Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: INF09
MultiStage: No
DXCat Label: Cytomegalovirus Disease, (Acquired) Specificity: A
Etiology: Infection, Viral
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Cytomegalovirus disease of the salivary
glands
Cytomegalovirus isolated from saliva [tissue culture reports isolation of cytomegalovirus]
DX 0785;
1.02 Cytomegalovirus retinitis Cytomegalovirus infection [isolation of cytomegalovirus from serum or body fluids or urine from
tissue cultures or convalescent/acute cytomegalovirus serum antibody titers ≥ 4 increase]
STAGE 1.01 + DX 36300-36320;
AND retinitis [ophthalmoscopy report]
OR cotton wool spots [ophthalmoscopy report]
1.03 Cytomegalovirus retinitis with retinal Stage 1.01-1.02
STAGE 1.02 + DX 36281-36283;
hemorhages or infiltrates or disk edema AND retinal hemorrhages [ophthalmoscopy report]
OR sectoral infiltrates [ophthalmoscopy report]
OR optic disk edema [ophthalmoscopy report]
1.04 Cytomegalovirus retinitis with retinal Stage 1.01-1.03
STAGE 1.02-1.03 + (DX 36100-
detachment
AND rhegmatogenous retinal detachment [ophthalmoscopy report]
36107, 36181-3619);
OR iris neovascularization [ophthalmoscopy report]
2.01 with hepatitis Cytomegalovirus infection [isolation of cytomegalovirus from serum or body fluids or urine from
tissue cultures or convalescent/acute cytomegalovirus serum antibody titers > 4 fold increase]
AND hepatosplenomegaly [liver/spleen scan report or CT scan report or sonogram report]
AND hepatitis:
2.02 Cytomegalovirus mononucleosis Stage 2.01
AND lymphocytosis:
AND atypical lymphocytes [hematology report]
AND heterophil antibody test negative [hematology report]
2.03 with ulcers of the gastrointestinal tract Duodenal ulcers [endoscopy report]
OR gastric ulcers [endoscopy report]
OR esophageal ulcers [endoscopy report]
OR small intestinal ulcers [endoscopy report
OR colonic ulcers [endoscopy report]
AND cytomegalovirus tissue infection [biopsy or operative/pathology tissue culture report]
STAGE 1.01-1.04 + GROUP
HEPATITIS;
STAGE 1.01-2.01 + DX 075;
STAGE 1.01-2.02 + DX 53100-
53491;
2.04 with pneumonitis Stage 1.02-2.03
AND new interstitial infiltrate [chest x-ray report]
OR cytomegalovirus pneumonitis [biopsy or operative/pathology tissue culture report]
3.01 with glomerulopathy or renal failure Stage 1.02-2.04
AND renal failure:
STAGE 1.01 + DX 4841;
DX 4841;
STAGE 1.01-2.04 + (DX 58081,
58181, 58281, 58381 OR GROUP
REN_FAIL_ACU OR GROUP
REN_FAIL_CHR);
Thursday, January 07, 2010 9:22:22 AM
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