Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: HEP03
MultiStage: No
DXCat Label: Disorders of Bilirubin Excretion Specificity: A
Etiology: Congenital; Genetic (or hereditary)
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Familial recurrent cholestasis or cholestasis Cholestasis [liver biopsy report]
DX 75161;
of pregnancy
AND family history of cholestasis
OR pregnant
AND alkaline phosphatase ≥ 143 u/l [chemistry report]
1.02 Gilbert's syndrome Unconjugated serum bilirubin ≥ 2 mg/dl [chemistry report]
AND unconjugated serum bilirubin ≤ 5 mg/dl [chemistry report]
AND SGOT ≤ 60 iu/l [chemistry report]
AND SGPT ≤ 60 iu/l [chemistry report]
OR GGT ≤ 38 u/l [chemistry report]
AND serum haptoglobin ≥ 50 mg/dl [chemistry report]
1.03 Dubin-Johnson Conjugated serum bilirubin ≥ 2 mg/dl [chemistry report]
AND deeply pigmented liver [biopsy report]
AND urine coproporphyrin ≥ 200 ug/24 hours [urine chemistry report]
1.04 Rotor's Conjugated serum bilirubin ≥ 2 mg/dl [chemistry report]
AND normal liver [biopsy report]
AND urine coproporphyrin ≥ 200 ug/24 hours [urine chemistry report
2.01 Type II Crigler-Najjar Glucuronyl transferase deficiency [biopsy report or chemistry report]
AND total serum bilirubin ≤ 20 mg/dl [chemistry report]
AND total serum bilirubin ≥ 1.225 mg/dl [chemistry report]
OR bile bilirubin ≥ 10 mg/dl [chemistry report]
2.02 Type I Crigler-Najjar Glucuronyl transferase deficiency [biopsy report or chemistry report]
OR colorless bile
AND total serum bilirubin ≥ 20 mg/dl [chemistry report]
OR bile bilirubin ≤ 10 mg/dl [chemistry report]
3.01 with kernicterus Stage 1.01-2.02
AND lethargy
OR poor feeding
OR opisthotonos
OR oculogyric crisis
OR seizures
AND total serum bilirubin ≥ 10 mg/dl [chemistry report]
DX 2774;
NO;
NO;
NO;
NO;
STAGE 1.01-1.02 + (DX 37887,
7747, 7790, 78032, 78039, 78079,
7810, 7961, 77931-77934);
3.02 with hepatic coma Stage 1.01-3.01
AND hepatic coma:
OR acute hepatic necrosis [operative or pathology report]
3.03 with shock Stage 1.01-3.02
AND shock:
STAGE 1.01-3.01 + (GROUP
COMA__HEP OR DX 570);
STAGE 1.01-3.02 + (GROUP
SHOCKC OR GROUP SHOCKN) ;
Thursday, January 07, 2010 9:22:16 AM
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