Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: CVS11
MultiStage: Yes
DXCat Label: Coronary Artery Disease without Prior Coronary Revascularization Specificity: A
Etiology: Degenerative; Genetic (or hereditary)
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Old myocardial infarction or coronary Coronary atherosclerosis
(DX 41181, 412, 41400-41401,
atherosclerosis or chronic ischemic heart OR chronic ischemic heart disease
4142-4143, 4292) + NOT (DX
disease
OR history of myocardial infarction ≥ 30 days old
V4581, 41402-41407, 99603);
AND ejection fraction ≥ 50% [echocardiogram report
or nuclear ejection fraction report]
1.02 Chronic stable exertional angina Chronic stable exertional angina
(DX 4139, 4148-4149) + NOT (DX
V4581, 41402-41407, 99603);
2.01 Progressing angina pectoris or exertional
myocardial ischemia at low workload or old
myocardial infarction with low ejection
fraction
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
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 4110, 41189) + NOT (DX
V4581, 41402-41407, 99603);
DX 4131 + NOT (DX V4581, 41402-
41407, 99603);
STAGE 1.01-2.02 + (DX 4293,
42789 OR GROUP
CHF__NON_HTN);
(DX 4111, 4130) + NOT (DX
V4581, 41402-41407, 99603);
((DX 4111, 4130) + GROUP
CHF__NON_HTN) + NOT (DX
V4581, 41402-41407, 99603);
3.01 Acute inferior or posterior wall myocardial
infarction
Acute inferior or posterior wall myocardial infarction [EKG report or cardiac catheterization report]
AND CPK-MB ≥ normal [CPK isoenzyme report]
(DX 41020-41022, 41030-41032,
41040-41042, 41050-41052, 41060-
41062, 41070-41072, 41080-
41082, 41090-41092) + NOT (DX
V4581, 41402-41407, 99603);
Thursday, January 07, 2010 9:21:16 AM
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