Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: EYE13
MultiStage: No
DXCat Label: Glaucoma Specificity: A
Etiology: Congenital; Genetic (or hereditary); Idiopathic
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Ocular hypertension Intraocular pressure ≥ 21 mmHg [tonometer report]
AND visual acuity ≥ 20/20
DX 36500, 36503-36504, 36531-
36532, 36551-36560, 36562-3659;
1.02 Glaucoma with scotoma or visual field
defects
Stage 1.01
AND cup/disk ratio ≥ 0.3
OR asymmetric cupping
AND arcuate or paracentral scotoma
AND visual acuity ≤ 20/40
1.03 Open angle glaucoma Normal ocular pressure
AND open angle [gonioscopy report]
2.01 Moderate glaucoma Stage 1.01
AND cup/disk ratio ≥ 0.5
AND visual field shows nasal step
AND visual acuity ≤ 20/40
2.02 Severe glaucoma Stage 1.01
AND cup/disk ratio ≥ 0.8
AND visual field limited to central vision
AND pale optic nerve head
2.03 Advanced glaucoma Stage 1.01
AND cup/disk ratio ≥ 0.8 [ophthalmoscopy report]
OR central field ≤ 20 degrees
AND pale optic nerve head [ophthalmoscopy report]
AND visual acuity ≤ 20/200 in either one or both eyes
2.04 Angle closure glaucoma Stage 1.03
AND closed or narrow angle
AND increased IOP > 21 mmHg [tonometer report]
AND ocular pain
OR nausea
OR headache
OR visual changes (halos)
STAGE 1.01 + DX 36840-36847;
DX 36510-36515, 36501, 36561;
STAGE 1.01-1.03 + (DX 36920-
36925, 3693, 36960-3699);
NO;
STAGE 1.01-2.02 + (DX 36900-
36908, 36910-36918, 3694);
DX 36042;
DX 36520-36524, 36502;
References:
Hoskins HD, Hetherington J. Developmental glaucomas. In: Duane TD, Jaeger EA, eds. Clinical Ophthalmology. Philadelphia, PA: Harper & Row; 1979, Vol. 3.
Migdel C. Primary open angle glaucoma. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. Philadelphia, PA: Lippencott-Raven; 1998.
Simons RB, Montenegro MH, Simons RJ, Migdel C. Primary angle closure glaucoma. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. Philadelphia, PA: Lippencott-Raven;
1998.
Thursday, January 07, 2010 9:21:36 AM
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