Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: MUS18
MultiStage: No
DXCat Label: Fracture, Dislocation, or Sprain: Facial Bones Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Sprain or dislocation, face and neck area Sprain or dislocation, face and neck area
DX 8300, 8480-8482;
1.02 Fracture of facial bones without
displacement of bones
Fracture of the maxilla without bony displacement [x-ray report]
DX 8020, 80220-80229, 8024,
8028;
1.03 Fracture of the lower third of the maxilla Fracture of the lower third of the maxilla with displacement [x-ray report]
NO;
with displacement
OR LeFort type I fracture [x-ray report]
OR horizontal segment fracture of the alveolar process of the maxilla where the teeth are
contained in the detached bony segment [x-ray report]
OR Guérin’s fracture [x-ray report]
OR horizontal maxillary fracture [x-ray report]
1.04 Fracture of the middle third of the maxilla
with displacement
1.05 Fracture of the upper third of the maxilla
with displacement
Fracture of the middle third of the maxilla with displacement [x-ray report]
OR LeFort type II fracture [x-ray report]
OR unilateral or bilateral fracture of the maxilla where the body of the maxilla is separated from
the facial skeleton and the separated portion is pyramidal in shape and extends through
the body of the maxilla to the hard palate, through the floor of the orbit and into the nasal
cavity [x-ray report]
OR pyramidal fracture [x-ray report]
Fracture of the upper third of the maxilla with displacement [x-ray report]
OR LeFort type III fracture [x-ray report]
OR the entire maxilla and facial bones are completely separated from the craniofacial skeleton
[x-ray report]]
OR craniofacial displacement [x-ray report]
OR transverse facial fracture [x-ray report]
NO;
NO;
2.01 Open dislocation or fracture of facial bones Fracture or dislocation of facial bones [x-ray report]
AND laceration of overlying skin
2.02 with ruptured ocular globe Stage 1.02-2.01
AND ruptured ocular globe [CT scan report]
2.03 Closed fracture of larynx or trachea Fracture of larynx or trachea [cervical x-ray, MRI or CT scan report]
2.04 Open fracture of larynx or trachea Fracture of larynx or trachea
AND laceration of overlying skin
2.05 with intracranial injury Stage 1.02-2.04
AND cerebrospinal fluid rhinorrhea
OR cerebrospinal fluid otorrhea
OR intracranial bleeding [CT scan or MRI report]
OR intracranial contusion [CT scan or MRI report]
DX 8301, 8021, 80230-80239,
8025, 8029;
STAGE 1.01-2.01 + DX 8710-8712;
DX 8075;
DX 8076;
STAGE 1.02-2.04 + DX 8500-85419;
Thursday, January 07, 2010 9:22:36 AM
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