Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: HEP12
MultiStage: Yes
DXCat Label: Pancreatitis Specificity: A
Etiology: Toxicologic
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Pancreatitis with pancreatic insufficiency History of ≥ 1 previous episode of acute pancreatitis
DX 5771, 5778;
OR calcification in pancreas [plain abdomen x-ray report or CT scan report]
AND pancreatic insufficiency:
1.02 with pancreatic pseudocyst Stage 1.01
STAGE 1.01 + DX 5772;
AND pancreatic pseudocyst [sonogram report or operative/pathology report]
1.03 Acute pancreatitis Pancreatitis [operative/pathology report or CT scan report or sonogram report or KUB x-ray report] DX 5770;
OR serum amylase ≥ 163 u/l [chemistry report]
OR serum p-type isoamylasemia [chemistry report]
AND serum lipase ≥ 200 u/l [ chemistry report]
OR sentinel loop [plain abdomen x-ray report]
OR edema of the pancreas [sonogram or CT scan report]
1.04 Acute and Chronic pancreatitis Stage 1.01-1.03
AND history of ≥ 1 episode of acute pancreatitis
2.01 with ascites Stage 1.01-1.04
AND ascites [sonogram report]
OR shifting dullness
2.02 Fulminant pancreatitis Stage 1.01-1.04
AND age ≥ 55 years old
OR serum glucose ≥ 200 mg/dl [chemistry report]
OR serum LDH ≥ 350 mg/dl [chemistry report]
OR SGOT ≥ 250 u/l [ chemistry report]
OR WBC ≥ 16,000/mm 3 [ complete blood count report]
OR hematocrit decrease ≥ 10% within 48 hours [ hematology report]
OR BUN increase ≥ 5 mg/dl within 48 hours [ chemistry report]
OR serum calcium ≤ 8 mg/dl within 48 hours[ chemistry report]
OR hypoxemia: within 48 hours
OR base deficit ≥ 4 mEq/L within 48 hours [ ABG report]
OR estimated fluid sequestration ≥ 6 liters within 48 hours
DX 5770 + DX 5771;
STAGE 1.01-1.04 + (DX 7895,
78959);
STAGE 1.03-2.01 + AGE 55-124 +
(GROUP HYPOXEMIA OR GROUP
HYPOCALCEMIA);
Thursday, January 07, 2010 9:22:18 AM
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