Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: MUS21
MultiStage: No
DXCat Label: Fracture, Dislocation, or Sprain: Humerus (Head) or Shoulder Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Sprains of shoulder and upper arm Sprain of shoulder
DX 8400-8409;
OR sprain of upper arm
1.02 Closed dislocation of the head of the Dislocation of the head of humerus [x-ray report]
DX 71821, 71831, 71871, 71881,
humerus, acromioclavicular joint or OR dislocation of the acromioclavicular joint [x-ray report]
71891, 83100, 83103-83104,
shoulder region
OR dislocation of the shoulder region [x-ray report]
83109;
1.03 Anterior, subcoracoid, subglenoid,
posterior or superior dislocation of the
head of the humerus
Anterior, subcoracoid, subglenoid, posterior or superior dislocation [x-ray report]
DX 83101, 83102;
1.04 Closed fracture of scapula or clavicle Fracture of the scapula [x-ray report]
OR fracture of the clavicle [x-ray report]
1.05 Closed fracture of the head or neck of
humerus
1.06 Closed fracture of greater or lesser
tuberosity of humerus
Fracture of the head and neck of humerus without displacement [x-ray report]
OR Neer Group I fracture
Fracture of the head and neck of the humerus with fracture of the greater or lesser tuberosities [xray
report]
OR Neer Group V fracture
1.07 Fracture of the head or neck of humerus Fracture of the head and neck of the humerus and impaction with 35-45 degrees of angulation and
with displacement of fragments or segment less than 2/3 diameter of lateral displacement
OR fracture of the head and neck of the humerus with displacement of the head greater than 1
cm.
OR Neer Group II fracture
OR fracture of the head and neck of humerus with displaced shaft segment and intact rotator
cuff
OR Neer Group III fracture [x-ray report]
DX 81100-81103, 81109, 81000-
81003;
DX 81200-81202, 81209;
DX 81203;
NO;
1.08 Fracture of the head and neck of the
humerus with fracture of the greater
tuberosity and unimpacted fracture of the
surgical neck
Fracture of the head and neck of the humerus with fracture of the greater tuberosity and unimpacted
fracture of the surgical neck [ x-ray report]
OR Neer Group IV fracture
(DX 81200, 81202, 81209) + DX
81201 + DX 81203;
2.01 Open dislocation or fracture of clavicle or Dislocation or fracture of clavicle or scapula
scapula
AND laceration of skin overlying dislocation
OR laceration of skin overlying fracture
2.02 Open dislocation of the shoulder Dislocation of the shoulder
AND laceration of the skin overlying the dislocation
2.03 Open fracture of the head or neck of the Fracture of the head or neck of the humerus
humerus
AND laceration of the skin with exposure of the fractured bone(s)
DX 83114, 83119, 81010-81013,
81110-81113, 81119 ;
DX 83110-83113;
DX 81210-81213, 81219;
Thursday, January 07, 2010 9:22:37 AM
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