
STAGE 1.01-2.02 + DXCAT ENT01;
STAGE 1.01-2.03 + DXCAT ENT08;
STAGE 1.01-2.04 + DX 38300-3831;
STAGE 1.01-2.05 + DX 3510;
STAGE 1.01-2.06 + DX 38320-
38322;
3.01 with meningitis Stage 1.01-2.07
AND meningitis:
STAGE 1.01-2.07 + (GROUP
MENGIT__BACT OR GROUP
MENING__VIR);
Thursday, January 07, 2010 9:21:32 AM
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