Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: INF12
MultiStage: No
DXCat Label: Histoplasmosis Specificity: A
Etiology: Infection
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Acute histoplasmosis New infiltrate [chest x-ray report]
DX 11500, 11509-11510, 11519-
AND Histoplasma infected sputum (gram stain documents presence of many WBC and
Histoplasma spp. by special stain or sputum culture reports growth of Histoplasma spp.)]
11590, 11599;
OR histoplasmin titer ≥ 1:32 [RIA or ELISA serology report]
OR histoplasmosis [compliment fixation serology report shows > 4 fold increase in
baseline titer]
OR histoplasmin urine antigen [serology report]
1.02 Histoplasma choroiditis History of residence in endemic area
OR history of systemic histoplasmosis
AND yellow-white spot in macular region [ophthalmoscopy report]
1.03 Histoplasma choroiditis with reduced vision Stage 1.01-1.02
AND vision ≤ 20/70
OR choroidal atrophic scars in macular region [ophthalmoscopy report]
OR choroidal atrophic scars in peripapillary region [ophthalmoscopy report]
OR choroidal atrophic scars in mid-peripheral region [ophthalmoscopy report]
1.04 Histoplasma choroiditis with active Stage 1.03
subretinal neovascularization
AND subretinal fluid [ophthalmoscopy report]
OR retinal hemorrhage [ophthalmoscopy report]
OR retinal exudates adjacent to choroidal scar [ophthalmoscopy report]
1.05 Histoplasma choroiditis with inactive Stage 1.04
subretinal neovascularization
AND atrophic chorioretinal scar [ophthalmoscopy report]
OR fibrotic subretinal scar [ophthalmoscopy report]
2.01 Mucocutaneous histoplasmosis Stage 1.01-1.05
AND skin ulcerations
OR oropharyngeal lesions
OR laryngeal lesions
2.02 with cavitary pneumonia Stage 1.01-2.01
AND cavitation or granuloma [chest x-ray report]
2.03 with hepatosplenomegaly Stage 1.01-2.02
AND hepatomegaly [physical examination or liver-spleen scan report or CT scan report or
sonogram report]
OR
2.04 with adrenal insufficiency Stage 1.01-2.03
AND adrenal insufficiency:
splenomegaly [physical examination or liver-spleen scan report or CT scan report
or sonogram report]
DX 11502, 11512, 11592;
STAGE 1.02 + GROUP BLINDNESS;
STAGE 1.02-1.03 + (DX 36216,
36281-36282);
STAGE 1.02-1.04 + (DX 36330,
36332-36335);
STAGE 1.01-1.05 + (DX 47829,
47879, 70710-7079);
DX 11505, 11515, 11595;
STAGE 1.01-2.02 + (DX 5718,
7891-7892);
STAGE 1.01-2.03 + DXCAT END01;
Thursday, January 07, 2010 9:22:23 AM
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