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Disease staging: CliniCal anD CoDeD Criteria - HCUP

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Clinical <strong>Criteria</strong> with Description, Diagnostic Findings and ICD-9-CM codes<br />

DXCat Number: EYE35<br />

MultiStage: No<br />

DXCat Label: Trachoma Specificity: A<br />

Etiology: Infection<br />

Stage Description Diagnostic findings ICD-9-CM Codes<br />

0.00 Screening exam for trachoma<br />

DX V736;<br />

1.01 Trachoma with immature tarsal conjunctiva Immature follicles on upper tarsal conjunctiva without scarring<br />

DX 0760, 0769;<br />

follicles<br />

OR diffuse punctate keratitis<br />

OR corneal neovascularization<br />

AND Chlamydia trachomatis conjunctivitis [conjunctiva culture reports serotype A,B,Ba or C]<br />

OR granular cytoplasmic inclusion bodies [Giemsa stain epithelial conjunctival scraping<br />

report]<br />

OR MacCallan Stage I trachoma<br />

1.02 with mature tarsal conjunctiva follicles Mature follicles on upper tarsal conjunctiva without scarring<br />

AND Chlamydia trachomatis conjunctivitis [conjunctiva culture report]<br />

OR granular cytoplasmic inclusion bodies [Giemsa stain epithelial conjunctival scraping<br />

report]<br />

OR MacCallan Stage IIa trachoma<br />

1.03 with papillary hypertrophy Stage 1.01-1.02<br />

AND papillary hypertrophy<br />

OR MacCallan Stage IIb trachoma<br />

2.01 with tarsal conjunctival scarring Stage 1.01-1.03<br />

AND tarsal conjunctival scarring<br />

OR Herbert’s pits<br />

OR MacCallan Stage III trachoma with follicles - superior scaring<br />

OR MacCallan Stage IV trachoma without follicles - extensive scaring<br />

2.02 with reduced vision or corneal scars or<br />

trichiasis or entropion<br />

Stage 1.01-2.01<br />

AND vision ≤ 20/200<br />

OR corneal scars<br />

OR trichiasis<br />

OR entropion<br />

DX 0761;<br />

STAGE 1.01-1.02 + DX 37430;<br />

STAGE 1.01-1.03 + DX 37264;<br />

STAGE 1.01-2.01 + (DX 36900-<br />

36918, 36921-36922, 3693-36969,<br />

36970-36973, 37100-37104, 37400-<br />

37405);<br />

DX 1391;<br />

References:<br />

Dawson CR. Follicular conjunctivitis. In: Duane TD, Jaeger EA, eds. Clinical Ophthalmology. Philadelphia, PA: Harper & Row; 1979:(4)9.<br />

Thursday, January 07, 2010 9:21:39 AM<br />

©2010 Thomson Reuters. All rights reserved.

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