Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: MUS40
MultiStage: No
DXCat Label: Rheumatoid Arthritis Specificity: A
Etiology: Immune
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Rheumatoid arthritis rheumatoid arthritis:
Any 4 of the 1987 criteria of the American College of Rheumatology:
history of morning stiffness ≥ 6 weeks
DX 7140, 7142, 7144;
AND ≥ 3 joints with swelling or effusion for ≥ 6 weeks: elbow, knee, ankle or
metatarsalphalangeal joints
OR swelling or effusion of the hand or wrist joints for ≥ 6 weeks
OR symmetrical bilateral joint swelling ≥ 6 weeks
OR subcutaneous nodules
OR rheumatoid arthritis [x-ray report of any joint]
OR rheumatoid factor titer ≥ 1:160 [chemistry report]
1.02 with uveitis Stage 1.01
AND uveitis [ophthamologist’s report]
1.03 with fusion of metacarpophalangeal or
interphalangeal joint spaces
Stage 1.01-1.02
AND fusion of metacarpophalangeal or interphalangeal joint spaces [x-ray report]
1.04 with carpal tunnel syndrome Stage 1.01-1.03
AND carpal tunnel syndrome [operative/pathology report]
OR atrophy of thenar muscles
OR Tinel’s sign
STAGE 1.01 + (DX 36400, 36404,
36411, 3643);
STAGE 1.01-1.02 + DX 71854;
STAGE 1.01-1.03 + DX 3540;
2.01 Juvenile onset rheumatoid arthritis Age ≤ 16 years old
AND Still’s disease
OR fever:
AND
AND
AND
AND
2.02 with anemia Stage 1.01-2.01
AND anemia:
splenomegaly
generalized lymphadenopathy
serositis
leukocytosis:
2.03 with Felty's syndrome Stage 1.01-2.02
AND splenomegaly
AND leukopenia:
2.04 with pneumoconiosis or interstitial fibrosis Stage 1.01-2.03
AND interstitial fibrosis [chest x-ray report]
OR pulmonary nodules [x-ray report]
OR pneumoconiosis or Caplan’s syndrome [x-ray report]
DX 71430-71433;
DX 71430-71433 + GROUP FEVER;
STAGE 1.01-2.01 + (GROUP
ANEM_OTH_CHR OR GROUP
ANEM_DEF_OTH OR GROUP
ANEM_OTH_UN);
DX 7141;
STAGE 1.01-2.03 + DX 515;
DX 71481;
Thursday, January 07, 2010 9:22:41 AM
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