Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: CVS10
MultiStage: Yes
DXCat Label: Coronary Artery Disease with Prior Coronary Revascularization Specificity: A
Etiology: Degenerative; Genetic (or hereditary)
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Coronary atherosclerosis or asymptomatic
chronic ischemic heart disease or old
myocardial infarction
1.02 Chronic stable exertional angina or chronic
ischemic heart disease
2.01 Progressing angina pectoris or exertional
myocardial ischemic at low workload or old
myocardial infarction with low ejection
fraction
Coronary atherosclerosis
OR asymptomatic chronic ischemic heart disease
OR old myocardial infarction
OR history of myocardial infarction ≥ 30 days old
AND ejection fraction ≥ 50% [echocardiogram report or
nuclear ejection fraction report]
Chronic stable exertional angina
OR chronic ischemic heart disease
Progressing angina pectoris
OR exercise induced myocardial ischemia at < 6 METS [stress test report]
OR history of prior myocardial infarction ≥ 30 days
AND left ventricular ejection fraction < 50% [echocardiogram report or nuclear
ejection fraction report]
AND left ventricular ejection fraction ≥ 30% [echocardiogram report or nuclear
ejection fraction report]
2.02 Prinzmetal's variant angina Anginal pain
AND ST-T elevations at time of pain [EKG report]
2.03 Angina with hypertrophy or akinesia or
dyskinesia or S3 gallop or S4 gallop
Stage 1.01-2.02
AND hypertrophy [nuclear ejection fraction report or echocardiogram report]
OR akinesia [nuclear ejection fraction report or echocardiogram report]
OR hypokinesia [nuclear ejection fraction report or echocardiogram report]
OR dyskinesia [nuclear ejection fraction report or echocardiogram report]
OR S4 gallop
OR S3 gallop
DX V4581, 99603, 41402-41407;
(DX 41181, 412, 41400-41401,
4142-4143, 4292) + (DX V4581,
41402-41407, 99603);
(DX 4139, 4148-4149) + (DX
V4581, 41402-41407, 99603);
(DX 4110, 41189) + (DX V4581,
41402-41407, 99603 );
DX 4131 + (DX V4581, 41402-
41407, 99603);
STAGE 1.01-2.02 + (DX 4293,
42789 OR GROUP
CHF__NON_HTN);
2.04 Unstable angina pectoris Stage 1.01-2.03
AND change in nature of onset of symptoms and severity of known anginal pain
AND past history of angina
OR angina occurring at rest
(DX 4111, 4130) + (DX V4581,
41402-41407, 99603) ;
(DX 4111, 4130) + (DX V4581,
41402-41407, 4142, 99603) +
GROUP CHF__NON_HTN;
3.01 Acute inferior or posterior wall myocardial
infarction
3.02 Acute inferior or posterior wall myocardial
infarction with heart block or pericarditis
Acute inferior or posterior wall myocardial infarction [EKG report or cardiac catheterization report]
AND CPK-MB ≥ normal [CPK isoenzyme report]
Stage 3.01
AND heart block [EKG report]
OR pericarditis [EKG report]
DX 41020-41092 + (DX V4581,
41402-41407, 99603);
STAGE 3.01 + (DX 42090-42099,
4260-4269);
Thursday, January 07, 2010 9:21:16 AM
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