Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: GIS31
MultiStage: No
DXCat Label: Peptic Ulcer Disease Specificity: A
Etiology: Idiopathic; Infection, Bacterial
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Peptic ulcer without complications Peptic ulcer [endoscopy report or UGI series report]
OR Helicobacter pylori infection [breath test report or pathology report]
DX 04186, 53130, 53170, 53190,
53230, 53270, 53290, 53330,
53370, 53390, 53430, 53470,
53490, 5356, 56982;
2.01 with chronic bleeding Stage 1.01
AND anemia:
AND guaiac positive stools
DX 53140, 53240, 53340, 53440;
STAGE 1.01 + (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);
2.02 with obstruction Stage 1.01-2.01
AND gastric outlet obstruction [endoscopy report or UGI series report]
OR peptic ulcer with obstruction [operative/pathology report]
DX 53131, 53141, 53171, 53191,
53231, 53241, 53271, 53291,
53331, 53341, 53371, 53391,
53431, 53441, 53471, 53491;
2.03 with fistula formation Stage 1.01-2.02
AND peptic ulcers with fistula formation [operative/pathology report or EGD report]
2.04 with free perforation or acute hemorrhage Stage 1.01-2.03
AND peptic ulcers with perforation [operative/pathology report or UGI series report or KUB
reports free air under diaphragm]
OR acute hemorrhage [endoscopy report or angiography report]
OR bleeding:
STAGE 1.01-2.02 + (DX 5374,
56981);
DX 53100-53101, 53110-53111,
53120-53121, 53150-53151, 53160-
53161, 53200-53201, 53210-
53211, 53220-53221, 53250-
53251, 53260-53261, 53300-
53301, 53310-53311, 53320-
53321, 53350-53351, 53360-
53361, 53400-53401, 53410-
53411, 53420-53421, 53450-
53451, 53460-53461;
STAGE 1.01-2.03 + DX 5780-5789;
2.05 with generalized peritonitis Stage 1.01-2.04
AND generalized peritonitis [operative or pathology report]
3.01 with hypotension Stage 1.01-2.05
AND hypotension:
STAGE 1.01-2.04 + (DX 5672-
5679, 56983);
STAGE 1.01-2.05 + GROUP
HYPOTENSION;
Thursday, January 07, 2010 9:21:47 AM
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