Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: CVS14
MultiStage: No
DXCat Label: Infective Endocarditis Specificity: A
Etiology: Infection
Stage Description Diagnostic findings ICD-9-CM Codes
3.01 Infective endocarditis Infective endocarditis:
DX 4210-4219, 42491;
3.02 with glomerulonephritis Stage 3.01
STAGE 3.01 + DX 58081;
AND hematuria:
AND proteinuria:
AND azotemia:
3.03 with renal failure Stage 3.01-3.02
AND renal failure:
3.04 with pulmonary embolism Stage 3.01-3.03
AND pulmonary embolism:
3.05 with transient cerebral ischemic attacks Stage 3.01-3.04
3.06 with myocarditis or myocardial abscess or
valve obstruction or prosthetic valve
dehiscence or acute mitral valve
regurgitation or acute aortic valve
regurgitation
AND
AND
transient ischemic attack [no new infarct or normal per CT scan report]
sudden onset of one of the following, with resolution within 24 hours:
cranial nerve palsy:
Stage 3.01-3.05
AND myocarditis:
OR myocardial abscess [ myocardial biopsy report]
OR valve obstruction [sonogram report or operative/pathology
report]
OR prosthetic valve dehiscence [sonogram report or operative/pathology
report]
OR acute mitral valve regurgitation
OR acute aortic valve regurgitation
STAGE 3.01-3.02 + (GROUP
REN_FAIL_ACU OR GROUP
REN_FAIL_CHR);
STAGE 3.01-3.03 + GROUP
PULMEMB;
STAGE 3.01-3.04 + (DX 4350-4359
OR GROUP CRAN_NRV_PAL OR
GROUP BLINDNESS);
STAGE 3.01-3.05 + (DX 4220,
42290, 42292, 42299, 4240, 4241,
99602, 99661);
DX 4220;
3.07 with meningitis or intracranial abscess or
intracranial infarction or intracranial
hemorrhage
Stage 3.01-3.06
AND intracranial infarction [CT scan or MRI report]
OR intracranial hemorrhage [CT scan or MRI report]
OR intracranial abscess [CT scan or MRI report]
OR meningitis:
3.08 with congestive heart failure Stage 3.01-3.07
AND congestive heart failure:
3.09 with sepsis Stage 3.01-3.08
AND sepsis:
3.10 with respiratory failure Stage 3.01-3.09
AND respiratory failure:
3.11 with shock Stage 3.01-3.10
AND shock:
STAGE 3.01-3.06 + (DX 3240, 430-
4329, 43411, 43491 OR GROUP
MENGIT__BACT);
STAGE 3.01-3.07 + GROUP
CHF__NON_HTN;
STAGE 3.01-3.08 + GROUP SEPSIS;
STAGE 3.01-3.09 + GROUP
RESP_FAIL;
STAGE 3.01-3.10 + GROUP
SHOCKN;
Thursday, January 07, 2010 9:21:17 AM
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