Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: INF21
MultiStage: No
DXCat Label: Post-Polio Syndrome Specificity: A
Etiology: Infection, Viral
Stage Description Diagnostic findings ICD-9-CM Codes
2.01 Post-Polio Syndrome Post polio syndrome
DX 138, 73070-73079;
OR Past history of poliomyelitis with functional stability or recovery for ≥ ten years
DX 73070-73000;
AND decreased asymmetric muscle strength distribution
OR acute muscle atrophy
OR acute musculoskeletal pain
OR reduced exercise tolerance
OR poor sleep quality with sleep disruption and/or hypersomnalence
OR acute dysphagia
OR acute dysphonia
AND electrophysiologic features of acute denervation superimposed on chronic
denervation-reinnervation
2.02 with progressive nocturnal hypoventilation
or sleep apnea
2.03 with pulmonary hypertension or cor
pulmonale
Stage 1.01
AND nocturnal hypoventilation or sleep apnea [polysomnography report]
Stage 2.01-2.02
AND pulmonary hypertension:
STAGE 2.01 + (DX 78051, 78053,
78057, 32720, 32726);
STAGE 2.01-2.02 + GROUP
COR_PULMONAL;
STAGE 2.01-2.02 + (DX 4160,
4168);
3.01 with respiratory failure Stage 2.01-2.03
AND respiratory failure:
3.02 with shock Stage 2.01-3.01
AND shock:
STAGE 2.01-2.03 + GROUP
RESP_FAIL;
STAGE 2.01-3.01 + (GROUP
SHOCKC OR GROUP SHOCKN) ;
References:
Bartfeld H and Ma D. Recognizing post-polio syndrome. Hospital Practice. 1996;31:95-107.
Cohen JI. Enteroviruses and reoviruses/poliovirus. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo, DL, eds. Harrison’s Principles
of Internal Medicine, 14th ed. New York, NY: McGraw-Hill; 1998:1120-1121.
Hsu AA, Staats BA. Postpolio sequelae and sleep-related disordered breathing. Mayo Clinic Proceedings 1998;73:216-224.
Nolan P, Beeston P. Post polio syndrome. Australian Family Physician. 1997;26:1055-1059.
Thorsteinsson G. Management of postpolio syndrome. Mayo Clinic Proceedings 1997;72:627-638.
Thursday, January 07, 2010 9:22:26 AM
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