Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: MUS25
MultiStage: No
DXCat Label: Intervertebral Disc Disorders: Lumbar and Lumbosacral Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Asymptomatic prolapse of the
intervertebral disc
Herniated intervertebral disc [spine x-ray or MRI or myelogram report]
DX 72210, 7222, 72230, 72232-
72239;
1.02 Symptomatic prolapse of the intervertebral Stage 1.01
DX 72270, 72273;
disc
AND pain radiating to leg(s) or arm(s)
OR weakness of arm(s) or leg(s)
OR cervical radiculopathy [physical examination or EMG report]
OR lumbar radiculopathy [EMG report]
2.01 with loss of bladder or bowel control Stage 1.01-1.02
AND incontinence of urine
OR incontinence of bowels
2.02 with cauda equina syndrome or conus Stage 1.01-2.01
medullaris syndrome
AND cauda equina syndrome:
OR conus medullaris syndrome:
2.03 with paraplegia Stage 1.01-2.02
AND paraplegia
2.04 with quadriplegia Stage 1.01-2.03
AND quadriplegia
2.05 with pneumonia (aspiration or bacterial) Stage 1.01-2.04
AND pneumonia:
3.01 with sepsis Stage 2.05
AND sepsis:
3.02 with shock Stage 2.05-3.01
AND shock:
4.00 with death Stage 2.05-3.02
AND death
STAGE 1.01-1.02 + (DX 78830,
78838, 7876);
STAGE 1.01-2.01 + DX 34460-
34461;
STAGE 1.01-2.02 + DX 3441;
STAGE 1.01-2.03 + (DX 34400-
34404);
STAGE 1.01-2.04 + (DXCAT RES15
OR DX 5070);
STAGE 2.05 + GROUP SEPSIS;
STAGE 2.05-3.01 + (GROUP
SHOCKC OR GROUP SHOCKN) ;
NO;
References:
Boden SD. The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. Journal of Bone & Joint Surgery - American
Volume. 1996;78(1):114-24.
Brandt KD. Osteoarthritis. 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; 1998:1935-1941.
Hellmann DB. Arthritis & musculoskeletal disorders. In: Tierney Jr LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment. Stamford, CT: Appleton & Lange;
1998:774-824.
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