Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: EYE14
MultiStage: No
DXCat Label: Herpes Virus Ocular Infection Specificity: A
Etiology: Infection, Viral
Stage Description Diagnostic findings ICD-9-CM Codes
1.01
1.02
Herpes keratitis or dendritic keratitis
with vision loss
Herpes keratitis or dendritic keratitis [corneal culture reports growth of pathologic organism(s) or
dendrites by fluorescein stain]
Stage 1.01
DX 05449;
STAGE 1.01 + (DX 3693, 3698,
AND visual acuity ≤ 20/70
3699);
OR ciliary flush [ophthalmoscopy report]
2.01 with trophic ulcer Stage 1.01-1.02
AND visual acuity ≤ 20/100
AND epithelial ulceration
OR stromal ulceration
OR stromal infiltrate
2.02 with stromal keratitis Stage 1.01-2.01
AND corneal necrosis with thinning
OR corneal perforation
2.03 with stromal scarring Stage 1.01-2.02
AND stromal scarring [ophthalmoscopy report]
2.04 Acute retinal necrosis syndrome Stage 1.01 - 2.03
AND anterior retinal necrosis
OR blurred vision
AND anterior chamber reaction [ophthalmoscopy report]
AND photophobia
2.05 Acute retinal necrosis syndrome with vision
loss
Stage 2.04
AND visual acuity ≤ 20/70
OR vitreitis [ophthalmoscopy report]
AND patchy white retinal infiltrates [ophthalmoscopy report]
OR retinal hemorrhages [ophthalmoscopy report]
AND macular edema [ophthalmoscopy report]
OR optic disk edema [ophthalmoscopy report]
STAGE 1.01-1.02 + (DX 36901-
36918, 36921-36925, 3694, 36960-
36976, 37301);
STAGE 1.01-2.01 + (DX 37000,
37006, 37140);
STAGE 1.01-2.02 + DX 37100;
STAGE 1.01-2.03 + (DX 3643,
3688) + DX 36813 + ( DX 36403,
36405);
STAGE 2.04 + DX 36901-3699;
STAGE 2.04 + (DX 36229 + (DX
36260-36263, 36265-36266,
36281)) + (DX 36283, 37700,
37703);
2.06 Acute retinal necrosis syndrome with
retinal detachment
Stage 2.04-2.05
AND retinal detachment [ophthalmoscopy report]
STAGE 2.04-2.05 + DXCAT EYE07;
References:
Fisher JP, Lewis ML, Blumenkrantz M, et al. The acute retinal necrosis syndrome. part I: clinical manifestations. Ophthalmology. 1982;(89)1309-1316.
O’Day DM, Jones BR. Herpes simplex keratitis. In: Duane TD, Jaeger EA, eds. Clinical Ophthalmology. Philadelphia, PA: Harper & Row; 1987:(4)19.
Thursday, January 07, 2010 9:21:36 AM
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