Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: ENT19
MultiStage: No
DXCat Label: Pharyngitis: Non-Streptococcal Specificity: A
Etiology: Infection
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Pharyngitis or tonsillitis Streptococcal infection of the pharynx [culture reports growth of pathologic organism(s)]
DX 462-463, 4650, 4721, 47400,
47402, 47410-47411;
2.01 with cervical suppurative adenitis Stage 1.01
AND cervical suppurative adenitis
2.02 with peritonsillar or retropharyngeal
abscess
Stage 1.01-2.01
AND peritonsillar or retropharyngeal abscess
2.03 with bronchopneumonia Stage 1.01-2.02
AND bronchopneumonia [chest x-ray report]
DX 47401, 47412;
STAGE 1.01 + (DX 2891, 2893,
683);
DX 475, 47821-47822, 47824,
47829;
STAGE 1.01-2.02 + (DX 4800-
4809, 4820-4822, 4824-4870);
2.04 with pharyngeal edema Stage 1.01-2.03
AND pharyngeal edema
3.01 with meningitis Stage 1.01-2.04
AND meningitis:
3.02 with sepsis Stage 1.01-3.01
AND sepsis:
3.03 with respiratory failure Stage 2.04-3.02
AND respiratory failure:
3.04 with shock Stage 1.01-3.03
AND shock:
4.00 with death Stage 2.02-3.04
AND death
STAGE 1.01-2.03 + DX 47825;
STAGE 1.01-2.04 + (DX 3201-3209
OR DXCAT NEU13);
STAGE 1.01-3.01 + DX 03810-0389;
STAGE 1.01-3.02 + GROUP
RESP_FAIL;
STAGE 1.01-3.03 + (GROUP
SHOCKC OR GROUP SHOCKN) ;
NO;
References:
Bisno AL. Acute pharyngitis: etiology and diagnosis. Pediatrics. 1996:97(6 Pt 2):949-54.
Chambers HF. Infectious diseases: bacterial and chlamydial. In: Tierney Jr LM, McPhee SJ Papadakis MA, eds. Current Medical Diagnosis & Treatment. Stamford, CT: Appleton
& Lange; 1998:1267-1268.
Jackler RK, Kaplan MJ. Ear, nose and throat. In: Tierney Jr LM, McPhee SJ Papadakis MA, eds. Current Medical Diagnosis & Treatment. Stamford, CT: Appleton & Lange;
1998:238-240.
Little PS, Williamson I. Are antibiotics appropriate for sore throats? Costs outweigh the benefits. BMJ. 1994:309(6960):1010-1.
Wessels MR. Streptococcal and enterococcal infections. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo, DL, eds. Harrison’s
Principles of Internal Medicine. 14th ed. New York. NY: McGraw-Hill; 1998:1197-1202.
Thursday, January 07, 2010 9:21:33 AM
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