Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: CVS23
MultiStage: No
DXCat Label: Tibial, lliac, Femoral, or Popliteal Artery Disease Specificity: A
Etiology: Degenerative
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Intermittent claudication History of lower extremity pain or aching or fatigue with walking subsiding with rest
DX 44020, 44021, 4439, 44502,
OR venous filling time ≥ 15 seconds
44381;
AND pallor of extremity with elevation for ≥ 1 minute
AND rubor on dependency
OR dorsalis pedis systolic pressure ≤ 90% of brachial systolic pressure [Doppler
ultrasonography report]
AND dorsalis pedis systolic pressure > 70%
OR ≤ 50% occlusion of tibial, iliac, femoral or popliteal artery [arteriogram report]
1.02 Persistent claudication History of lower extremity pain or aching or fatigue with walking subsiding with rest
AND dorsalis pedis systolic pressure ≤ 70% of brachial systolic pressure [Doppler
ultrasonography report
OR ≥ 50% occlusion of tibial, iliac, femoral or popliteal artery [arteriogram report]
2.01 with ischemic ulceration Stage 1.01-1.02
AND ulcerations
2.02 with gangrene Stage 1.01-2.01
AND gangrene of the extremity [physical examination or operative/pathology report
3.01 with sepsis Stage 2.01-2.02
AND sepsis:
3.02 with shock Stage 2.01-3.01
AND shock:
4.00 with death Stage 2.01-3.02
AND death
References:
DX 44022, 4404, 4422, 4423,
44422, 44481;
DX 44023, 44322;
STAGE 1.01-1.02 + (DX 70710-
70719);
DX 44024;
STAGE 1.01-2.01 + DX 7854;
STAGE 1.01-2.02 + GROUP SEPSIS;
STAGE 1.01-3.01 + GROUP
SHOCKA;
Anonymous. Thrombolysis in the management of lower limb peripheral arterial occlusion--a consensus document. Working Party on Thrombolysis in the Management of Limb
Ischemia. American Journal of Cardiology. 1998;81(2):207-18.
Cantwell-Gab K. Identifying chronic peripheral arterial disease. American Journal of Nursing. 1996;96(7):40-6; quiz 47.
Golledge J. Lower-limb arterial disease. Lancet. 1997;350(9089):1459-65.
NO;
Thursday, January 07, 2010 9:21:19 AM
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