Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: GIS09
MultiStage: No
DXCat Label: Crohn's Disease Specificity: A
Etiology: Idiopathic
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Crohn's disease Crohn’s Disease [operative/pathology report]
DX 5550-5559;
OR patchy mucosal 'aphthoid' ulcerations with underlying nodules of lymphoid tissue or
granulomas later developing submucosal edema and further lymphoid infiltration
which eventually involve the entire bowel wall. There is lymphedema and thickening
of the surrounding mesentery and hypertrophy of local lymph nodes. Inevitably,
involved areas fibrose and are sharply demarcated from normal areas
[operative/pathology report]
Presumptive Diagnostic Findings:
Irregularity, thickening, nodularity and narrowing lumen of the bowel wall [barium enema
report or colonoscopy report or UGI series report]
2.01 with arthritis or involvement of the eyes or
involvement of the mouth or erythema
nodosum or pyoderma gangrenosum or
anemia or hypoproteinemia or growth
retardation or hypertropic osteoarthropathy
Stage 1.01
AND stomatitis
OR arthritis:
OR ankylosing spondylitis [chest x-ray report]
OR uveitis [ophthalmologist's report]
OR episcleritis [ophthalmologist's report]
OR erythema nodosum
OR red, tender nodules on the anterior tibial surface
OR pyoderma gangrenosum (rapidly evolving cutaneous ulcer(s) with markedly
undermined borders)
OR hypertrophic osteoarthropathy
OR anemia:
OR growth retardation
OR hypoproteinemia:
STAGE 1.01 + (DX 2632, 36400-
36404, 36410-36411, 3643, 37900,
37909, 68601, 6952, 70712-70719,
7078-7079, 7200, 7312, 7822,
78343 OR GROUP ANEM_DEF_B12
OR GROUP ANEM_DEF_FE OR
GROUP ANEM_DEF_FOL OR GROUP
ANEM_DEF_OTH OR GROUP
ANEM_OTH_CHR OR GROUP
ANEM_OTH_UN OR GROUP
ARTHR_OTH OR GROUP
HYPOPROTEIN);
2.02 with obstructive uropathy or biliary tract
stones
2.03 with entroenteric or enterovesical or
enterovaginal or enterocutaneous fistula
Stage 1.01-2.01
AND obstructive uropathy [IVP report or nuclear renogram report or sonogram reports
dilated ureters or hydronephrosis]
OR cholelithiasis or choledocholithiasis [oral cholecystogram report or HIDA scan
report or sonogram report or endoscopic retrograde cholangiopancreatography
report or CT scan report]
Stage 1.01-2.02
AND enteroenteric fistula [barium enema report or UGI series report]
OR nterovesical fistula [barium enema report or urinalysis reports fecaluria]
OR enterovaginal fistula [barium enema report or feces and flatus per vagina]
OR enterocutaneous fistula [barium enema report or feces and flatus per sinus tract]
STAGE 1.01-2.01 + (DX 57400-
57491, 591, 5934-5935, 5996-
59969);
STAGE 1.01-2.02 + (DX 56981,
5961, 6191);
Thursday, January 07, 2010 9:21:42 AM
©2010 Thomson Reuters. All rights reserved.